M7 Osteoporosis and Case Study Approach

Suominen et al 2021

Purpose: Examine whether continued high-intensity strength and sprint training in middle-aged to older men is associated with attenuated age-related deterioration of bone properties over a 10-year period

Goal: Find whether former or active sprint/strength athletes who keep training maintain better bone structure and density than those who reduce training

Suominen et al methods

Design: Longitudinal follow-up over ~10 years. PMC+1

Participants: 69 male “masters” sprint athletes aged 40-85 at baseline, with long-term training backgrounds. PMC

At follow-up the sample was divided into two groups (based on self-report):

• “Well-trained” (n ≈ 36): still actively competing, sprint training plus strength training ≥2 times/week. PMC+1

• “Less-trained” (n ≈ 33): switched to endurance training, no strength training, training <2 times/week.

Suominen et al results

The well-trained group showed maintained bone properties at the distal site, and even improved properties at the mid‐shaft, whereas the less-trained group showed declines in bone parameters

Suominen et al discussion

aging skeleton retains adaptability in response to mechanical loading (strength + sprint training) even into older age

• regular, intensive training appears to counteract the typical age‐related deterioration of bone geometry and density

Suominen et al strengths

strengths of the Suominen study:

• longitudinal design (looked at the same group of people)

• good indexes for things like bone density, assessed a wide range of variables regarding bone

• homogenous group

Suominen et al limitations

limitations of Suominen study:

• only male participants

• retrospective study

  • couldn’t control or verify exactly what participants did throughout the decade

  • couldn’t ensure differences were only due to training rather than other factors (diet, injuries, lifestyle)

• participants asked to keep track of their own activity w/ activity logs

Suominen et al conclusion

Continued strength (key) and sprint training over 10 years helped maintain bone properties vs. those who reduced or stopped strength training

Differences seen between distal tibia and mid-shaft for bone strength, density, and cross-sectional area (CSA)

osteopersosis

skeletal (bone) disorder where bones become weaker and more fragile, making them more likely to fracture even from minor stresses or falls

• compromised bone strength

osteoporosis the pediatric disease

often described as a “pediatric disease with geriatric consequences.”
→ foundation for strong bones is built early in life, but the effects of poor bone development aren’t seen until older adulthood, when fractures occur

osteoporosis and childhood

about 90% of peak bone mass is achieved during pre-puberty to puberty, a critical window for bone growth and mineral accumulation

• inadequate nutrition, low PA, or illness can inc osteoporosis later in life

bone strength

depends on two main factors

• bone density

• bone quality

bone density

the amount of mineral (like calcium) in the bone

bone quality

the structure, organization, and integrity of the bone tissue

who can have ostoeperosis

osteoporosis can affect many different groups

• Men – especially older men or those with low testosterone.

• Individuals with eating disorders (e.g., anorexia nervosa) – due to low nutrient and hormone levels.

• People taking corticosteroids (e.g., prednisone) – these medications reduce bone formation and increase bone resorption.

• Individuals with gastrointestinal diseases (e.g., Crohn’s, IBS, celiac disease) – reduced nutrient absorption affects bone health.

• Those with heavy alcohol use – alcohol interferes with calcium absorption and bone remodeling.

• People undergoing chemotherapy – some cancer treatments accelerate bone loss.

• Women in early menopause – reduced estrogen levels speed up bone loss.

osteoporosis the silent condition

osteoporosis is often silent in its early stages — many people have no symptoms until a fracture occurs

osteoporosis signs

possible signs as the disease progresses:

• Loss of height over time

• Stooped or hunched posture (kyphosis)

• Shortness of breath (due to spinal curvature)

• Bone fractures, often from minor falls or even everyday activities

• Lower back pain (often from vertebral fractures)

fragility fracture

a fracture caused by injury that would be insufficient to fracture normal bone

• result of reduced compressive and/or torsional strength of bone

fragility fracture SFT consideration

• Avoid having the person bend down or reach the floor to pick up weights, as this increases spinal and hip fracture risk.

