Osteoporiosis resistance exercise

Osteoporosis Resistance Exercise
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Osteoporosis is derived from the Greek words for bones that are permeable. It is the most
frequent metabolic disorder of the bone with multiple factors of etiology that causes severe
physical, psychological, and financial repercussions. It is a progressive systemic chronic skeletal
illness defined by low bone mineral density of T score of less than -2.5 and microarchitectural
degeneration of tissue of bone, resulting in increased fragility of bone and, as a result, an
increased risk of fracture (Tu et al.,2018). Although it affects both genders, all ethnicities, and
different age groups, it is most commonly seen in postmenopausal females, the elderly,
Caucasians and Asians, and individuals with less bone makeup. The study discusses the
incidence and prevalence of osteoporosis, its underlying mechanisms, its physiologic
manifestations, how it impacts the ability to exercise, how exercise can influence the disease, and
the risks to exercise this might create.
Epidemiologically, the incidence and prevalence of osteoporosis are high, and globally it
is the leading metabolic disorder of bone by far. It has been approximated to involve above 200
million individuals worldwide. In the United States, Europe, and Japan, approximately 75
million individuals have Osteoporosis (Yedavally-Yellayi et al.,2019). The disease affects 9.9
million Americans, with another 43.1 million having inadequate bone mass. Osteoporosis is
responsible for 2 million bone fractures in the United States each year, involving 180,000
nursing facilities and 432,000 inpatient hospitalizations, and 2.5 million hospital center visits.
Above 50% of females and around 30 to 45 percent of the total number of men above fifty years
have osteoporosis. Females of white origin above fifty years have a 50% incidence rate of
fractures due to osteoporosis, 15% hip fracture risk, and 25% spinal cord fracture risk. Men
above sixty years are 25% more likely to suffer osteoporotic fractures, while 70% of people
above eighty years have osteoporosis. In comparing the disease with age demographics, as bone
mineral density decreases, the risk of osteoporosis rises. For gender demographics, females have
a higher potential risk of osteoporosis compared to males. Following racial demographics,
osteoporosis can affect people of any race or ethnicity. Whites, particularly those of northern
European heritage and Asians, on the other hand, are at a higher risk. Asian females and NonHispanic females, in particular, have an increased risk for the development of Osteoporosis
(Clynes et al., 2020)
Osteoporosis is a disease with an etiology of multiple factors and different underlying
mechanisms. These involve mechanisms that cause interference in the formation of bone and
bone resorption and other additional abnormalities and conditions. Foremost, lack of or
deficiency of estrogen causes increased loss of bone in postmenopausal females. Secondly, old
age is linked to a gradual decrease in osteoblastic production with demand, resulting in decreased
bone density. Furthermore, calcium deficiency causes secondary hyperparathyroidism due to
increased calcium turnover from bone, decreased excretion of calcium by the kidneys, and
increased synthesis of 1,25-dihydroxy vitamin D by the renal system. Vitamin D deficiency due
to osteoporosis can cause secondary hyperparathyroidism through reduced absorption of calcium
by the gastrointestinal system. Besides, alteration of the formation of bone due to osteoporotic
fractures indicates the clinical relevance of bone abnormalities (Pouresmaeili et al.,2018). Other
mechanisms include inhibition of Insulin-like growth factor-1, prostaglandin E2, nitrous oxide,
leukotriene levels, and idiosyncrasies of collagen, leading to decreased bone density.
Etiologically, osteoporosis can be either primary or secondary. There are two types of
osteoporosis: primary and secondary. The most frequent kind of osteoporosis is primary
osteoporosis. This includes Juvenile Osteoporosis, which affects kids and teenagers and is
marked by sudden pain and bone fractures after injury, and idiopathic Osteoporosis, which can
be either postmenopausal attributed to estrogen shortage or senile-related calcium deficiency or
vertebral aging. When an underlying illness such as diabetes mellitus, defects like Marfan
syndrome and cystic fibrosis, or medications such as glucocorticoids, it is known as secondary
The disease is usually asymptomatic, and it is sometimes referred to as a silent disease.
