Osteoporosis is sometimes referred to as a “silent killer” — “silent” because women may not realize they have a problem until they break a bone, and “killer” because complications from osteoporotic hip fractures kill more women in the US than breast cancer.

Osteoporosis is a thinning of bone, reducing both density and quality and making bone much more fragile. While there are medications that can help with osteoporosis, we also know that diet, exercise, and other lifestyle factors can really benefit your bones.

If you’re wanting to make some changes to help you maintain bone density, especially coming out of a period of drastic lifestyle changes due to COVID 19, we’ve got help. We chatted with Dr. Meagan Peeters-Gebler about ways to make the best choices for your bones.

Risk factors for osteoporosis

Some people are more at risk of weaker bones than others, says Meagan: thin Caucasian women, women generally, women over 50, women in menopause. Underweight women are more at risk than at-weight or overweight women.

Genetics can also play a role, so a family history of osteoporosis may indicate that you are more likely to develop the condition. Women who are currently dealing with or have a history of an eating disorder such as anorexia or bulimia may have thinner bones. Chronic dieters may have missed out on some nutrients over years of food restrictions.

Also, women on steroids or blood thinners, women who smoke or consume excessive caffeine or don’t get enough Vitamin D and/or calcium may have a higher risk; women who take some medications, including some for breast cancer, and women who don’t get enough weight-bearing exercise are also at higher risk.

If you are in any of these categories — and especially if you fall into more than one — making changes to protect your bones now can help you stay healthier in the long run.

What do we do about bone density?

From a physical therapist’s perspective, exercise and posture are two of the biggest changes you should make now.

Exercise: It really needs to be weight-bearing and against gravity, says Meagan.

“Being vertical and having gravity go through your long bones is the most important piece. That could mean walking, running, climbing stairs. That’s why swimming and cycling aren’t as helpful for bone strengthening. When we are only swimmers, or only cyclists, we're not getting gravity going through the length of our bone. We are getting various tugs on tendons and muscle insertions, but we're not loading the length of the bone.

“When we are vertical and exposed to gravity, your body reacts to that stress by creating more bone. Your body thinks, ‘Oh, I really need to be good at this. I should create something that's a little bit more dense with the tools that I have, thus being better able to do that activity, got it. Okay.’”

Another key piece of the osteoporosis puzzle is posture.

As Meagan says, “When we look at the shape of our spine against gravity that you know shape is designed to tolerate loading from above.” But we don’t sit that way most of the time. We bend over keyboards, look down at laptop monitors and phones, and suddenly gravity isn’t working for us anymore.

“The more we start to bend over and get that C shape,” says Meagan,  “the more we change which part of the bone has pressure on it. And now you're no longer loading in the center, you're loading off to one side, so you create asymmetry in the bone. If that bone is already compromised and not dense, you now are wedging and putting pressure through one half, and it's kind of like walking on thin ice. You know, you can lie on thin ice — but you can't stand on it.

"So you're loading up where all of that pressure is going through, making it much more vulnerable typically on the front portion of the vertebral bodies because of that rounded C-shape position, and then you end up with vertebral body compression fracture. And then when that fractures, you get more hunched and more hunched and more hunched."

Possible end result: fractures in the bones of the spine (usually the thoracic or mid/back region).

And it’s not just the neck that’s at risk. When your posture is poor, that asymmetry of pressure translates down your body, into the pelvic bone and femur (thigh bone), and the whole chain is impacted, says Meagan.

Our life is geared toward leaning forward. Think of all the things we do that involve bending forward: working at a desk, picking up a child or your groceries, many of the physical games we play, cooking, driving. Meagan recommends balancing that out by doing some backward bending. Reach up straight above your head. If you carry something, try to keep your back straight rather than hunching forward.  

Do the right exercises for your body

If you already have fractures or are at risk due to osteoporosis or osteopenia, some exercises just aren’t for you, says Meagan.

If you’ve had a compression fracture, sit ups, that forward ab-machine at the gym, crunches, big spinal twists with a medicine ball, bringing your knee up to your shoulder, virtually any exercise where you’re flexing forward Is going to put you at risk.

The better plan, according to Meagan, is to get vertical and strengthen those back muscles. “We want those muscles as strong as possible because they feed into the overall durability of the system. Then you have the structural integrity in the tendons around and attached to the bones to translate the forces and impacts through the whole system more effectively.”

Basically, the idea, Meagan says, is to get your muscles to do more of the active support, so your bones aren’t bearing all the load.

“Have a strengthening regimen that’s well thought-out. Work with a physical therapist who understands your risks and get a plan that strengthens your back muscles like your rhomboids, your low trapezius, your middle trapezius, your back extensors – not just the front muscles that everyone likes to strengthen because they’re visible.”

Balancing act

One thing that can really help you stay healthier, even with some bone loss, is having good balance. “Falls are really the concern with osteoporosis, because so many women suffer hip fractures from a fall. Yes, there are spontaneous fractures from a sneeze or cough, but if you fall, it’s going to be your hip, your wrist, your femur, or your vertebra. Having appropriate balance reactions and balance skills will make you safer.”

Do these things

So: if you have to sit a lot, have a good chair, stick a pillow behind you to maintain the natural curve of your lower back. Your feet should be flat on the floor. Stack yourself, starting with your “sits bones” (the bony bits of your butt – if you’re not sure where those are, ask a cyclist!).

It may be tough right now to keep up your regular exercise routine, and many of us are still working from home, meaning we may not have the good ergonomic set-up we had at the office.

The key is to do what you can. Get your monitor up to eye level so you’re not looking down. Get a separate keyboard if necessary so your arms stay at the ideal 90-degree angle. Bring in some crates or boxes to give you the option to stand or sit and mix it up a bit.

An easy fix: take a break, go outside, get your vitamin D, and walk.

Get a strengthening routine, but first, if you suspect you may be at risk of osteoporosis, get a DEXA scan and share the results with your physical therapist. If you don’t have one, or need one with a specialty in women with bone issues, Meagan suggests consulting the Academy of Pelvic Health.

“I would recommend seeing a PT with this specialty before joining any classes, even a ‘strong bones’ class, “says Meagan. “You just want to be sure you’re fully informed, know how to move safely, and know what your limitations are.”

Do you have osteoporosis or osteopenia or are you at risk? What are you doing to maintain bone density? We’d love to hear your thoughts, so please join the Gennev Community forums!