Osteoporosis

Osteoporosis is a serious condition in which bones become thin, brittle and easily broken. The National Osteoporosis Foundation estimates that more than 55 million Americans have osteoporosis or low bone density placing them at risk for osteoporosis. This represents 55% of the people aged 50 and older in the United States.

While the majority (80%) of persons affected by osteoporosis are women, one in eight men also suffers from the disease. This rate is expected to increase as men live longer. Similarly, while osteoporosis is more prevalent in Caucasian and Asian populations, African-Americans and Latinos are also at significant risk of developing the disease. Osteoporosis is called the "silent disease" because people do not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, a fall, or even a sneeze can cause a fracture.

The most common fractures associated with osteoporosis include wrist, vertebral and hip fractures. It is estimated that half of all women and 20 percent of all men will have an osteoporotic fracture in their lifetime. In the United States, 300,000 hip fractures occur each year in persons age 65 and older. The majority of these hip fractures are associated with a fall in an individual with osteoporosis.

The disability associated with osteoporosis-related fractures places heavy demands on the health care system. The estimated national direct expenditures (hospitals and nursing homes) for osteoporotic and associated fractures was $19 billion in 2005 ($52 million each day) and the cost is rising.

The outlook for persons experiencing a hip fracture is particularly alarming:

  • 20% of hip fracture patients may require long-term nursing home care.
  • 50% never regain their ability to walk independently, and up to 20% die within one year due to complications of the fracture or accompanying surgery.
  • Approximately 33% of people are totally dependent on others for their care following hip fracture.

Osteoporosis is a pediatric disease with geriatric consequences. Peak bone mass is built during our first three decades. Failure to build strong bones during childhood and adolescent years manifests in fractures later in life.


Osteoporosis is both preventable and treatable.  Steps can be taken at any age to prevent or minimize the effect of osteoporosis.

Governor Phil Murphy has proclaimed the month of May 2021 as Osteoporosis Awareness and Prevention Month in New Jersey.

In commemoration of this observance, the Department of Human Services and the Interagency Council on Osteoporosis (ICO) recognized a number of individuals and agencies that contributed to osteopoprosis awareness and prevention in the past year. A press release lists those presented with virtual award certificates as well as their accomplishments.

The ICO is also sharing the following links to special resources designed to draw attention to osteoporosis so that individuals of all ages can take steps to prevent the disease or mitigate its affects.

Economic cost of osteoporosis

It is estimated that half of all women and 20 percent of all men will have an osteoporotic fracture in their lifetime. In the United States, 300,000 hip fractures occur each year in persons age 65 and older. The majority of these hip fractures are associated with a fall in an individual with osteoporosis.

In 2005, osteoporosis-related fractures were responsible for an estimated $19 billion in costs. By 2025, experts predict that these costs will rise to approximately $25.3 billion.

In the year 2000, it is estimated that osteoporosis caused 36,630 bone fractures in New Jersey residents, at a cost of $496 million. The cumulative cost of osteoporosis over the next decade is estimated at $5.2 billion.

Personal cost of osteoporosis

The impact of osteoporosis and its associated disability affects both the individual and his or her family. It can impair quality of life and interfere with physical, psychological and social health.

The outlook for persons experiencing a hip fracture is particularly alarming:

  • 20%of hip fracture patients may require long-term nursing home care.
  • 50% never regain their ability to walk independently, and up to 20% die within one year due to complications of the fracture or accompanying surgery.
  • Approximately 33% of people are totally dependent following hip fracture.

Everyone is at risk for osteoporosis and risk increases with age. Certain factors increase a person's risk. The following self-assessment will help you determine your risk for developing osteoporosis.

After you take this self-risk assessment, return to this website for more important information on osteoporosis.

Find Out Your Risk For Osteoporosis

If the quiz indicates you are at risk, talk to your doctor about bone health and your personal risk for osteoporosis.

