Interviewer: Gail Edgell
Gail Edgell: What exactly is osteoporosis?
Joan Pagano: Osteoporosis literally means “porous bones,” a bone-thinning disease caused by a loss of minerals — primarily calcium — that weakens the bone structure. The bone becomes vulnerable to fracture, especially the bones of the hip, spine and wrist. Being female and menopausal are two risk factors that women over 40 share for osteoporosis. It is a silent disease with no apparent symptoms until a fracture occurs. Because of this, many women are not being diagnosed in the early stages of the disease, when therapy can be effective in both preventing and treating it. Therapy consists of exercise, calcium and, if necessary, medication.
Gail Edgell: How do you know if you have an issue with osteoporosis?
Joan Pagano: That’s a good question because it is a silent disease with no apparent symptoms.
A bone-density test will tell you how strong your bones are by measuring the amount of minerals in them. Your results are then compared to those of a young woman at the time of her peak bone mass, around the age of 30. The young woman’s bones provide a gold standard against which we measure future bone loss.
Test results are expressed in a number called a T-score. Your T-score will tell you if you have normal bone density, low bone density, called osteopenia, or osteoporosis.
Gail Edgell: How can fitness training really help maintain healthy bones and a healthy skeleton during menopause?
Joan Pagano: Exercise is part of the three-pronged approach to both prevention and treatment. Exercise has the most dramatic impact on the growing skeleton, which is why we must encourage activity in childhood, adolescence and early adulthood to build a healthy peak bone mass. In our 30s, a subtle decline in bone mass begins. It accelerates in the first few years after menopause due to the loss of estrogen. After age 40, the goal is to maintain bone mass, reduce bone loss and prevent falls by improving coordination and balance. Your fitness-training program should include four types of exercise: weight-bearing cardio, strength training, stretching and balance.
Gail Edgell: What do you mean by weight-bearing cardio?
Joan Pagano: In a standing position, the skeleton maintains its upright posture against the pull of gravity. This exerts a healthy resistance on the bones and strengthens them. Activities such as walking, jogging, stair climbing, dancing, etc. are all examples of weight-bearing aerobic exercise. Weight-supported exercise like cycling and swimming offer many health benefits but are not optimal for strengthening the bones.
Gail Edgell: I have heard that when you are walking, it’s about 3 1/2 to 4 times your body weight. When you are running, obviously it’s much higher. But all of this contributes to that bone density.
Joan Pagano: Strength training is also very important. Research has been focused on this recently. It’s also called weight lifting or resistance training.
As you lift weights or lift your own body weight against gravity, as in a push-up or squat, the pull of the muscle on the bone strengthens it. The benefits are site-specific, meaning that you need to do exercises for all the major muscle groups of the body. Be sure to include exercises for the sites that are most vulnerable to fracture: the wrist, spine and hip. To prevent osteoporosis, you should lift the heaviest weight that you can in good form. The last few repetitions should be somewhat difficult. If you already have osteoporosis, use lighter weights so as not to overload the fragile bones.
Gail Edgell: You almost have to laugh at people in the gym who are lifting a weight of about 4 pounds for a bicep curl and could do about 300 of them. Why aren’t you overloading your muscles a little bit more? Really, encourage women to actually go to a number that is fatiguing to them.
One thing that you did mention was stretching and posture. Could you tell us a little bit about that?
Joan Pagano: Over time, the natural curves of the spine may become exaggerated by daily routines. It is common, for instance, to develop a forward slouch from all the activities we perform to the front, like bending over baby carriages, computers and steering wheels. It is important to stretch the front of the chest and shoulders to counteract these habitual postures and prevent excessive rounding of the upper back. If the spine has become weakened by osteoporosis, stretching can help decrease the risk of vertebral fractures.
Gail Edgell: The last thing, which I think is very important, is balance exercise, especially during a women’s menopausal years.
Joan Pagano: Right. The ultimate goal of exercise for osteoporosis is to reduce the risk of falls and fractures. A hip fracture is a really debilitating injury. Strengthening the large muscles of the legs improves overall stability and walking ability. Adding balance training will also help. Practice standing on one leg or in a tandem stance, with one foot in front of the other, as if you were on a tightrope.
Gail Edgell: Could you just recap what we’ve been talking about today regarding exercise and osteoporosis and what you can do to prevent it when establishing an exercise program?
Joan Pagano: Exercise is part of the three-pronged approach to preventing and treating osteoporosis, the other two prongs being calcium and, if necessary, medication. In the field of exercise, a well-rounded program of prevention and treatment consists of weight-bearing cardio activities — where you actually are standing on your own two feet and moving across the ground — as well as strength training, stretching and balance exercises.
Note: This article is an edited transcript of an audio interview. Changes have been made.
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