Have you just discovered that you have osteopenia? Guest blogger Dr. Sara Mahoney gives tips for getting started with exercise that can benefit your bone strength.

​Generally speaking, osteopenia means that your bones are less dense than they should be, and you are at a higher risk for developing a more serious condition called osteoporosis. As we age, we stop creating as much new bone and over time our bones become less dense, increasing our risk for fractures and pain. Women who have gone through menopause are particularly at risk for this because of the change in estrogen levels, as estrogen helps to regulate bone density. Osteopenia can also be caused by inadequate calorie intake, metabolic or hormonal disorders, or other medical treatments like chemotherapy. If you have been diagnosed with osteopenia, make sure you talk with your health care provider about the potential causes, and discuss whether it is safe for you to exercise. 

​Exercise has two primary benefits; it can help you build new bone, and it can increase muscle strength and balance so you reduce your risk of falling (and potentially having a fracture). With weight-bearing exercise such as jogging or jumping, you are actually placing a load on the bone that stimulates new growth in response, much in the same way lifting weights would cause you to increase muscle size. 

The good news is that all different kinds of exercise can be beneficial! If you are starting an exercise program for the first time, keep in mind that any exercise is better than none and small steps over time can have a big impact later. Speaking of impact, the first type of exercise to consider is one that loads the bone. This means that your hips and spine are holding your body up against gravity and you are adding a repeated load. Examples of weight bearing exercise would be walking, jogging, and jumping based exercise like a jump rope. The faster and/or higher you go, the more load you add to your bones, so jogging loads more than walking. When adding this type of activity, start where you are and increase slowly in time and intensity. So, if you are not walking at all right now, start with 10-15 minutes, several times a week. Each week, add 5 minutes to your walk until you are walking 30-45 minutes per day. If you currently walk regularly, trying slowly increasing the intensity by adding small jogs into your routine. You might try 3 minute walk, 1 minute jog for 30 minutes. As you feel comfortable, increase the number of jogging minutes and decrease the walking until you can jog for 30 minutes at a time. After that, experiment a bit and have fun! Add some 10-20 second sprints into your routine or utilize a jump rope for 30 seconds at a time during your jog. 

​The second component to think about is muscle strength and balance. The American College of Sports Medicine recommends that adults engage in resistance training at least twice per week, using exercises that target large muscle groups and lift 1-2 sets of at least 8-12 reps. If you don’t have access to a gym with weights, or prefer not to use them, resistance bands or even household items like cans and milk jugs will suffice. There are no magic exercises when it comes to resistance training, but think about trying to get both the front and back of your body, as well as the top and bottom.  With balance exercises, you can start with simply standing on one foot (and for first timers, make sure you have a rail, wall or a friend to grab onto) for 30 sec at a time. Work your way up to 3-4 sets of 30 sec on each foot, and when that becomes easy, close your eyes (again, for first timers, make sure you have support).
No matter where you are now, you can start to take steps towards a more active life and using exercise to support your bones. ​

 In a study from the Mayo Clinic, an exercise that strengthened back muscles helped women in their 60s protect spinal bone density even years after they stopped doing the exercise daily. 

Here's a video with a series of back-strengthening exercises you may want to try. (These are not the same as in the study, but are designed to strengthen different areas of the back. As far as I know, they have not been tested for effectiveness in preventing osteoporosis, they are just examples of back exercises.)  

A couple of months ago, when my foot cramps seemed to be happening more and more frequently, my chiropractor asked me if I was taking vitamin K2. I was taking alfalfa, which turns out to provide K1, not K2.  A quick online search suggested that K2 has a role in bone metabolism - that it helps calcium to be absorbed in the bones and joints. A study of the effects of vitamin K on calcium and bone metabolism in Curr Opin Clin Nutr Metab Care. 2001 Nov;4(6):483-7 stated that "vitamin K2 menatetrenone has impressively been used to prevent further bone mineral loss and fracture risk in osteoporotic patients."  Another study  showed that vitamin K2 was linked with fewer fractures. 