  • Consider having a bone density test.
  • Modify the risk factors you can change.
  • Contact the NJ Interagency Council on Osteoporosis for additional information.
 
You are at increased risk for osteoporosis if you are:
  • Female

    • Your risk is even greater if you are postmenopausal (no longer menstruating), including early or surgically induced menopause (removal of ovaries) or
    • Have an abnormal absence of menstrual periods (amenorrhea).
  • Caucasian (white) or Asian (although Hispanic Americans and African American are also at risk)
  • Thin and/or have a small frame
  • Over 50 years of age
  • Physically inactive
  • A smoker
  • Have more than 2 alcoholic beverages a day
  • Male and have low testosterone levels
  • Have a family history of osteoporosis
  • Have a diet low in calcium and other important nutrients
  • Use medications such as corticosteroids used to treat asthma or arthritis, anticonvulsants, certain cancer treatments or aluminum-containing antacids
  • Have Anorexia nervosa or bulimi
Risk Factors You Can Change

Alcohol and Osteoporosis.
Limiting your alcohol intake can reduce your risk of osteoporosis. Drinking more than two alcoholic beverages per day can increase your risk of bone loss and fractures. This daily amount of alcohol may lead to poor nutrition (less calcium and other important nutrients) and to a greater risk of falling.

Medications and Osteoporosis Risk.
Long-term intake (3 months or more) of thyroid or cortisone-like drugs and anti-seizure drugs (phenytoin, barbiturates) increases your risk of bone loss. Several other drugs including anticonvulsants, certain cancer treatments and aluminum-containing antacids can cause bone loss. Ask your health care provider about your medications and their impact on the health of your bones.

Other Diseases and Osteoporosis Risk.
Chronic disease that affects the kidneys, lungs, stomach or intestines, or diseases that alter hormone levels can increase osteoporosis risk. Asthma and Rheumatoid Arthritis can increase osteoporosis risk because of the drugs used to control these diseases. Ask your health care provider how other diseases may impact your bone health.

Risk Factors You Cannot Change

Personal History of Broken Bones During Adulthood. The first symptom of osteoporosis is often a fracture. Women or men with a single vertebral fracture are 5 to 25 times more likely to have another spine fracture. A non-impact broken bone may be a sign of osteoporosis. (For example, if you are 30 years of age and break a bone while skiing, you are not in this category.)

Gender. Women are more at risk for developing osteoporosis due to lower peak bone mass and the loss of bone at menopause. Men can and do, however, get osteoporosis.

Ethnicity. People of Caucasian or people of Asian descent are at greater risk than members of other ethnic groups. Regardless of heritage, osteoporosis can happen to anyone.

Family History. If someone in your family has or had osteoporosis, you have a greater risk of developing the disease. A family history does not mean, however, that you will absolutely develop it. Alternately, no family history does not mean you are not at risk.

Body Frame. Small bones, thin frame or body weight less than 127 pounds are risk factors for both women and men. People who are heavier or have a larger frame can still get the disease.

Age. Bone loss occurs over time. The risk of osteoporosis is significant for both men and women as they advance in age, especially over 65.

What kids eat and the amount of exercise they get can make a big difference in whether they get osteoporosis later in life. Visit the "Best Bones Forever" website.

KidStrong (Inside & Out). A video program with five lessons on nutrition, physical activity and bone health information for grades 5 and 6. For additional information, contact NJ Department of Health and Senior Services at 609-777-9045 for additional information.

Jump Start Your Bones. A program for 7th and 8th grade classes available at schools. The 12- lesson program includes information on calcium consumption, physical activity and bone density. Contact NJ Department of Health and Senior Services at 609-777-9045 for additional information.

Contact the New Jersey Department of Health and Senior Services at 609-984-0792 for additional information.

Menopause - Estrogen replacement therapy (ERT) has been approved by the FDA for the prevention and, for some products, management of osteoporosis. Women who are menopausal or post-menopausal and not on ERT should discuss prevention and treatment options with their physician. Discuss possible side effects of ERT with your health care provider or pharmacist.

