The osteoporosis coeliac link and how exercise can help.

I recently gave a talk about the role of exercise in preventing and treating osteoporosis. Since many of my followers could not attend, I have decided to write a post, highlighting the points I mentioned.

What is osteoporosis?

Osteoporosis is a condition where there is loss of calcium and other minerals in a person’s bones making them thin and brittle. Osteoporosis literally means porous bone. Osteopenia is a precursor to osteoporosis, and is a condition where the bone mineral density (BMD) is lower than normal, but not as low as osteoporosis.

Several factors can prevent osteoporosis in the general population. A nutritious diet including calcium-rich foods and regular exercise throughout a person’s life will reduce the risk of osteoporosis in later years. Exercise should start at an early age, preferably through childhood.

leafy          act

Coeliac disease & osteoporosis

According to Coeliac UK, studies have shown that more than 75% of adults with untreated coeliac disease suffer from osteopenia or osteoporosis. Osteoporotic fractures are a major public health problem. People diagnosed with coeliac disease are almost twice as likely as those without it to break a bone, according to a new review of the evidence.

The mechanism underlying osteoporosis in coeliac disease is likely to be related to calcium malabsorption leading to increased parathormone secretion which, in turn, increases bone turnover and cortical bone loss.Vitamin D malabsorption is probably of less importance. 

Here’s the thing

We reach our peak bone mineral density in our mid twenties but the average age that a person is diagnosed with coeliac disease is between 40 & 60 years of age. Furthermore, according to coeliac UK. the average time for a person to get diagnosed with coeliac disease is 13 years. During that time, the body is not absorbing the nutrients it needs to function well, and one of these important nutrients is calcium that is needed for strong bones. Sadly, most people are diagnosed with coeliac disease after they reach their peak bone density, so on diagnosis they often have osteoporosis or osteopaenia.

What if somebody is diagnosed in childhood or early teens?

Then they most probably will not have a problem with bone mineral density as they would be established on a gluten free diet. There would be no need for any special treatment apart from a gluten free diet, and there is probably no need to do a bone density scan.

The good news and the ”not so good” news

The good news is that bone mineral density improves significantly when established on a gluten free diet, even in adults. The bad news is that women diagnosed with coeliac disease after the menopause find it more difficult to improve their Bone Mineral Density. This is because there is less of the hormone oestrogen, which speeds up the loss of bone strength.

The risk of osteoporosis increases as you get older. There are also other factors that can make you more at risk of osteoporosis, including:

  • late or delayed diagnosis of coeliac disease in adult life
  • lapses from the gluten-free diet
  • lactose intolerance
  • being underweight

So what should we do?

  1. Follow a strict gluten free diet with no cheating.
  2. Ensure you are consuming adequate dietary calcium. Coeliac UK recommend that adults with coeliac disease have between 1000mg and 1500mg of calcium each day. The recommended intake of calcium for the general population is 700mg per day in the UK. The main sources of calcium are dairy products like milk, yogurt, and cheese. But we must remember that calcium can be obtained from other sources like leafy greens (e.g. kale, broccoli), seafood (salmon, tinned fish), legumes, and fruit also contain calcium and many foods and drinks are fortified with the mineral.
  3. Quit smoking
  4. Do not consume excess amounts of alcohol.
  5. Get enough vitamin D. In sunny Malta where I live, this is not a problem.Try to expose your bare skin to sunlight daily, but not during the peak hours of sunshine. Vitamin D is needed for the absorbtion of calcium.
  6. Exercise! A sedentary lifestyle encourages the loss of bone mass, while exercising regularly can reduce the rate of bone loss. Choose exercises that are appropriate for your fitness level, abilities and health status.

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What exercise should I do?

A combination of weight bearing exercises, muscle strengthening and balance exercises are needed.

Weight bearing exercises:

  • In weight bearing exercise, muscles and bones of the legs and trunk work against gravity while supporting your body weight. Examples of low impact weight bearing exercises that can be done by people with existing low bone mineral density include walking, dancing, low-impact step aerobics, & stair climbing. If you do not have osteoporosis. High-impact exercises include activities such as jumping, running or jogging. The latter should only be done by people who do not have osteoporosis and a high risk of fractures.