• Instead, hand the dumbbell or object to them to reduce load on vulnerable bones

common fracture sites

common osteoporotic fracture sites

1. hip

2. wrist

3. vertebrae (body of the vertebra)

hip

bears a large portion of body weight and transmits force from the upper body to the legs.

• falls, even from standing height, concentrate stress here.

wrist

often first site to fracture when a person instinctively extends their hand to break a fall (“FOOSH” – Fall On Outstretched Hand)

• relatively thin cortical bone, making it weaker under impact

vertebrae

spinal bones support weight and posture.

• small compressive forces over time or minor trauma can cause vertebral compression fractures in weakened bone

insidious development

vertebral fractures develop insidiously (gradually)

vertebral fracture mechanism

mechanisms

1. Posture & movement factors

2. Microfracture formation

3. Force amplification

4. Bone quality factor

5. Outcome

posture and movement factors

Habitual slouching, repetitive lifting, or ADLs that flex the spine move the line of gravity forward.

• This increases the flexion moment on vertebral bodies.

microfracture formation

flexion and repetitive stress cause small anterior vertebral microfractures.

• spinal extensor muscles activate to counteract flexion, increasing compressive forces on the anterior vertebrae.

force amplification

in the thoracic spine, anterior compressive forces can increase 10-fold compared to erect posture.

• extensor contraction itself adds additional load, accounting for 92–100% of spinal stress in that region.

bone quality factor

if bone density is suboptimal, microfractures can progress to anterior wedging.

outcome

progressive vertebral collapse leads to postural kyphosis (hunched posture)

vertebral fractures and age

vertebral fractures are very frequent in people over 50 years of age

preventing the first vertebral fracture

preventing the first vertebral fracture is very important

• history of fracture is the strongest risk factor for subsequent fractures

silent vertebral fractures

about 2/3 of vertebral fractures are undiagnosed — earning the nickname the “silent thief”

detected vertebral fractures

radiographically-identified vertebral fractures are associated with pain, disability, and increased risk of premature death

vertebral fracture consequences

Consequences of a first vertebral fracture:

• Higher likelihood of additional vertebral fractures and progressive kyphosis.

• Altered postural control, increased sway, and poorer balance reactions, which raises fall risk

OP and exercise

key benefits to exercising and OP

• Fall Prevention – improves balance, coordination, and reaction time to reduce fracture risk.

• Safe Movement – teaches proper body mechanics and strengthens muscles to support joints and spine.

• Prevention of Further Bone Loss – weight-bearing and resistance exercises stimulate bone formation and maintain bone strength

Nachemason 1976

Purpose: Investigate the mechanical stresses on the lumbar spine during various activities and postures, and assess their implications for low back pain

• measured intradiscal pressure at lumbar spine

Nachemason results

Reclining / lying supine: reduces intradiscal pressure (by 50-80%) → spinal discs under the least stress

Sitting upright: increases intradiscal pressure (by 40%) compared to standing

Forward flexion and rotation (bending, twisting): increases intradiscal pressure by up to 200% → maximal stress on lumbar discs

Nachemason conclusion

found that certain posture and activities (e.g. sitting) significantly increased intradiscal pressure

• may contribute to disc degeneration and low back pain

24 Hour Movement Guidelines

some changes may need to be made to the 24 Hour Movement Guidelines 65+

• aerobic / strength training elements

  • consider:

    • someone who doesn’t exercise at all

    • someone w/ severe OP

    • someone susceptible to fragility fractures

• balance training

  • someone w/ OP at higher risk of falls

  • center of gravity affected potentially

OP guidelines

emphasis on slow progression + good technique

• aerobic activity→ 150 min/week

• RT for major muscle groups → 2x / week

• balance training → 2 hrs / week or 20 mins / day

• back extensor strengthening → daily

  • strong back extensors pull on vertebrae

• spine sparing strategies → daily

  • strategies highly dependent on individuals daily activities

TFTF guidelines