The physiologic manifestations of the symptomatic form include brittle and weakened bones
leading to fractures, lower back pain, decrease in height, difficulty in breathing, and change in
posture due to development of conditions such as kyphosis (Sözen et al.,2017).
The disease has an impact on the ability to exercise. Foremost, due to calcium deficiency
in an individual’s bones, the bones become very weak and brittle predisposing to bone fractures,
which may interfere with the ability to exercise. Due to the increased fragility of the bones, a
person has a higher chance of falling, hence making it difficult to exercise. Aging and bedridden
people with osteoporosis may find it challenging to engage in exercises. Moreover, people with
severe osteoporosis are prone to uncomplicated bone fractures due to increased loss of bone
density and a lot of pain hence unable to do exercises (Harding et al.,2017). Patients with
vertebral abnormalities such as kyphosis due to osteoporosis may not engage in weight-bearing
practices due to loss of coordination and flexibility.
Exercise has a positive impact on osteoporosis as some help in preventing and
management of the disease. Osteoporosis resistance exercises promote stress in the bones,
stimulating osteoblasts and preserving the mass of muscles and bones, decreasing the risk of falls
and back pain. Weight-bearing training in patients with mild osteoporosis, such as walking,
reinforces and reduces bone loss in the vertebrae, lower spinal cord, and hips. Greater impact
exercises like running increase the pressure on the bones hence providing increased
strengthening advantages (Tong et al.,2019). More minor impact exercises like walking promote
the building of bones and make them stronger. Reinforcing muscle exercises such as the usage of
free lightweight builds up the muscles making them stronger hence facilitating posture and
maintaining bone density. Balance activities strengthen the lower limb muscles, making them
steady and helping improve coordination. Posture exercises prevent slopping of shoulders which
is a risk in osteoporosis, decreasing the risk of spinal fractures and promoting flexibility. Others
like swimming for patients with kyphosis promote muscle strengthening and cardiovascular
advantages that boost the pericardium and circulation.
However, exercise can pose various risks to individuals with osteoporosis. Some moves
and activities exacerbate the risk of bone fractures. Solid and high-impact exercises such as
forceful jumping and increased twisting and bending exerts a lot of force and pressure on the
vertebrae and spinal cord. Due to decreased bone density, these can predispose to compression
fractures and back pains. Some exercises can cause tension in the spinal cord and predispose
weak bones to a higher risk of fractures. Others, such as playing tennis and golf, cause twisting
forcefully of the hip joints and waist, which exerts a lot of pressure on the spinal discs and joints,
which can cause fractures (Sinaki,2021). Some exercises can lead to overstretching of the
ligaments and muscles, causing stress in the weak bones, and this can affect their range of
motion increasing the risk of bone fractures. High fall activities such as ice skating increase the
chances of falling, and this causes further injuries and fractures. Moreover, excessive exercises
interfere with hormonal balance, and this can cause osteopenia.
Review of literature
This chapter will be reviewing literature that will shape and inform the study about
osteoporosis resistance exercise by comparing and contrasting the results of various studies. This
will help define the type of methods to specific results and the ideal techniques that would be the
best to use to train the participants. Hence, help determine the rationale for the study prescription
and methods. This chapter will evaluate past literature to see what research has previously been
done and identify patterns, gaps, and prospects of the impact of osteoporosis on exercise, the
influence of exercise on patients with osteoporosis, and the risks of these exercises.