Individuals who are in good general health and are trying to reduce their risk of osteoporosis will be able to do much more vigorous and frequent exercise than those who have a greater risk of fracture.

Strength training: Strength training refers to exercise where free weights (dumbbells), weight machines or exercise bands (also known as therabands like their trade name) are used to make the bones and muscles work by lifting, pushing or pulling a load. Strength training is useful to improve muscle mass, and protect the bone.

 

Balance exercises can include anything depending on your age and general condition. Tai chi is an excellent exercise for people with existing osteoporosis. Balance exercises can be done in various ways, using equipment or free standing. It is best to consult a physiotherapist for an individualised program.

 

What about Swimming and water aerobics? 

Swimming is an excellent exercise to improve all over body strength and endurance, but it does not have the impact your bones need to slow mineral loss since you are weightless in water. These activities can be useful in cases of extreme osteoporosis, and during rehabilitation following a fracture.

 

The effect of exercise at different stages of one’s life.

After puberty, bone mineral density (BMD) is not easily augmented. The main role of exercise in young adults and pre-menopausal women, therefore, is to maintain BMD rather than to increase it. Nevertheless, high-intensity exercise can lead to modest bone accrual in targeted areas. Even small increases in bone mineral may significantly reduce the risk of fracture in later life. Use a combination of warm up, high impact aerobics, strengthening, and stretching and cool down.

 

Besides maintaining bone strength, the main goal of exercise therapy in postmenopausal women is to increase muscle mass in order to improve parameters of muscle function such as balance and strength, which are both important risk factors for falls and – independent of bone density – risk factors for bone fractures.

According to Margaret Martin, of Melio guide, new research shows that the frequency of exercise can affect whether stem cells located in your bone marrow become bone or fat cells. If you exercise frequently, the quality, density and strength of your bone will be affected. Aim for short frequent sessions rather than 1 long session. So it is preferable to split your long session into 2 shorter sessions. For example, you could do weight bearing exercise in the morning, and strengthening and balance in the afternoon. Aim to exercise most days of the week.

What to avoid if you already have osteoporosis.

  1. Exercises that increase the risk of falling- no skiing or rollerblading please.
  2. Avoid high impact exercises as these can lead to fractures in weakened bones.
  3. Avoid jerky, rapid movements.
  4. Bending and twisting. Exercises in which you bend forward and twist your waist, such as touching your toes or doing situps, can increase your risk of compression fractures in your spine. Other activities that may require you to bend or twist forcefully at the waist are golf, tennis, bowling and some yoga poses.

Regular exercise should be a part of every osteoporosis program. Consult a physiotherapist for a tailored program and for advice. Always start slowly, and at a low intensity.

WARNING:

Always consult with your doctor, physiotherapist or health care professional before you decide on an exercise program if you suffer from cardiovascular or pulmonary disease, arthritis, or neurological problems.

____________________

Sources:

https://www.coeliac.org.uk/coeliac-disease/associated-conditions-and-complications/osteoporosis/

http://gut.bmj.com/content/46/suppl_1/I1.full#ref-26

http://gut.bmj.com/content/35/2/150.full.pdf+html?ijkey=414e4a6a5eb14e040faa9acf1bb7b0d7b1364501&keytype2=tf_ipsecsha

http://www.iofbonehealth.org/exercise-recommendations

http://www.melioguide.com/

http://www.reuters.com/article/2014/10/29/us-health-celiac-bone-risk-idUSKBN0II2EX20141029

photo credit: <a href=”https://www.flickr.com/photos/chiotsrun/5987690435/”>Chiot’s Run</a> via <a href=”http://photopin.com”>photopin</a&gt; <a href=”http://creativecommons.org/licenses/by-nc/2.0/”>cc</a&gt;

photo credit: <a href=”https://www.flickr.com/photos/mikeyphillips/14949530990/”>mikeyp2000</a&gt; via <a href=”http://photopin.com”>photopin</a&gt; <a href=”http://creativecommons.org/licenses/by-nc-nd/2.0/”>cc</a&gt;

photo credit: <a href=”https://www.flickr.com/photos/glenscott/1578514678/”>hey mr glen</a> via <a href=”http://photopin.com”>photopin</a&gt; <a href=”http://creativecommons.org/licenses/by-nc/2.0/”>cc</a&gt;

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