Natural Menopause or Ovaries Removed Before Age 45 - Both of these situations put women at lower estrogen levels for an increased number of years, increasing their risk of osteoporosis.

Missed Menstrual Cycle - Low estrogen levels can change the pattern of menstrual periods. These low levels may be due to eating disorders, excessive exercise or other hormonal problems. Estrogen loss during adolescence can have a significant effect on bone health. Failure to achieve maximum bone strength before age 30 can increase the risk of osteoporosis later in life.

Prescription drugs that can increase the risk of osteoporosis. Thyroid, cortisone-like drugs and anti-inflammatory drugs can increase your risk of bone loss.

Missed Menstrual Cycle - Low estrogen levels can change the pattern of menstrual periods. These low levels may be due to eating disorders, excessive exercise or other hormonal problems. Estrogen loss during adolescence can have a significant effect on bone health. Failure to achieve maximum bone strength before age 30 can increase the risk of osteoporosis later in life.

Prescription drugs that can increase the risk of osteoporosis. Thyroid, cortisone-like drugs and anti-inflammatory drugs can increase your risk of bone loss.

Although osteoporosis is frequently thought of as a "woman's disease", nearly 2 million American men have been diagnosed with the disease, and it is estimated that this number will increase by nearly 20 percent by 2015.

20% of all osteoporotic fractures and 30% of hip fractures in the United State occur in men. Research shows that fracture outcomes are worse in men. The one year mortality rate following hip fracture is 20% in women and 30% in men; vertebral fractures cause higher mortality in men than women, and the institutionalization rate after fracture is higher in men than women.

Osteoporosis is less common in men than women because they have larger, and therefore, stronger bones. Men do not experience the distinct bone loss equivalent of menopause and they have a shorter lifespan. The most significant risk factors which lead to osteoporosis in men are a family history of osteoporosis, advanced age, smoking, alcohol abuse, certain medical conditions and low levels of testosterone.

Low Testosterone. Hormones are important for both men and women. Low testosterone levels (determined by blood test) can increase the risk of osteoporosis. Treatment for prostate cancer involves depressing testosterone levels, so such treatment is also a risk factor.

Prescription drugs that can increase the risk of osteoporosis. Thyroid, cortisone-like drugs and anti-inflammatory drugs can increase your risk of bone loss.

Prostate Cancer Men undergoing hormonal treatment for prostate cancer may have lower bone density. This is because anti-cancer therapy targets testosterone, which stimulates the growth of hormone-sensitive prostate tumors. While these medications can stop or slow down cancer growth, they can also accelerate bone loss and dramatically increase bone fragility.

Resources: Real Men Need Strong Bones [pdf 116k]

More than 44 million Americans have osteoporosis or low bone density placing them at risk for osteoporosis. This represents 55% of the people aged 50 and older in the United States.

In fact, half of all women and 20 percent of all men will have an osteoporotic fracture in their lifetime. In the United States, 300,000 hip fractures occur each year in persons age 65 and older.

The first symptom of osteoporosis is often a fracture. Your risk of future fracture is greatly increased following fracture. Individuals who have had a single vertebral fracture are 5 to 25 times more likely to have another spine fracture.

Osteoporosis is both preventable and treatable. Steps can be taken at any age to prevent or minimize the effect of osteoporosis.

To find out about your bone health is to get a bone density test. This simple, painless test can be done on your spine, hip, wrist, heel or hand. The most accurate bone density test, the DXA (Dual Energy X-ray Absorptiometry), measures bone density at the hip and spine.

Many insurance companies, including Medicare, cover the cost of a bone density test if you meet certain criteria.

To build or maintain your bone mass as you get older

  • Eat foods high in calcium and vitamin D.
  • Do weight-bearing or resistance activities.
  • Maintain a healthy lifestyle – exercise, limit alcohol and avoid smoking.
  • Speak with your doctor about specific steps to take to help keep your bones strong, including medications you can take to prevent the disease.