Foot cramps can be a sign of insufficient calcium, magnesium or potassium. Perhaps I needed K2 to make use of the calcium supplements and foods I was careful to consume every day. So a began taking 320 mcg of K2 a day. I just realized yesterday that my foot cramps have gone away!  As much as I dislike adding any more supplements and pills to my daily diet, I think I will continue with K2. 

Good news about yoga and your bones! A study reported in the journal, Topics in Geriatric Rehabilitation showed that practicing just 12 minutes of yoga daily or every other day resulted in gains in bone density over a 10-year period. An article by Jane Brody in the New York Times discusses the study, noting that the subjects' average age was 68 and that 83% had low bone density. Gaining bone density is unusual at this age; however, those who complied with the yoga routine gained bone density in the spine and femur. 

The 12 poses in the yoga practice for this study were each held for 30 seconds and included the following: tree, triangle, warrior II, side-angle, twisted triangle, locust, bridge, supine hand-to-foot I, supine hand-to-foot II, straight-legged twist, bent-knee twist and corpse pose. They are pictured in this article in the Harvard women's Health Watch and below is a link to a video with Dr. Fishman, the researcher, narrating.

Another encouraging result from this study is that none of the participants reported suffering spinal fractures during their 10-year practice of daily yoga. 

Some articles (Livestrong)  have warned that certain yoga poses can increase fracture risk by flexing the spine. The general rule of thumb is to hinge at the hips and keep your back straight, bending the knees if needed, rather than curving the spine.

Poses that involve gentle twisting of the spine do not seem to cause fractures, in fact, Dr. Fishman, the author of the 10-year study mentioned above, recommends gentle twisting as a way to strengthen the spine. 

Practicing these 12 poses is something you can do at home, with minimal props. And a 12-minute routine seems possible, even if you are busy.  I'm planning to try it, in addition to my once-a-week yoga class. What a great way to start or end the day!

 Lately I've been experiencing more fluctuations in weight...gaining a pound or two and then losing it, I have read that especially for post-menopausal women, weight loss often is accompanied by bone loss. Losing a pound should not make much difference, but add that up over a year of losing a pound every week and maybe it does affect bone significantly.

A 2008 study at the University of Illinois found that eating a protein and calcium rich diet can prevent bone loss, even with weight loss.

With a goal of maintaining a steady weight, I've tried to prevent those sudden, unintentional weight gains by cutting down snacking and trying not to eat anything after dinner. Surprisingly, waiting until you are actually hungry before you eat can be a good thing for your bones. The hunger hormone, ghrelin,  has been shown to regulate bone formation by increasing the number of osteoblasts (bone building cells) and has increased bone mineral density in rats. 

Although I've also read about intermittent fasting for longer periods as having health benefits, I'm not convinced that fasting longer than 10 or 12 hours between dinner and breakfast is beneficial for bones. So I'm sticking to a protein, calcium-rich diet with plenty of fruits and vegetables and as little added sugar as possible, and eating in three meals with a snack if I'm really hungry.  So far so good! 

Each week I continue to be challenged on the Biodensity machine to push or pull harder than I did the week before. Like any exercise that stimulates bone growth, it must be done repeatedly and with increasing intensity. Some weeks it feels easy to push harder and other weeks I seem to hit the wall.  

​Dr. Cammisa at Ultimate Chiro Care, where I go to use the Biodensity machine, suggested trying a Tabata routine during the week. Tabata is intense interval training, done in 8 sets of 20 seconds of sprinting, etc. at maximum capacity with 10 seconds rest after each sprint. Tabata training has been shown to increase anaerobic capacity, which should help with the isometric exercises done on the Biodensity machine. 

I've tried Tabata a few times on an elliptical at home and once on a recumbent bike at the gym. Definitely gets me out of breath with muscles burning. However, it's hard to maintain the all-out effort for the entire 20 seconds, especially after two or three sets.  It's very challenging.  I'm trying to keep it up 3 days a week for a month.  At least it's a very quick workout, even adding the recommended 5-minute warm up, 3-minute cool down and some stretching afterwards. 