Recent studies on the effect of resistance exercise on osteoprotegerin(OPG) in adult
women with osteoporosis have portrayed that OPG is a specific disease metabolic prognostic
marker in humans.OPG belongs to a class of glycoproteins that have generally been found as an
antagonist of osteoclastic demineralization (Zhang et al.,2021). Effect of exercise on bone
mineral density among patients with osteoporosis and osteopenia: A systematic review and
network meta‐analysis. Journal of clinical nursing. . Elevated OPG levels in the blood have been
linked to a higher risk of osteoporosis. Previous contradictory studies have been found
demonstrating an elevation and a decline in OPG serum concentrations in postmenopausal
women after exercise. When compared to a sedentary group of postmenopausal women, In 2012,
Bergström et al. discovered that blood levels of OPG increased in a cohort of postmenopausal
females who had completed strength exercises for a year. The researchers hypothesized an
increase in OPG caused by exercise substitutes for OPG loss due to decreased estrogen levels in
postmenopausal females. Younger women with high OPG levels in their blood were more likely
to have enhanced metabolic markers and lower osteoporosis risk. The current study found that an
elevation in serum OPG levels in adult women with osteoporosis exhibited remarkable protective
properties in response to a resistance training exercise program for eight weeks, which was
corroborated by data from earlier studies. Resistance exercise may have resulted in a rise in
blood OPG levels as a measure of inflammation reduction in this study. Under this study, adult
women with osteoporosis had significantly higher serum OPG levels before beginning the
exercise program for eight weeks. As previously demonstrated in studies, exercising could have
a considerable impact on OPG blood levels, which could be attributed to the fact that OPG
levels rise in situations of decreased bone density, such as osteoporosis. Independent of age and
many other factors, postmenopausal females presenting with osteoporosis reveal an elevated
death rate from other conditions such as cardiovascular disease that relate to osteoporosis.
Enhanced bone mineralization consumption is thought to have come from the resistance
exercises utilized in this study, resulting in elevation of regional breakdown. The observed
favorable effects are considered to be attributable to the impact of resistance training on bone.
The implications of the research findings must be eligible by the caveat that the success of a
resistance exercise program is contingent on selecting a specific and appropriate training
purpose. The current study discovered that systemic or OPG levels in blood were linked to
some risk factors for osteoporosis in adult women. The findings support the concept that OPG is
related to some characteristics of osteoporosis. Resistance exercise may help adult women
improve their osteoporosis by boosting their OPG serum levels. (Hur et al.,2018).
The latest study on the impacts and clinical proof of resistance exercise for bone health
revealed that practicing resistance exercise in a week about two to three times for a year resulted
in the preservation or rise of Areal bone mineral density (BMD) in the hips the lumbar spine of
postmenopausal. Resistance exercise improved the femoral neck and lumbar spine BMD in
postmenopausal females in a study group of the Cochrane study review and prior meta-analyses.
Resistance exercise training offered muscular stress, while weight-bearing exercises such as
jumping added mechanical pressure on the bone against gravity. In older women and men, this
composition revealed numerous musculoskeletal results, including bone strength, the mass of
muscles, and aBND. According to a recent review and analysis, most prior trials with coupled
resistance training and greater-impact or muscle mass activities in postmenopausal women
showed better BMD of the femoral neck and the lumbar spine. Only Resistance exercise or in
conjunction with greater loading exercises retained or enhanced aBMD, according to a systemic
evaluation of the impact of activity on BMD in young and older men. The findings were in line
with those of the analysis of older persons’ controlled randomized trials. Resistance exercise,
only or in conjunction with other therapies, was shown to be perfect for preventing or perhaps
even increasing BMD in the neck of the femur and the lumbar spine, not just in postmenopausal
females and young men also in the elderly. Changes in the structure of the bone and localized
response in the distribution of bone in the regions exposed to the highest strain was postulated to
improve bone density irrespective of alterations in BMD. Increased thickness of the cortex due to
heavy-induced osseous apposition and, to a minor degree, decrease in the resorption of the
neocortex would increase the resistance of bone to bending during exercise. However, Dualenergy X-ray (DXA) was employed in most older trials to investigate changes of bone following
training. Bone density was also influenced by the shape, the size of bone size, structure, and the
chemical qualities of collagen, in addition to bone mass. Exercise studies based on DXA claimed
to misrepresent the actual impact of mechanical stress on bone as it only measures the group of
bone, which accounts for a small fraction of bone density. DXA was insufficient to give details
on significant factors of the strength of bone s because most of the good benefits of exercise in
the bones of adults are defined by alterations in geometry. A software tool based on DXA scans
was suggested to measure the geometry of the hip, which analyzed the most architecture of bone.