The Asthma-Osteoporosis Connection. Millions of men, women and children suffering from arthritis, asthma, or other diseases take corticosteroids, often resulting in the development of osteoporosis. Powerful anti-inflammatory drugs such as prednisone and cortisone greatly increase the risk of developing osteoporosis, a bone-thinning disease that leads to painful fractures, loss of height and independence, and can even lead to death. Check with your health care provider or pharmacist if you are taking asthma, arthritis, anti-inflammatory or anti-convulsant drugs.

Asthma and bone loss. Asthma affects between 12 and 14 million Americans, more than four million of whom are under the age of 18. Asthma is becoming more common, with African Americans especially at risk. People with asthma are at increased risk for osteoporosis, especially in the spine. Anti-inflammatory medications taken by mouth decrease calcium absorbed from food, increase calcium loss from the kidneys, and decrease bone formation. Corticosteroids also interfere with the production of sex hormones in both women and men, contributing to bone loss and causing muscle weakness, both of which can increase the risk of falling.

Asthma medication can increase risk of osteoporosis. People with asthma who are treated with 40 to 60 mg per day of oral corticosteroids for long periods of time are most likely to experience bone loss. Even those patients taking 10 mg per day are likely to experience some bone loss over time. Bone loss increases with increased glucocorticoid doses and prolonged use.

Asthmatics who use corticosteroids to manage their asthma are at significant risk for bone loss and should ask their doctor about a bone density test to measure their current bone mass and to diagnose osteoporosis before fractures occur.

Asthma and Osteoporosis Medications. Maintaining appropriate hormone levels of estrogen in women and testosterone in men will help maintain optimal bone health. At menopause, estrogen replacement therapy (ERT) or hormone replacement therapy (HRT) may effectively prevent the bone loss and osteoporosis resulting from corticosteroid use. Other medications to stop bone loss include Fosomax (alendronate), Miacalcin (calcitonin), Actonel (risedronate), and Evista (raloxifene).

Calcium and Asthma. Many asthma sufferers think that milk and dairy products trigger asthmatic attacks. This frequently results in the avoidance of dairy products, which is especially damaging for asthmatic children and adolescents who need calcium to build bone.

Exercise and Asthma. Physical exercise can trigger an asthma attack and many people with asthma avoid weight-bearing physical activities that can strengthen bone. Weight-bearing exercises that work the body against gravity, such as walking, racquet sports, basketball, volleyball, aerobics, dancing or weight-training can improve bone health. Talk to your health care provider or ask for a referral to physical therapist. Consult a physical therapist about the best types of exercise before beginning an exercise program.

People of Caucasian or people of Asian descent are at greater risk than members of other ethnic groups. Regardless of heritage, osteoporosis can happen to anyone.

Significant risk has been reported in people of all ethnic backgrounds.

Twenty percent of non-Hispanic Caucasian and Asian women aged 50 and older are estimated to have osteoporosis, and 52 percent are estimated to have low bone mass.

Seven percent of non-Hispanic Caucasian and Asian men aged 50 and older are estimated to have osteoporosis, and 35 percent are estimated to have low bone mass.

Five percent of non-Hispanic black women over age 50 are estimated to have osteoporosis; an estimated additional 35 percent have low bone mass that puts them at risk of developing osteoporosis.

Four percent of non-Hispanic black men aged 50 and older estimated to have osteoporosis, and 19 percent are estimated to have low bone mass.

Osteoporosis is under recognized and under-treated not only in Caucasian women, but in African-American women as well.

Ten percent of Hispanic women aged 50 and older are estimated to have osteoporosis, and 49 percent are estimated to have low bone mass.

Three percent of Hispanic men aged 50 and older are estimated to have osteoporosis, and 23 percent are estimated to have low bone mass.

When compared with other ethnic/racial groups, risk is increasing most rapidly among Hispanic women.

