Osteoporosis : bone remodeling

Our bone substance is not a rigid structure, but is adapted to the respective conditions and loads through constant remodelling phases. Old bone substance is broken down and replaced by newly formed bone mass. Damage to the bone system caused by everyday loads and movements is continuously repaired.

After a bone fracture (fracture), functional bone can be formed again within a few weeks. These processes serve to maintain a stable, load-bearing skeletal system. Within 7 – 10 years, the entire human bone mass is broken down and replaced by new bone substance.

The individual bone density varies due to genetic preconditions, nutrition, sunlight supply and continuous sufficient mechanical stress e.g. through sports. Normally there is a constant balance between bone resorption and bone regeneration. In growth, bone formation predominates until about 30 years of age, after a constant phase until about 50 years of age, bone resorption increases with increasing age and especially in postmenopausal women.

The stability of the bone mass is significantly influenced by sufficiently dosed mechanical stress on the bone, especially in adolescence. The sufficient build-up of muscle mass leads to the development of a stable “bone bank” (peak bone mass), which significantly delays and reduces bone resorption in old age. Today, this sufficient mechanical load from sports or physical work is often no longer present in young people due to long periods of sitting at school and at the PC.

A lack of mechanical stress on the bone skeleton leads to bone resorption, which can be proven in studies on bedridden patients (approx. 4-5% bone resorption per month) or by investigations on astronauts after a long stay in weightlessness. The process of efficient bone regeneration takes 3-4 months on average, which means that short-term sporting activity without continuity has little positive effect on bone regeneration.

Osteoporosis: effects of sports training

Sports training and adequate physical activity are important therapeutic components as well as in the prevention and treatment of osteoporosis. Training goals:

Health promotion and prevention
Increase of bone formation, inhibition of bone resorption and stability (especially of the spine)
Increase in muscle mass, strength building
Improving mobility, balance, coordination and response
Posture improvement
Increase in cardiopulmonary endurance
Pain relief
Reduction of fear of falling, fall and fracture prophylaxis
General improvement of vitality

Osteoporosis: training goals, principles, training contents

Training goals: Training and execution principles: training contents:

Health promotion and prevention
Increase of bone formation, inhibition of bone resorption and stability (especially of the spine)
Increase in muscle mass, strength building
Improving mobility, balance, coordination and response
Posture improvement
Increase of cardiopulmonary (heart, lung) endurance
Pain relief
Reduction of fear of falling, fall and fracture prophylaxis
General improvement of vitality
As a preventive measure, training should definitely begin in adolescence
Positive effects on bone mass are also achievable at the beginning of training in old age
Older patients, (especially those with a high risk of falling) under continuous supervision as part of functional training, rehabilitation sports, or in the gym. In individual therapy under the supervision of a physiotherapist. – The training stimulus must be above the daily physical demands (slow, progressive load build-up, taking into account the individual performance level, until high stimulus intensity is reached)
Continuous training adjustment, (otherwise there is the danger that after approx. 1 Lahr a constant bone density plateau is reached)
Minimum requirement: 2-3 training units/week
Training structure and intensity depends on the individual performance (initial values), age and cardiopulmonary (heart/lung) resilience, consider individual risk of falling when choosing the exercises
Except for the muscular exertion feeling, training must be painless, light muscle ache is tolerable/desired
Continue to breathe during the exercises or exhale for exertion
In addition to the specific exercises daily brisk walking of about 30 minutes, hiking, climbing stairs
The training must be continued continuously, interruptions lead to the loss of the effects on the bone bank already worked out
Collection of the initial values
Information (oral and written)
Strength-emphasized dynamic training forms for all major muscle groups, in particular trunk muscles, hip and arm muscles) characterized by high muscular activity, axial load (upright against gravity), flexibility, jumping units (only in younger subjects without risk of fracture)
Rapid strength, reaction, balance and coordination for fall prevention (plus residential renovation)
Endurance training in a mixture of high and low impact training
Body awareness exercises and posture training
Vibration training
Whole-body electro-myostimulation
Relaxation and stretching units for pain reduction
For older patients, choose exercises that are close to everyday life and are easy on the joints, no jumping load, intensive training controls and support
Basically avoid high-risk sports with increased risk of fracture
Variable mixed programs to avoid lack of motivation and stagnating performance development