Working With Osteoporotic Clients

Osteoporosis is a condition that affects the mineral density of bones, it is more commonly known as brittle bone disease. This is caused by a reduction in bone mineral density, which leads to an increased risk of fractures and breaks.

The condition is heavily associated with aging as our bone mineral density naturally starts to decrease after the age of 35, osteoporosis occurs in populations where this natural decrease is accelerated. There are a number of groups that are seen as high risk these include post menopausal females, nulliparity (females who have not had a baby), those on hormone based medications and males/females who have a low dietary intake of calcium. Additionally smoking and long term alcohol use increases the risk of developing the condition.

This condition itself can present with pain, loss of height, kyphosis, fractures on failing or impact, but may initially be asymptomatic. With the long term outlook for the condition being increasingly common fractures and breaks, which may lead to more permanent disability.

Exercise is key in the effective treatment of osteoporosis, the condition can be helped by implementing a resistance training programme that places end to end stress through the bones. This type of training is known to help maintain and in some cases increase the density of bones, as the density increases the fracture risk decreases. This can also be improved by making lifestyle improvements such as cessation of smoking and reduced alcohol intake.

There are some guiding principles when it comes to the prescription of exercise for osteoporotic clients. These are detailed below:-

Aerobic Fitness – it is recommended that clients do some form of aerobic activity three to five days per week, working at around 40-70% of maximum heart rate. It is recommended that this is done for 20-30 minutes per session.

Resistance Exercise – it is recommended that clients look at training with some form of resistance on between two to three days per week this should be done using a 2 sets of 8-12 reps, with an intensity of 75% 1 rep max. However exercises that compressively load the lumbar spine, hips or radius should be avoided, and an emphasis should be placed on increasing resistance and decreasing reps over time.

Flexibility – a regular stretching routine should be implemented to help maintain and improve range of motion, this should be done 5-7 days per week and focus in on developing a good rounded level of mobility.

Functionality – osteoporosis is a condition that can be debilitating, it can reduce the ability of the individual to live their life optimally. Maintaining basic function is vital and as the condition progresses the trainer should implement some falls prevention (to avoid fracturing of weak bones) and additionally falls recovery (to show a client how to get back up once fallen, thus avoiding exposure).

The key precautions are as follows:-

Chair and water based alternatives can be used

Working with osteoporotic clients can help to improve bone density, but most importantly can improve functionality and outlook. Helping to ensure the client remains active and a healthy state is prolonged.

• Avoid forward flexion
• Avoid high impact work with those clinically diagnosed
• Lying prone and supine may be inappropriate if client susceptible to vertebral fractures
• Target muscles around the fracture sites (hip, wrist, collarbone)
• Reduce risk of falls by ensuring area is free of obstacles