Experts predict that costs related to osteoporotic fractures among Hispanics will increase from an estimated $754 million in 2005 to $2 billion per year in 2025.

Bone Mineral Density Tests (BMD)

An important step to find out about your bone health is to get a bone mineral density test (BMD). This simple, painless test can be done on your spine, hip, wrist, or heel. This test helps to estimate the density of your bones and can predict your risk of fracture over the next ten years. The most accurate test, known as DEXA or DXA scan (Dual Energy X-ray Absorptiometry), involves measuring the bone density of the hip and lumbar spine. In addition to being simple and painless, the test is quick and has minimal radiation exposure.

Who Pays for Bone Density Tests?

Many insurance companies, including Medicare, cover the cost of these tests for people meeting certain criteria.  Examples of this criteria include:

  • you are a woman age 65 or older
  • you are a man age 70 or older
  • you break a bone after age 50
  • you are a women of menopausal age with risk factors
  • you are a postmenopausal woman under age 65 with risk factors
  • you are a man age 50-69 with risk factors

Check with your insurance company to find our  when a BMD is covered. For most people over age 65, bone density tests are covered once every two years.

Although there is no cure for osteoporosis, several medications approved by the U.S. Food and Drug Administration (FDA) can help stop or slow bone loss, or help form new bone, and reduce the risk of fractures. These medications come in a range of formulations, from daily tablets to yearly intravenous infusions.  There is no ideal medication for everyone.  Your health history and personal preferences are considerations that should be discussed with your healthcare provider when selecting a medication.

Osteoporosis medications fall into two different categories: antiresorptives and anabolics.

  • Antiresorptive medications include bisphosphonates, denosumab, calcitonin, hormone therapy, and raloxifene.  These medications work by slowing bone breakdown.
  • Anabolic medications include teriparatide, abaloparatide, and romosozumab-aqqg. These medications work by stimulating bone formation.

NOTE: Brand names included in this publication are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

 

Bisphosphonates

Alendronate (Fosamax, Fosamax Plus D, and Binosto) is approved for the prevention and treatment of osteoporosis in postmenopausal women and for the treatment of osteoporosis in men. It also is approved for the treatment of glucocorticoid-induced osteoporosis in men and women.  For prevention and treatment, alendronate can be taken as either a daily or weekly tablet.

Ibandronate (Boniva) is approved for the prevention and treatment of osteoporosis in postmenopausal women.  For both prevention and treatment it is taken as a once monthly tablet.  For treatment, it is also available as an intravenous injection given every three months by a healthcare professional.

Risendronate (Actonel) is approved for the prevention and treatment of osteoporosis in postmenopausal women and for the treatment of osteoporosis in men.  It is also approved for the prevention and treatment of glucocorticoid-induced osteoporosis in men and women. For both prevention and treatment, risendronate is a tablet that can be taken daily, weekly, or monthly.

Zoledronic acid (Reclast) is approved for the prevention and treatment of osteoporosis in postmenopausal women.  It is also approved to increase bone mass in men with osteoporosis and for the prevention of new clinical fractures in patients who have recently had a low-trauma hip fracture. It is also approved for the prevention and treatment of glucocorticoid-induced osteoporosis in men and women. It is given as an intravenous infusion once-a-year for osteoporosis treatment and every two years for osteoporosis prevention.

Alendronate, risendronate, and zoledronic acid increase bone density and reduce the incidence of spine, hip, and other fractures. Ibandronate reduces the incidence of spine fractures. Most oral bisphosphonates must be taken first thing in the morning after waking up and on an empty stomach, at least 30-60 minutes before having anything to eat or drink. Patients must remain upright during this 30-60 minute period. This careful dosing is necessary to ensure that the medication is absorbed and to minimize the risk of irritation of the esophagus. Side effects for oral bisphosphonates include gastrointestinal problems such as difficulty swallowing, inflammation of the esophagus, and gastric ulcers. Side effects for intravenous bisphosphonates include flu-like symptoms, fever, pain in muscles or joints, and headache. There have also been rare reports of osteonecrosis of the jaw.