Just got the results of my DEXA (bone density scan), which is compared to the results from 2 years ago.  It's mostly good news:  7% gain in the femoral neck (one of the hip measurements),  1% gain in total hip and holding steady in the spine. Pretty good, considering that most post-menopausal women lose 1% of bone mineral density each year. 

These DEXA results continue a 3-year trend to reverse a 20--year record of losing bone. I attribute the success mainly  to the weekly challenge of the biodensity machine, where for 10 seconds I leg press  with a force of 1100 pounds and lift with a force of 376 pounds - something I would never try in a gym. Thanks to Dr. Perry Cammisa and his colleagues for developing and researching the biodensity machine and other elements of the B-Strong 4 Life program.

Also part of my overall strategy to build bone is the following:

•  Calcium-rich foods, including kefir, bok choy, string cheese, leafy greens, nuts
• Vitamin D, magnesium, Vitamin K (alfalfa), boron, calcium, collagen and multi-vitamin supplements
• Regular, weight-bearing exercise, including body-weight exercises like push-ups, strength training, walking with a backpack, dancing, yoga and yard work
• Adequate sleep
• Bio-identical hormone replacement therapy


• Gaining bone density in the spine seems difficult - but I'll begin a renewed effort to target that area, with a rowing machine, squats, back extensions, the "superman" exercise, and more.  

A new fitness center opened in our community, with the rowing machines pictured here. Rowing has been shown to help increase bone density, so I was eager to try this machine. As you pull, water swishes around inside the front part of the machine, as if you were rowing on a lake. I'm glad to be able to include some cardio time on this machine in my weekly routine.

Meanwhile, I've almost logged 3 years of weekly exercise on the biodensity machine.  A few weeks ago I began holding the exercises for 10 seconds instead of 5 seconds. Much harder..but I'm getting used to it. Here's the latest report. I'm due for another Dexa scan in December, so I'll be able to see the results of these past 2 years of biodensity training. For the first year, I gained 2% in bone density, reversing a steady trend of losses. 
​

A friend told me about Chi running, how it's worked for her as a beginning runner. After recently recovering from knee pain that is probably from arthritis, I wanted to learn more about Chi running and whether it could help me resume some running without damaging my knees. I am experimenting with it in half-mile runs around the block and so far, so good. 

The posture check that is step one of the Chi running technique reminds me of the "home position" that is encouraged as part of the B Strong for Life program - basically stabilizing your core with shoulders down and abs engaged. 

The above video gives a quick overview of Chi running. There also are apps, books, and training sessions available. 

It's been 5 years since I've been bothered by runner's knee - and I hoped it would go away on its own. Instead, it's starting to feel stiff and is sore when I try to sit on my heels or in child's pose. A sore knee needs to be rested by not running or jumping, which cuts out two main weight-bearing exercises to build bone density. 

However, I am able to continue with the B Strong 4 Life program, with weekly exercises on the Biodensity machine, even doing leg presses without pain. This is my "insurance" that I'm continuing to build bone density even if I need to rest from jumping, etc. My chiropractor, Dr. Perry Cammisa, who developed and tested the Biodensity machine, also can treat my knee, and the physical therapist who works with him has given me strengthening and stretching exercises to do at home. Soaking in a bath with Epsom salts not only calms the inflammation of the knee but also provides magnesium which is absorbed through the skin and benefits bones. I'm also continuing core strength and posture exercises, PowerPlate work, and exercises that don't stress knees, such as swimming, biking and walking.

As I've said before, maintaining and building bone is a lifelong process, a marathon. Even obstacles such as runner's knee or other injuries can be overcome and the change in routine they bring can be refreshing. Here's to quick healing! 
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​Here are a couple of hip/glut strengthening exercises to help with sore knees. For the squat, I use both legs, narrow stance, with a belt or yoga strap with no stretch around my thighs right above the knee and hold the sides of a doorway for stability (not quite like the video).