Stress and Osteoporosis
By: Robyn Kade, B.A., cpt, MBMS
We are entering a new era with medical fitness in terms of understanding how exercise can help individuals with chronic illness and stress. This is a very exciting time for the fitness industry as baby boomers are becoming our target population. Fitness Professionals, through quality education, can be well-positioned to help these individuals!
Osteoporosis is a common condition that affects both women and men, and exercise may be an important factor in helping to reverse this condition, or at least help prevent progression. In this article, we will take a look at what osteoporosis is, the different risk factors, how stress affects it, and how exercise can help.
What is Osteoporosis?
Osteoporosis is a disease that is characterized by low bone mass and where there is a significant deterioration of bone tissue that leads to an increased risk of fracture over time. Bone deterioration can occur over a number of years without presenting any symptoms and often is only detected when a broken bone or fracture occurs, at which point it is already fairly advanced and less treatable. The most common fracture areas associated with osteoporosis are the hips, spine, shoulder, and wrists.
According to the International Osteoporosis Foundation, there are currently 200 million individuals who are suffering from osteoporosis worldwide and it is estimated that bone fractures happen about once every three seconds around the world due to osteoporosis. Nearly 2 million Canadians, and more than 10. 3 million Americans over the age of 50 have been diagnosed with osteoporosis and it is estimated that 4 times that many are living with low bone mass. In Canada, it's estimated that 1 in 3 women and 1 in 5 men will have osteoporotic fractures in their lifetime. Chances that you will have clients with this chronic illness grow as our population continues to skew towards an older demographic.
Your bones are in a constant state of renewal — new bone is made, and old bone is broken down. When you’re young, your body makes new bone faster than it breaks down old bone, and your bone mass increases. After the early 20s, this process slows, and most people reach their peak bone mass by age 30. As people age, bone mass is lost faster than it’s created.
How likely you are to develop osteoporosis depends partly on how much bone mass you attained in your youth. Peak bone mass is somewhat inherited and varies also by ethnic group and other factors such as nutrition, hormonal effects, and the environment. Research suggests that suboptimal bone growth related to poor nutrition or low calcium intake during childhood and adolescence is as important as bone loss related to the development of osteoporosis. The higher your peak bone mass, the more bone you have “in the bank” and the less likely you are to develop osteoporosis as you age.
Prevention is key when it comes to mitigating risk for developing osteoporosis. Looking for the risk factors and working with medical professionals after diagnosis is important.
The commonly known risk factors for osteoporosis are:
a family history
broken bones and fractures after the age of 50
early menopause, and being in menopause
calcium, magnesium, vitamin D, and vitamin K deficiency
extended bed rest or long periods of inactivity
asthma or arthritis medication (steroids)
Some of these risk factors are ones that can be mitigated, especially around lifestyle. And as we are learning more about epigenetics, we are beginning to understand that just because we may have genes that predispose us to certain diseases, such as osteoporosis, does not mean that we will develop osteoporosis. Our behaviors, including what we eat and how we move, as well as our environment, can determine whether those genes get expressed and disease develops, or not…
There are Several Ways that Stress is Correlated with Osteoporosis.
One way is that stress can induce physiological changes that actually lead to osteoporosis. In the stress cycle (fight or flight response), cortisol is continually elevated, and elevated cortisol can interfere with osteoblast (active bone-forming cells) formation and dramatically decreases bone-building which can result in reduced bone density. Simply put, more bone is broken down than deposited, so as a result, chronically stressed clients with elevated cortisol levels have an increased risk of developing osteoporosis.
Another way is that stress can induce behaviors such as unhealthy eating (leading to nutrient deficiencies), drinking alcohol in access, poor sleep habits, and foregoing exercise, which then become risk factors for developing osteoporosis.
And thirdly, having osteoporosis may bring about feelings of anxiety, depression, loss of social roles, and social isolation, which promotes more stress and creates a negative cycle. Several studies have shown that depression is a predictor of osteoporosis and fracture. As well, some pharmacological interventions for stress-induced illnesses such as depression and anxiety themselves may increase the risk of developing osteoporosis. Recent published studies, for example, have indicated that taking SSRI’s (Select Serotonin Reuptake Inhibitors) may increase the risk for developing osteoporosis. Serotonin receptors are found in all major types of bone cells (osteoblast, osteoclasts, and osteocytes) which indicate an important role of the neuroendocrine system in bone. SSRIs have been correlated with decreased BMD (bone mineral density) and both SSRIs and tricyclic antidepressants increase fracture risk. The increase in risk has been shown to be the greatest in the early stages of treatment.
Exercise and Osteoporosis
When developing exercise programs for clients with osteoporosis or who are at risk for developing osteoporosis, it is important to review your client’s health history and ask viable questions to fully understand their risk factors. Weight-bearing exercises such as walking, and weight training are important to help increase bone density. Balance and flexibility exercises should also be included in their program to help with fall prevention. If a client is under a lot of stress, however, easing up on workout intensity is key to helping your client to recover from the flight or fight response. An intense workout can make cortisol levels spike even higher than they already are and can make the client more susceptible to osteoporosis. For clients who are looking to reduce their weight, stress can induce resistance to weight loss. Helping clients address their stress can help them break through plateaus in weight loss and performance and will help them to attain better outcomes.
Fitness professionals may want to think about incorporating mind/body approaches such as Yoga, Tai Chi, and meditation, and/or Mindfulness into their client’s program. The approaches you choose will depend on the severity of osteoporosis and what your client is comfortable doing. Some positive aspects of these practices are better balance, coordination, and body awareness for fall prevention. Another benefit of stress reduction is that it lowers cortisol levels that may help with bone regeneration. For more information on helping you client address their stress, check out these programs from the Stress Management Institute for Health and Fitness Professionals and download a free e-Book which contains breathing techniques and exercises for stress reduction.
Robyn Kade: Robyn is the President/CEO of The Stress Management Institute for Health and Fitness Professionals™ and Elevate World Fitness Summit/Retreat™.
Robyn received her Bachelor’s Degree from Rowan University in Health Promotion and Fitness Management. She is an American Council on Exercise (ACE) personal trainer and group fitness instructor. She received a certificate in PTSD through the Kew Training Academy and is a Compassion Fatigue Resiliency and Recovery – Educator.
Stress Management Institute for Health and Fitness Professionals
Frontiers | Impacts of Psychological Stress on Osteoporosis: Clinical Implications and Treatment Interactions | Psychiatry (frontiersin.org)
[Osteoporosis and stress] – PubMed (nih.gov)