Denosumab (Prolia) is approved for the treatment of osteoporosis in postmenopausal women at high risk of fracture and to increase bone mass in men with osteoporosis at high risk of fracture. It is also approved to increase bone mass in men receiving androgen deprivation therapy for prostate cancer who are at high risk of fracture, to increase bone mass in women at high risk for fracture receiving aromatase inhibitor therapy for breast cancer, and for the treatment of glucocorticoid-induced osteoporosis in men and women at high risk of fracture. Denosumab increases bone density and reduces the incidence of spine, hip, and other fractures. Denosumab is an injection that is administered by a healthcare professional every six months. It may lower the calcium levels in the blood. Patients with weak immune systems may have an increased chance of having serious infections with denosumab. Even patients who have no immune system problems may be at higher risk of certain infections. Patients should contact their healthcare provider right away if signs of infection occur including fever, chills, red and swollen skin, skin that is hot or sore to the touch, severe pains in the abdomen, or pain or burning when passing urine. 

Calcitonin (Fortical, Miacalcin) is a synthetic hormone for the treatment of osteoporosis in postmenopausal women who are at least five years beyond menopause when other medications are not suitable. Calcitonin slows bone breakdown and increases bone density in the spine. It reduces the risk of spine fractures, but has not been shown to decrease the risk of non-spine or hip fractures. Calcitonin is available as a daily nasal spray or a daily injection. Common side effects with nasal calcitonin are a runny nose, headache, back pain and nosebleed. Injectable calcitonin may cause an allergic reaction and unpleasant side effects including flushing of the face and hands, urinary frequency, nausea and a skin rash. Due to the possible connection between cancer and the use of calcitonin, the use of this medicine should be reviewed from time to time with your healthcare provider.

Menopausal hormone therapy is approved for the prevention of osteoporosis in postmenopausal women. It reduces bone loss, increases bone density in both the spine and hip, and reduces the risk of hip, spine and other fractures in postmenopausal women while also helping to relieve menopausal symptoms. It is commonly available as a tablet, skin patch, and a variety of other formulations. According to the FDA, postmenopausal women should consider other osteoporosis medications before taking menopausal hormone therapy to prevent osteoporosis. Because estrogen use has risks, women should discuss with their healthcare provider whether the benefits outweigh the risks. Women who decide to take menopausal hormone therapy should take the lowest possible dose for the shortest period of time to control menopausal symptoms and achieve desired goals.

Raloxifene (Evista) is approved for the prevention and treatment of osteoporosis in postmenopausal women. It is neither an estrogen nor a hormone, but a selective estrogen receptor modulator, developed to provide the beneficial effects of estrogens without all of the potential disadvantages. Raloxifene reduces the risk of spine fractures. There is no data showing that raloxifene reduces the risk of hip and other non-spine fractures. It is approved to decrease the risk of invasive breast cancer in postmenopausal women with osteoporosis and even in women without osteoporosis who are at high risk of breast cancer. For both prevention and treatment, raloxifene is taken as a daily tablet. Side effects include hot flashes, leg cramps, increased risk of deep vein thrombosis, swelling and temporary flu-like symptoms.

Teriparatide (Forteo) is a daily injection approved for the treatment of osteoporosis in postmenopausal women and in men who are at high risk for fracture. It is also approved for the treatment of osteoporosis in men and women who are at high risk for fracture as a result of long-term use of steroid medications. This medication rebuilds bone and significantly increases bone mineral density. Teriparatide reduces the risk of spine and non-spine fractures. It can be taken for a maximum of two years. Side effects can include leg cramps, nausea, and dizziness.

Abaloparatide (Tymlos) is a daily injection approved for the treatment of osteoporosis and is specifically indicated for the treatment of postmenopausal women with osteoporosis at high risk for fracture. Cumulative use of abaloparatide and parathyroid hormone analogs (e.g. teriparatide) for more than two years during a patient’s lifetime is not recommended. Adverse effects may include excess calcium in the urine, dizziness, nausea, headache, palpitations, fatigue, upper abdominal pain, and vertigo. 

