Osteoporosis is a condition that causes the bones to become weak, brittle, and easily breakable. In older adults, osteoporosis is a common, indirect cause of death, and one of the most common causes of poor quality of life (Holt 2002).

Now think about it: do you ask your clients if they have osteoporosis?

I didn't, until one of my clients, Connie, broke two of her ribs during our session while executing the butterfly with a 3-pound dumbbell in each hand. It wasn't until she got the report from her doctor of her broken ribs that she mentioned her osteoporosis.

These results made me think that many personal trainers may be in the dark about what doctors call "the silent disease" (Betz 2005).

The good news is, treatments for osteoporosis  as well as preventions are available. And weight-bearing exercise has been proven to build strong bones. (Fletcher 2013)

As fitness and wellness professionals we have a grand responsibility to educate our clients, communities, and selves about this literally bone shattering disease.

We also have an opportunity to get more personal training clients by promoting the bone-building benefits of our personal training services!

Read on to get the facts about osteoporosis and how you can help your current clients while recruiting new clients through selling personal training services to several niche populations.

We Have Intelligent Bones

Bone is a living and growing tissue. Our amazing bodies are constantly losing old bone and making new bone. From childhood to about age 30, we form more bone than we lose. Experts call this our peak bone mass. Peak bone mass of 95% is achieved by the age of 17 for girls and 20 for boys (Fletcher 2013).

The more bone you have in your early 30's, the less likely you are to break a bone or get osteoporosis later in life. (Holt 2002)

What Causes Osteoporosis?

Living a sedentary life-style, specifically standing less then four hours a day, is the primary cause for weak bones. "Bones stay healthy only when they have vertical vectors of force placed on them regularly," says Dr. Christiane Northrup, M.D., author of The Wisdom of Menopause (2006).

Sadly, according to a report by the Surgeon General, by the year 2020, half of all Americans 50 and older will have osteoporosis.

Who Is at Risk?

According to Dr. Northrup, genetics and age are major risks factors for osteoporosis:

• Small framed, fair skinned, blue-eyed, blond or redheaded women age 50 and up who have gone through menopause are at high risk. Small bones, low levels of collagen, and lack of estrogen are the culprits in this population. 

• Men in their late 60's, when accelerated bone loss usually begins, are at risk.

• Thin, tall, or smaller framed individuals, and individuals with less than 18% body fat are at risk.

In a lifetime, a woman may lose up to 38% of peak bone mass, whereas a man may lose only 23% (Northrup 2006) 

Other risk factors include:

• Over-exercising and eating disorders
• Menstrual irregularities in teens and young adults
• Smoking and/or drinking too much alcohol.
• Age - The elite elderly (age 80 and up) commonly have porous bones
• Hormonal changes in both men and women in middle age
• Poor eating habits - lack of calcium
• Lack of sunshine - lack of vitamin D
• Medications such as those that treat lupus, asthma, seizures, and thyroid deficiencies
• Family History
• Depression 

Populations who are less likely to get osteoporosis: 

• African American women and men tend to have thicker bones, genetically

• People who are overweight tend to not get osteoporosis due to the excess weight carried around on a regular basis. An encouraging fact for people who have unrealistic expectations of getting back to the size they were in their 20s! 

Training Clients for Prevention and Treatment of Osteoporosis

There are very different protocols for prevention and treatment. The following will help you understand the vital differences and give you ideas for safe exercise programs.

Preventing Osteoperosis 

You are already preventing. The routines you take your clients through that involve weight-bearing exercises, that is anything that works against the force of gravity, build strong bones by stimulating the bone building cells called osteoblasts. (Shoback 2013).

Weight-Bearing Exercises: Walking, Jogging, Dancing, Push-Ups

Non-Weight-Bearing Ex.: Swimming, Cycling 

Teens and young adults are encouraged to lead a healthy lifestyle today to prevent osteoporosis later in life. Dr. Jennifer A Fletcher from The Canadian Academy of Sports and Exercise Medicine recommends a minimum of 60 minutes of weight-bearing activity daily for teens. Participation in sports during childhood and the teen years should be strongly advocated, as is essential in building strong bones.

