Under a microscope, healthy bone looks like a honeycomb, but bone tissue affected by osteoporosis becomes more porous, and
the holes and spaces in the honeycomb are bigger, thus weakening the scaffolding that makes up the bone. Bone tissue is alive and
continuously changing, storing minerals, and forming blood cells. Your skeleton is rebuilding throughout early adulthood,
reaching a peak bone mass in your late 20s/early 30s.

There are two types of cells busy in our bones, those that build bone, and those that break down old bone. In a healthy
skeleton, these cell types work in sync. In someone with osteoporosis, the bone builders slow down while the cells that break down keep chugging along. When bone breaks down more rapidly than it is rebuilt, over time, bone mass and density decrease.

Once bone density loss reaches 25%, you’ve got osteoporosis. Since the signs of osteoporosis are loss of height or a fracture, preventative measures are important.

Clients who have their bone mineral density (BMD) tested receive a T-score, which tells them how their BMD compares with that of a young adult (25-30 years old). A standard deviation (SD) of -1 to -2.5 below this average indicates osteopenia. A deviation of more than -2.5 indicates osteoporosis. For every 1-point SD drop below the mean, the fracture risk doubles.

Ask your healthcare provider for a baseline density test, with recommended follow-ups to monitor your scores. Research shows that most fractures occur due to activities of daily living. Therefore, the lifestyle education is crucial.

Lifting objects from the floor with a rounded back, such as picking up a laundry basket, or loading the dishwasher are examples of daily motions that should be modified.  As the disease progresses, simply coughing or sneezing can cause a spinal fracture.

Osteopenia, the precursor to osteoporosis, should also be considered as it is reduced bone mass less than 25%. When clients have a diagnosis of osteopenia, we still use precautions, and here’s why: the thoracic vertebra have the greatest risk of fracture, especially the area between and just below the shoulder blades. The x-ray test used tomeasure, called the DEXA, measures the lumbar spine. It can’t measure the thoracic vertebrae because the surrounding ribs, scapula, and sternum would skew the results.

The bones in the lumbar spine are larger than those of the thoracic spine, and the ability to distribute force load decreases from the lumbar to the cervical spine. So if someone has osteopenia of the lumbar spine, an exercise specialist should assume that the person may have osteoporosis of the thoracic spine. Plus, until the results of the client’s nextbone density test are known, the instructor doesn’t know if bone loss is progressing as they are working with the client. Therefore, all exercise specialists should use the same precautions for clients with osteopenia as for those with osteoporosis (Sheri Betz, PT, Polestar Pilates).

Some medicines can be harmful to your bones, even as they may benefit another issue, such as some steroids, chemotherapeutics, SSRIs, and even some antacids. Dietary choices, a sedentary lifestyle, genetics, acidifying foods, smoking, and hormonal changes can all contribute to bone loss.

Weight-bearing and resistance training is crucial for building bone. Many Pilates mat exercises are not suitable for those with osteoporosis. Working on the Pilates equipment that utilizes spring tension as resistance is a great option. Our sessions also focus on coordination and balance, as the risk for fracture with a fall is increased with osteoporosis.