Romosozumab-aqqg (Evenity) is approved for the treatment of osteoporosis in postmenopausal women at high risk for fracture. It comes as a set of two subcutaneous injections that should be administered by a healthcare provider once monthly for 12 months. Its use is limited to 12 monthly doses as the anabolic effect of romosozumab-aqqg wanes after this period of time.

Osteoporosis is preventable and treatable

Preventing Osteoporosis

The key to preventing osteoporosis is to eat calcium-rich foods and increase physical activity by doing weight-bearing or resistance exercises to build bone mass.

Your risk of developing osteoporosis depends on the amount of bone mass built through age 35, when most people reach their peak bone mass.

 
YOU Can Take Steps To Build Peak Bone Mass:
  • Get plenty of calcium and physical activity early in life.
  • Maintain your bone mass as you get older by eating foods high in calcium and vitamin D.
  • Do weight-bearing or resistance activities
  • Live a healthy lifestyle - exercise regularly, limit alcohol and avoid smoking.
  • Speak with your doctor about specific steps to take to help keep your bones strong, including medications you can take to prevent the disease.
 
Diet and Nutrition

Dairy products and other foods high in calcium and vitamin D will help keep your bones strong. To build strong bones, make sure you get enough calcium at every age.

 
EXERCISE can help prevent osteoporosis

If you already have osteoporosis, exercise can help maintain bone strength.

If you have a diagnosis of osteoporosis, there are treatments to stop bone loss and, in some cases, you can increase bone strength.

Exercise can help prevent osteoporosis. If you already have osteoporosis, exercise can help maintain bone strength.

Osteoporosis Exercise Guidelines
  • Check with your physician concerning any restrictions you may have before beginning an exercise program.
  • Avoid any exercise that causes or increases pain.
  • Stop exercising if you feel dizzy or short of breath.
  • Never hold your breath while exercising.
  • Make sure to keep your body in alignment when performing all exercises.
  • Avoid exercises that involve forward bending of your spine (i.e. toe touches, sit-ups). These exercises can increase the incidence of vertebral fractures.
  • Avoid exercises that involve excessive twisting (i.e. windmill toe touches). This puts too much force on your spine.
  • Do resistance exercises. Free weights, exercise machines and resistance bands are examples of this type of exercise. Strive to do one set of eight to ten repetitions of each resistance exercise. For a more challenging program, progress to three sets of eight to ten repetitions.
  • When using weights, rest one to two minutes between sets of exercises.
  • When using weights, start with one-pound weights, then gradually increase the amount of weight. Too much weight can be harmful.
  • Wear shoes with good support and cushioning while exercising. Replace shoes when cushioning begins to wear out.

Increase your exercise - Physical activity throughout life helps develop and maintain strong bones and decrease bone loss. Persons age 35 and older should consult their physician before beginning an exercise program. Your health care provider can make a referral to a physical therapist. Before you exercise, consult a physical therapist about the best types of exercise.

A complete osteoporosis exercise program should include weight-bearing, resistance, postural and balance exercises. It is important to check with your physician or physical therapist before starting any exercise program.

Weight-bearing exercises use the weight of the body to work against gravity and are recommended for all ages. Your bones respond to this force by growing stronger. Walking, jogging, dancing, hiking, stair climbing and aerobic exercises are all examples of weight-bearing exercises. The goal is to work up to 45 minutes or more per session. Perform these exercises at least 3 to 5 times per week. (Bike riding and swimming, although good exercises, are not weight bearing exercises).

Resistance exercises generate muscle tension on the bones and are recommended for everyone after the age of 14. Resistance exercise strengthens the muscles and stimulates the bones to grow stronger. Free weights, exercise machines and resistance bands are examples of this type of exercise. Start exercising without weights. Begin with 1 set of 8 to 10 repetitions of each exercise increasing gradually to 3 sets. When that becomes easy, add 1 lb.of weight at a time. These exercises should be done 2 to 3 times a week but not on consecutive days.