A healthy diet complete with calcium and Vitamin D, avoiding smoking and drinking alcohol, and proper sleep habits are also key components to optimize the bone building years.

Osteoporosis prevention should start no later than the age of 30, especially in women which is the age peak bone mass is achieved. (Fletcher 2013) 

Treatments for Osteoporosis     

Educate those who have been diagnosed about the proven benefits of weight-bearing exercises for osteoporosis and its ability to build bone, reversing the osteoporosis. Clients who have been diagnosed with osteopenia, a precursor to osteoporosis, should be taught the benefits of your personal training services in preventing full-blown osteoporosis. Most post-menopausal women have osteopenia.

Encourage your clients by assuring them it's never too late to start bone building! Just 30 to 60 minutes, 3 days per week of high intensity weight bearing, endurance, resistance, and jumping activities are recommended to achieve maximum bone-building benefits (Fletcher 2013).

Osteoporosis Exercises to Avoid and other Crucial Guidelines

• Train the spine in extension only (Betz 2005)

That means no crunches for the client who has osteoporosis! When we flex the spine in any direction, we're putting pressure on the vertebrae. Fine if we have a strong, healthy spine. Not fine if the spine is brittle.

• Avoid all flexion, including bending from the waist, and excessive sideways bending, and rotation exercises (Betz 2005)

Simply bending forward can cause hairline fractures that can lead to curvature of the spine. This is why we see several elderly individuals with hunched backs. Our job is to help our clients prevent this demise.

• Don't test the spine's mobility (Betz 2005)

Even a standing roll-down can have grave consequences for osteoporotic bones. 

• No foam rolling for a client who has been diagnosed!

The pressure of the rolling could cause a fracture. A half roller under a cushioned mat is safe for your client to lie on to open up the chest-vertical or horizontal. I also use a rolled up yoga mat. 

All this certainly does limit movement choices, so you have to get creative. The following ideas should get your juices flowing:

Posture - You'll be focusing more on keeping proper posture during upper and lower bodywork, creating length in the spine. (National Osteoporosis Foundation) Teach clients how to properly bend from the knees without compromising the spine. 

The Spine as a Rubber Band- A concept that seems to help my clients is the idea of the spine (or any body part) as a rubber band. You have to pull from both sides to make a rubber band stretch.

To apply that idea to the spine, have your client reach or press down through their feet or seat, depending on whether you are sitting or standing, and lengthen or reach through the top of the head as if a string is pulling them up, initiating all movement from the core. Encourage them to find his or her neutral pelvis.

Encourage proper posture for the benefit of strengthening the spinal muscles, reducing pain, boosting confidence and lowering the stress hormone cortisol.

Core Awareness -Teach your client to strengthen their core using the transverse and oblique abdominals and tapping into their back core including the intercostals, lattisumus dorsi muscles, and psoas.

After teaching the above foundational elements, most importantly the avoidance of flexion and excessive side bending and rotation of the spine, continue on with the following methods to help your clients build strong bone wellness. 

1. Condition with Balancing and Reaction Exercises

According to the National Osteoporosis Foundation, each year about one-third of all people over age 65 fall, many of these falls resulting in broken bones.

• Teach your clients how to properly catch themselves in a fall. For example, with a wall push-up, have your client push away from the wall and fall back to the wall catching their weight. I've had a few clients report falling, but because of the consistent physical training with me, they come away with little repercussion -- no broken bones or sprains.

• Train your clients using a big ball. Along with working core stability, jumping wakes up the proprioceptors, testing spatial awareness, and balance.

• Have your clients practice balancing on one foot (with support for safety) on a solid surface or a cushion.

• Encourage heel raises to strengthen ankles and awareness of moving in space.

