1. The Use of Resistance Training in
the Prevention and Treatment of
Osteoporosis in the Elderly
Alicia Jackson

2. Outline
• What is osteoporosis?
• What causes it?
• Who is affected and at risk?
• How is it diagnosed?
• What are the signs and symptoms?
• What are prevention and treatment methods?
• How does resistant training have a positive impact?
• What do we need to consider when advising resistance
training?
• Conclusion

3. What is Osteoporosis?
Osteoporosis is the decrease in bone density that enhances bone
fragility and increases the risk of fractures and falls in the elderly
• Type 1: Related to vertebrae and distal radius fractures effecting women 8x more than men.
• Type 2: found in 70 year old and above: hip pelvic and distal humerous fractures - 2 x more
common in women than men. 1
The difference between a normal and osteoporotic bone 2

4. Possible Causes
• Inadequate physical activity - decrease in bone mineral density
• Diet
• Previous chronic disease or injury
In the hormone-related condition:
• Hyperthyroidism: low blood level of thyroid stimulating hormone
• Diabetes mellitus
• Particular gene LRP5: may play a role inhibiting release of serotonin
by cells of the gut. Because Serotonin inhibits osteoblast growth,
reducing serotonin synthesis, increases bone density. 3

5. Risk Factors
Inherited Factors Environmental Factors
Caucasian or Asian Below normal weight
Female Loss of menstrual function
Osteoporotic fracture in the first degree relative Low calcium or vitamin D intake
Height <170cm Inactivity
Weight < 58kg Prolonged corticosteroid use
Smoking
Excessive alcohol intake
Caffeine 4

6. Risk Factors
The risk of osteoporosis increases with age
About 3.4% of Australians have osteoporosis. More than eight out of 10 of these people are females and
most are aged 55 years and over (Figure 1). 5

7. Diagnosis
• GP will conduct an assessment of the risk factors
• A bone density test Dual-energy X-ray Absorptiometry; (DXA) will be
performed.
6
7
Bone Density Scanner

8. Signs and Symptoms
Peak bone mass:
the highest
amount of bone
mass achieved in
life.
Maximal bone
mass: the highest
bone mass that
could be possible
achieved through
life – this is
effected by
genetics and also
physical activity,
dietary intake and
hormone
regulation. 4

9. Prevention
• Regular participation in physical activity, including resistance exercise
• Healthy diet
• Quit smoking
• Decrease alcohol consumption
• Increasing your exposure to limited sunlight
• Falls prevention measures (as falls can lead to fractures)
Calcium Vitamin D Exercise
Prevention measures for osteoporosis

10. Treatment
• Medication to stop further bone loss and
prevent fractures. Types of medication
include:
– Bisphosphonates
– Strontium Ranelat
– Monoclonal Antibodies (denosumab)

11. Treatment (cont.)
• Hormone Replacement Therapy.
• Selective Estrogens Receptor Modulator
(SERMS)
• Calcium and Vitamin D supplements
• Drinking fluoridated water

12. Resistance Training (Used for
Prevention and Treatment)
Regularly performed resistance training can offset the age related
declines in bone health by maintaining or increasing bone
mineral density.
Table 1. Resistance Training Program
Intensity Frequency Duration Progression Goals Special
Considerations
15 reps of 8-10 2 days per week 1 or 2 sets up to Add a set after 3 – 4 days per •Avoid spinal
exercises (may (reference) 30-60 mins initial 2 weeks week at 10-12 flexion
require less Could be reps per set •Use slow and
strenuous progressed to 3 controlled
program initially) days per week movements
•Target legs and
back 4

13. Resistance Training Exercises
Exercises including Thero bands, steps, soup tins and raising from a chair
may increase the compliance to exercise for individuals as they are easy to
administer, cost effective and can be done in the privacy of one’s own home
being ideal for those who are self-conscious and lack confidence to exercise
in public (at a gym).

14. Recommendations
• A pre-exercise evaluation should be completed
just before beginning resistance training program.
(In particular for elderly participants)
• Resistance exercise should focus on all areas of
the body.
• Exercise intensity should be decreased initially.
• Progression to cause positive adaptations
• High velocity and power can be incorporated.
• Aim for an increase in daily physical activity
levels.8

15. Safety considerations
• Warm up & down.
• Allow 48-72hrs recovery between sessions
• Lessen the likelihood of overtraining
• A range a motion for each exercise that is pain free.
• Ensure they have had advice from medical staff and quality
supervision by an instructor or medical professional. 9

16. Conclusion
Osteoporosis is a concern for all in terms of prevention, however
particular measures need to be taken by those who have inherited and
environmental risk factors. Resistance training is a suitable method for
both the prevention and treatment of osteoporosis and should
become a part of a daily lifestyle. A combination of aerobic exercise
and a healthy diet should be incorporated into everyday life in order to
minimise the risk of other chronic diseases as well.
For further information:
• Osteoporosis Australia http://www.osteoporosis.org.au/
• Wolrd Health Organisation
http://www.who.int/chp/topics/Osteoporosis.pdf
• Australian Bureau of Statistics http://www.abs.gov.au/

17. References
1. Marieb, E.N. and K. Hoehn, Human anatomy & physiology, 2007: Pearson Education.
2. Image – Bone Density 246 × 163 (Same size1.3x larger), 32KB. Normal and Osteoporotic bone.
http://www.parathyroid.com/osteoporosis.htm
3. Baechle, T.R. and R.W. Earle, Essentials of strength training and conditioning, 2008: Human Kinetics
Publishers.
4. Ehrman, J.K., Clinical exercise physiology, 2009: Human Kinetics Publishers.
5. Australian Bureau of Statistics 2006c, National Health Survey: Summary of Results, Australia, 2004–05,
cat. no. 4364.0, ABS, Canberra. (Figure 1)
6. Osteoporosis Australia, 06 July 2011; Available from:http://www.osteoporosis.org.au/about/about-
osteoporosis/what-is-osteoporosis/.
7. Image – 428 × 320 (Same sizex larger), 28KB Dexa Scan http://www.nutritiongurus.com.au/your-body-
composition
8. Australian Institute of Health and Welfare 2005, Arthritis and musculoskeletal conditions in Australia,
2005, AIHW Cat. No. PHE67, AIHW, Canberra.
9. Mazzeo R.S.; Tanaka H. Exercise Prescription for the Elderly: Current Recommendations, Sports
Medicine, Volume 31, Number 11, 1 November 2001 , pp. 809-818(10)
10. Pollock, M.L., et al., American Heart Association. Circulation, 2000. 101(7): p. 828.
11. Layne, J.E. and M.E. Nelson, The effects of progressive resistance training on bone density: a review.
Medicine & science in sports & exercise, 1999. 31(1): p. 25.