Stick 'Em Up
Sit or stand, bringing arms into a "W" position without hunching shoulders. If sitting, place feet on the floor with knees apart. If standing, tighten lower abdominal muscles and keep knees soft (not locked). Bring arms backward to a comfortable position and pinch shoulder blades together. Slowly return to the starting position. Work up to 10 repetitions. When you can do this 10 times without difficulty, add 1-lb. weights to each hand or wrist. Increase weight gradually. 		 Picture of exercise: woman stands with hands up and palms on the head level 

Postural exercises decrease harmful stress on the back. By performing these exercises, you can reduce your risk of spinal fractures and the rounded shoulders commonly seen with osteoporosis. These exercises should be performed throughout the day to reinforce good posture.

Shoulder Stretch
Sit at the edge of a chair. Draw shoulders back to a comfortable position pulling shoulder blades together. At the same time, visualize stretching and lengthening your spine. Hold for 3 seconds. Perform 3 -5 repetitions.		 Picture of exercise: woman sits on the chair 

Balance exercises help maintain equilibrium and reduce the risk of falling. These exercises should be performed daily.

Balancing on One Leg
Stand in a comfortable, balanced position near a counter or sturdy chair for support. Keep knees soft (not locked) and toes facing forward. Tighten lower abdominal muscles and lift left knee to a comfortable position. Hold 5 to 10 seconds. Maintain tightness of abdominal muscles. Alternate legs and perform 5-10 repetitions with each leg.

 Picture of exercise: woman stands in front of the chair

"Illustrated by Cecily Byk; from Osteoporosis, An Exercise Guide by Margie Bissinger, MS, PT." 

If you have osteoporosis, check with your doctor before doing high impact activities like jogging or high-impact aerobics. These exercises jar the spine and might increase the risk of spinal fractures.

 
 
Exercise and the Role of the Physical Therapist

A physical therapist can design an exercise program that is safe and appropriate for both prevention and treatment of osteoporosis. Physical therapists are trained to teach proper ways to perform daily activities to reduce fracture risk. Talk to your physician about referral to a physical therapist.

Many individuals with osteoporosis will have postural changes, muscle, and soft tissue tightness that requires the hands-on treatment of a physical therapist.

 

Falls Prevention

STOP Osteoporosis - Screen, Treat, Overcome, Prevent.

The New Jersey Interagency Council on Osteoporosis (ICO) is a multidisciplinary coalition comprised of members of the public; state government; and healthcare, academic and corporate communities. The ICO's mission is to advise the New Jersey Department of Human Services on and to participate in the development, implementation, and evaluation of a comprehensive osteoporosis prevention and education program for the benefit of New Jersey residents.

Established in 1997, the ICO has successfully developed and implemented a range of consumer and professional education programs. A strategic plan was developed in 2018 to guide the ICO's activities through 2023.

Participation in Council initiatives is open to interested individuals and organizations.

The ICO provides guidance to the NJ Department of Human Services in the development and management of its Osteoporosis Outreach and Education Program. This program provides written materials to the public on the prevention, detection and management of osteoporosis. The Department also sponsors specific osteoporosis initiatives for older adults and adolescents.

Osteoporosis Outreach and Education. As part of the Interagency Council on Osteoporosis' Strategic Plan, outreach and education efforts focus on the following populations: children and adolescents; women age 25-50; early post-menopausal women; late post-menopausal women; older adults; persons with fractures; men; and patients with long-term glucocorticoid steroid use. Look for articles in the health section of your local newspaper and written material at public sites throughout your community. For more information, contact the New Jersey Department of Human Services at 609-438-4798.

Contact the New Jersey Department of Human Services (609-438-4798) for free educational material and/or additional information on the New Jersey Interagency Council on Osteoporosis.