Resistance exercises with a greater – intensity combined with pressure training demonstrated
significant gains in the thickness of the cortex and the mineral composition of bone in the neck
of the femur in a recent survey using 3-dimensional hip technology for geometry analysis of the
femur. A Resistance exercise for 18 months with muscle mass impact exercise in young and
elderly males demonstrated a substantial elevation in section elasticity using quantitative
computed tomography to measure cross-sectional area, the strength of bone, and femur neck
Furthermore, the difference in the density of the cortex of the shin of radius and tibia in
the QCT periphery in older women in a six-month resistance exercise program, albeit no
significant differences in DXA values observed. These findings point to resistance exercise
having a favorable influence on the porosity of the cortex as people age. The exercise was
reported to reduce bone resorption by preserving trabecular and the bone cortex volumetric
BMD, according to an analysis of the impact of exercise on the geometry of bone and vBMD in
postmenopausal females. Unfortunately, the study’s six controlled randomized trials had limited
sample numbers and were highly varied in exercise duration, kind, and intensity. Furthermore,
only two researchers looked at the impact of resistance exercise on BMD, and neither study
found any significant variations in pQCT values between control and resistance exercise groups.
( Hong et al.,2018).
Studies have examined the benefits of physical exercise to improve bone density in
patients with osteoporosis. According to the evidence provided by (Benedetti et al.,2018), the
efficiency of resistance training, especially in the spinal cord and the hip regions, was associated
with the amplitude of the exercise. The training required heavy loads of 70-90 percent of an
optimum repetition for a minimum of one year. Some forms of exercise were shown to help
boost the mineral density of bone, such as pressures applied on the legs, heavy squatting, and
extension of the hip and the lower back. According to the investigations, the exercise was
beneficial if it affected the glutes, the lesser trochanter, the iliopsoas muscle, and Ward’s triangle
if the hip adductors and extensors were involved. The authors found that different muscle
attachments, duration, and type of the exercise variable weight or contraction were all possible
causes for the various efficiency of exercises involving specific sites. Likewise, (Mack et
al.)found that the power of the back muscles in osteoporotic females to be lower than in women
in good health conditions; thus, training such muscles could minimize the incidence of fractures
of the vertebral with basic resistance extension activities in the prone state.BMD loss in
participants being treated was significantly reduced after two years of training. Despite a decline
in both BMD and strength of muscle, the substantial change was retained eight years later when
compared to the control group(Beck et al.,2017) studied the dose potency impact of resistance
training on bone mineral density in postmenopausal women and found that the increase in BMD
lumbar spine an the proximal part of the femur was independent on the amount and duration of
standard lower and lower limb activity. There was no gender difference in the femur region,
while the effect was higher in women at the spine level. It appeared that a schedule of
strengthening activities with more significant and low load repeats could significantly improve
the mass of bone in postmenopausal women and not a routine of resistance exercises with
minimum-load more significant repetitions. In older females, the peak demand exerted appears to
be more essential than the number of repetitions in increasing the mass of bone. Other factors
considered included females’ need for higher exercise intensity to achieve some bone mass
results. The efficacy of continuous resistance training was also validated in a review by (Beck et
al.,2017), who deemed it the best training for improving hip and spinal BMD in older women.
However, this was not the case for older persons, for whom exercise had only minor impacts on
BMD and recommended muscle strength (Benedetti et al.,2018).
Having discussed literature reviews from multiple research papers, many gaps need to be
addressed. Foremost, In medical care, the application and usage of resistance training machines
in patients with osteoporosis at a high exposure to vertebral fractures should be carefully
considered( Martelli et al.,2020). This should be considered and addressed as the technique
frequently demands forward bowing and flexion of the back and trunk to accomplish the strength
training or adjust the services and materials good setting. Hence, they can only be applied and
appropriately placed if they are used and modified correctly. Secondly, more samples and further
extensive studies of a more extended duration are required. This is because they will help
promote the best understanding of the impact of resistance exercise on volumetric bone mineral
density in osteoporotic patients. Measurements of the geometry of bone at the clinical level
should be routine practice in all future exercise treatments in all groups. Despite men having a
reduced lifetime risk of osteoporosis, they are more likely to have catastrophic after fracture
sequelae, necessitating the collection of more data on men. O osteopenic and osteoporotic
patients at risk of fewer energy fractures, osteopenia, and those with a history of fracture, need
consideration as well. Moreover, the advancement of ideal exercise guidelines for bone density is
insufficient . Exercise surveys need to consider changes in the geometry of bone in addition to
aBMD from DXA to gain a better understanding of the impact of mechanical stress on the
morphology of bone, risk of osteoporosis, and bone strength (Pinheiro et al.).
