By Dr. Claudia Tamas
In April 2018, The Wall Street Journal published an article on a revolutionary exercise program for osteoporosis. It described it as having the potential to become the first-line therapy in the treatment and prevention of osteoporosis and osteopenia. The same article made the top five in the highest-ranking bone journal in the world, The Journal of Bone Mineral Research, as one of the most “attention-grabbing” papers in 2017.
Osteoporosis claims about 1.5 million low trauma fractures and an estimated economic burden from hospitalizations of up to 36 billion dollars each year in the US. It is characterized by skeletal fragility and bone micro-architectural changes that lead to fractures with minimal trauma. Women are more affected than men by far. These debilitating fractures result from simple daily activities and lead to severe deformities and loss of independence.
In 2014, the US Surgeon General recommended lifestyle interventions including diet and exercise as a first-line therapy for osteoporosis. However, these recommendations remain very general, vague, and largely unsuccessful. The success rate of pharmaceuticals is also lower than desired due to poor medication compliance. Approximately half of patients discontinue medication one year after initiation from bothersome side effects.
But has osteoporosis always been part of the human experience? In 2017, Cambridge University conducted a comparison bone study between an ancient humerus (upper arm bone) of a female who lived in 4000 BC and a young 25-year-old female Olympic rower. Astonishingly, the 6000-year-old bone, perfectly preserved, had a higher bone density than our 21st-century athlete. This study points to very specific physical activities performed by women in communities that didn’t develop osteoporosis. These activities involved carrying loads, pushing overhead, pulling, and lifting. These women carried most of the loads that required transportation on their bodies.
Ironically, these are the very activities that people in our Western society avoid. We have developed modern ways to comfort and our bodies have adapted to these lifestyles. The response from our skeletal system to lack of loading is less mineral density and a weaker-than-optimal architecture. Our bodies are highly adaptable and do not build structures that are not needed or used. We build peak bone density through our mid-thirties and this is built largely as a response to mechanical demands (loading). Since we have fewer and fewer demands of this kind, this peak becomes less than optimal, and at menopause when women naturally lose 10% of bone density, they find themselves in a serious crisis.
In 2011, the researchers at The Australian Bone Clinic designed a study that mimicked these movements and activities with a high-intensity resistance and impact training program in a supervised clinical setting. The results were impressive with a significant effect. 80% of the participants built bone in their spine and hips. Moreover, we can argue that exercise, when it is specifically applied can not only evoke bone growth but also increase muscle strength, improve balance, and decrease the risk for falls. These largely beneficial effects, with no adverse effects, cannot be matched by any pharmaceutical intervention.
Dr. Claudia Tamas is the Director of Women’s Health at NMR, 399 Campus Dr., Somerset. She is a Doctor of Physical Therapy, a Registered Nurse, and a Strength and Conditioning Specialist certified by The National Strength and Conditioning Association. She is the first clinician in the US to provide Onero, developed by The Bone Clinic.