2. Activities of Daily Living (ADL) - Teach how to safely perform ADL's

• Teach clients how to safely reach, push, pull, bend, rotate by initiating from the hips, squat, lift, step or lung, walk, sit and stand. (National Posture Institute - Posture Specialist Certification 2012)

• Apply these movements to common activities such as vacuuming, walking up the stairs, reaching for a cup from the cupboard, and waiting in line at the grocery store.

• Also emphasize that everyday activities can be used as bone building exercises.

• Always encourage engaging and initiating from the transverse abs.

3. Supporting Self - Something as simple as a cough or a sneeze can cause the osteoporotic bones to break.

• Teach clients to cross arms and place both hands against the chest when coughing or sneezing to support the bones.

4. Educate! Educate! Educate! - There are several resources on-line for fitness professionals and the layperson.

• National Osteoporosis Foundation NOF.org
• NIH Osteoporosis and Related Bone Diseases National Resource Center niams.nih.gov
• Guide2bonehealth.com
• Americanbonehealth.org 

5. Build a trusting relationship with your clients - You don't have to treat your clients with osteoporosis like fragile porcelain dolls. Just be alert throughout your session that you're taking the necessary precautions, but avoid making them feel helpless.

Give your clients encouragement, pointing out that they are on the right track to gaining strength.

Promote your personal training service with the facts about osteoporosis and how your method of training includes an effective method of preventing this disease.

Here are a few other facts about exercises for osteoporosis:

• Weight bearing exercise has also been proven to retain the vitality of cartilage, reducing symptoms of arthritis. Those with osteoporosis commonly have arthritis. (Holt 2002)

• Exercise increases the release of endorphins, the feel good chemicals that act as natural painkillers. Pain is common if a client has had fractures or if they also have osteoarthritis.

• Exercise also reduces levels of cortisol, the stress hormone that blocks the bone building effects of progesterone.

As personal trainers, we have a responsibility to our clients. Every client is unique and comes with issues whether that is physical or emotional. If you want to retain clients for years to come, show them you care about all aspects of their health and are willing to take the journey through life and aging with them.

We achieve this through taking the time to listen and learn, caring for the whole person. If you don't know much about a condition or disease your client has, take the time to do a little research. Then use your genius training brain to apply the information.

Go be awesome! Happy training!

Resources

Betz, S. (2005, April). Modifying Pilates for Clients with Osteoporosis. IDEA Fitness Journal. Retrieved June 6, 2014, from http://www.ideafit.com/fitness-library/pilates-osteoporosis.

Exercise Examples. (nd). National Osteoporosis Foundation. Retrieved June 23, 2014 from http://nof.org/articles/543

Fletcher, J (2013, September). Canadian Academy of Sport and Exercise Medicine Position Statement: Osteoporosis and Exercise. Retrieved September 4, 2014 from http://journals.lww.com/cjsportsmed/Fulltext/2013/11000/Canadian_Academy_of_Sport_and_Exercise_Medicine.21.aspx

Holt, S. (2002). The Antiporosis Plan. NJ: Wellness Publishing.

Baldwin, R. (nd). Keeping Your Balance. National Osteoporosis Foundation. Retrieved June 23, 2014 from http://nof.org/articles/15

Osteoporosis and Your Spine. (nd). National Osteoporosis Foundation. Retrieved June 23, 2014 from http://nof.org/articles/18

Shoback, D. (Professor of Medicine). (2013) Bone 101: Bone Basics for the Provider . San Francisco VA Medical Center

Northrup, C. (2006). The Wisdom of Menopause. NY: Bantam Dell.

Preventing Falls. (nd). National Osteoporosis Foundation. Retrieved June 23, 2014 from http://nof.org/articles/17

Proper Body Alignment. (nd). National Osteoporosis Foundation. Retrieved June 23, 2014 from http://nof.org/articles/549

U.S. Department of Health and Human Services. (2004). Bone Health and Osteoporosis-A Report of the Surgeon General. Retrieved July 2, 2014, from http://www.ncbi.nlm.nih.gov/books/NBK45513/