(Benedetti et al.,2018), A. R., & Kim, S. W. (2018). Effects of resistance exercise on bone
health. Endocrinology and Metabolism, 33(4), 435-444.
Beck, B. R., Daly, R. M., Singh, M. A. F., & Taaffe, D. R. (2017). Exercise and Sports Science
Australia (ESSA) position statement on exercise prescription for preventing and
managing osteoporosis. Journal of science and medicine in sport, 20(5), 438-445.
Benedetti, M. G., Furlini, G., Zati, A., & Letizia Mauro, G. (2018). The effectiveness of physical
exercise on bone density in osteoporotic patients. BioMed research international, 2018.
Clynes, M. A., Harvey, N. C., Curtis, E. M., Fuggle, N. R., Dennison, E. M., & Cooper, C.
(2020). The epidemiology of osteoporosis. British medical bulletin.
Harding, A. T., & Beck, B. R. (2017). Exercise, osteoporosis, and bone geometry. Sports, 5(2),
Hur, S., Cho, S. H., Song, B. K., & Cho, B. J. (2018). Effect of resistance exercise on serum
osteoprotegerin levels and insulin resistance in middle-aged women with metabolic
syndrome. Medical science monitor: international medical journal of experimental and
clinical research, 24, 9385.
Mack, D. E., Wilson, P. M., & Gunnell, K. E. (2017). Land of confusion: unpacking the relationship
between physical activity and well-being in individuals living with osteoporosis. International
Review of Sport and Exercise Psychology, 10(1), 212-229.
Martelli, S., Beck, B., Saxby, D., Lloyd, D., Pivonka, P., & Taylor, M. (2020). Modeling human
locomotion to inform exercise prescription for osteoporosis. Current osteoporosis
reports, 18(3), 301-311.
Pinheiro, M. B., Oliveira, J., Bauman, A., Fairhall, N., Kwok, W., & Sherrington, C. (2020).
Evidence on physical activity and osteoporosis prevention for people aged 65+ years: a
systematic review to inform the WHO guidelines on physical activity and sedentary
behavior. International Journal of Behavioral Nutrition and Physical Activity, 17(1), 153.
Pouresmaeili, F., Kamalidehghan, B., Kamarehei, M., & Goh, Y. M. (2018). A comprehensive
overview of osteoporosis and its risk factors. Therapeutics and clinical risk management,
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Sinaki, M. (2021). Osteoporosis. In Braddom’s Physical Medicine and Rehabilitation (pp. 690714). Elsevier.
Sözen, T., Özışık, L., & Başaran, N. Ç. (2017). An overview and management of osteoporosis.
European journal of rheumatology, 4(1), 46., T., Özışık, L., & Başaran, N. Ç. (2017). A
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Tong, X., Chen, X., Zhang, S., Huang, M., Shen, X., Xu, J., & Zou, J. (2019). The effect of
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(2018). Osteoporosis: a review of treatment options. Pharmacy and Therapeutics, 43(2),
Yedavally-Yellayi, S., Ho, A. M., & Patalinghug, E. M. (2019). Update on Osteoporosis.
Primary Care: Clinics in Office Practice, 46(1), 175-190.
Zhang, S., Huang, X., Zhao, X., Li, B., Cai, Y., Liang, X., & Wan, Q. (2021). Effect of exercise
on bone mineral density among patients with osteoporosis and osteopenia: A systematic
review and network meta‐analysis. Journal of clinical nursing., S., Huang, X., Zhao, X.,
Li, B., Cai, Y., Liang, X., & Wan, Q. (2021). Effect of exercise on bone mineral density
among patients with osteoporosis and osteopenia: A systematic review and network
meta‐analysis. Journal of clinical nursing.

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