Author
DR. Lief Edwardson
Training to prevent falls and fractures
Move over biceps and six packs- today we are talking about building bone and balance.
Something often overlooked until it becomes an issue is training to prevent falls and fractures,
which can be a serious concern for older adults. After about age 25-40 (depending on the
specific bone) bone density gradually decreases as normal bone breakdown outpaces
remodelling of bones. When a bone does not have adequate density, it is termed osteoporotic.
Menopause is a time with increased bone loss and there can be up to a 25% decrease in bone
density at this time with an average loss of 10%, putting post-menopausal women at higher
risks for osteoporosis.
What is bone density testing:
When bone density scans are performed, they compare your bone density to that of a healthy
young adult and to individuals of your own age, and you are given a score based on your
difference from the norms. They may also include a 10 year fracture risk assessment based on
density and other risks associated with fracture, and highlight specific areas of low bone density
allowing guidance for exercise intervention. The test is typically in a DXA unit, which is a safe
and simple procedure utilizing two low energy x-ray beams to determine bone density of areas
of concern such as the hip and spine.
Who should have their bone density tested:
Canadian guidelines recommend everyone over the age 65 have a bone density test performed.
Those younger than 65 with certain risk factors, such as some medications or previous fractures
may also be assessed. A chiropractor, some physical therapists, or your medical doctor are able
to order the testing through a diagnostic centre and can help you interpret the results.
Who should be training to prevent falls:
Nobody wants to fall and hurt themselves, but it is especially important for aging adults and
post-menopausal women. There is no right time to begin training for this, but the best time to
start is now. Training should focus on your specific deficits or concerns, and generally would fall
into categories of balance, strength, or bone density exercises.
Best exercises for building bone and preventing osteoporosis:
Exercises that best improve bone density should be load bearing or impact style movements.
Greater forces through the bones have a larger effect on bone producing cells, so we try to
target movements that provide this. Jumping is often brought up in regards to building bone- but
this should be noted that it will affect different areas of the body differently. When we jump there
is a large amount of force sent through the bones of the lower extremity, but much less force
into the lumbar spine. In that regard, jumping is a great choice for someone with lower bone
density in the femoral neck (part of the thigh), but not necessarily for someone with low bone
mass elsewhere. For help building a tailored program, come see us in the clinic and we can
help guide your training to what you need.
Best exercises for improving balance to prevent falls:
Balance exercises can be as simple or as complex as you want, and anytime we are standing
and moving we are training our balance. As with other exercises, the best ones are the ones
you will do, and specific to you. This can be as simple as practicing standing on one foot or with
both feet close together while flowing your teeth, or finding an activity such as Tai Chi which
may be more enjoyable for some people. An evaluation by one of our clinicians will be a great
way to get ideas for exercises that match your current abilities, and a roadmap for how to
challenge you further as you improve.
References:
Ji, M. X., & Yu, Q. (2015). Primary osteoporosis in postmenopausal women. Chronic diseases
and translational medicine, 1(1), 9–13. https://doi.org/10.1016/j.cdtm.2015.02.006
Sherrington, C., Fairhall, N. J., Wallbank, G. K., Tiedemann, A., Michaleff, Z. A., Howard, K.,
Clemson, L., Hopewell, S., & Lamb, S. E. (2019). Exercise for preventing falls in older people
living in the community. The Cochrane database of systematic reviews, 1(1), CD012424.
https://doi.org/10.1002/14651858.CD012424.pub2
Osteoporosis Canada, Bone Mineral Density Test
https://osteoporosis.ca/bone-mineral-density-testing/
