Scott Josephson, M.S., R.D.Director of Operations Hippocrates Health Institute

Advisory Board of Sport Nutrition Vancouver 2010 Olympic Games

NO BONES ABOUT IT!Osteoporosis Programs and Prevention

WHAT IS WHAT IS OSTEOPOROSIS?Low bone mass & deterioration of bone. It effects 30 million Americans. 80% are women.Osteoporosis is a silent disease. Bone loss occurs without symptoms.

OSTEOPOROSISWHY? Bone breakdown occurs too quickly, or replacement occurs to slowly. 2 types:

1. Osteopenia: BMD deviation of 1 to 2.5 below normal values.

2. Osteoporosis: BMD deviation of greater than 2.5 below normal values.

DEXA: DUAL ENERGY X-RAY ABSORBIOMETRY

OSTEOPOROSIS FACTSMost fractures occur in the spine, hip or wrist. ~~ 2 million a year, mostly in women with LBD.

Chemo & radiation usually cause osteoporosis.

YOUR BONESWhat is bone? Living tissue of collagen & calcium. In life old bone is removed, & new bone is added.Bone loss occurs about 1% a year after 35.Bone breakdown exceeds bone formation.

PHYSIOLOGY OF BONE 1. Cortical: Dense & compact.2. Trabecular: Spongy & porous.

99% of our calcium is stored in our bones.1% is stored in our blood at 9 to 11mg/dl.

PHYSIOLOGY OF BONEWhen calcium drops the thyroid sends a signal:

1. Use calcium to form new bone = Osteoblasts. 2. Osteoblasts: Use calcium! Restore to normal level.3. Osteoclasts: Dissolve bone, ↓ calcium absorption.

WHAT INCREASES OSTEOBLASTS?1. Vitamins C, D & K.2. Magnesium & boron.3. Isoflavones.4. Testosterone.5. Estrogen.

WHAT INCREASES OSTEOCLASTS?1. Poor calcium to phosphorus ratio.2. A high fat protein diet. 3. Depleted hormones.4. Aluminum intake. 5. Excess sodium.

TYPES OF OSTEOPOROSISACSM (2008) Exercise Management for Persons with Chronic Disease

Type IOsteoporosisOsteoporosis

(estrogen decline)

Type IIOsteoporosis(age related)

Age at onset ~~ 50 to 70 ~~ 70+

Bone loss Trabecular(spongy)

Cortical(dense)

Fracture sites VertebraeWrist

VertebraeHip

WHO’S AT RISK?Small or thin boned Caucasian’s & Asian’s.

Family history of Osteo.

Early menopause before 45 or abnormal periods.

Excessive exercise can lead to amenorrhea & bone loss.

Eating disorders. Anorexia & Bulimia increase bone loss.

WHO’S AT RISK?Glucocorticoids meds (cortisone, prednisone)

induce substantial bone loss during treatment.Cancer treatments & seizure medications.↓ Calcium & Vitamin D. Excessive caffeine.

GLUCOCORTICOIDS USAGE

Endocrinology Dept at Wyeth Research, Translational Medicine, Collegeville, PA.

OSTEOPOROSIS IN MEN?Affects over 2 million men.

Chances increase with:

Low testosterone levels.

Steroid medications.

Excessive alcohol.

Smoking.

PUTTING CALCIUM TO USEHow it works? As we age, we become less efficient at absorbing calcium & other nutrients.Calcium passes through the intestines for absorption. This keeps blood levels consistent at 9-11mg/dl.

CALCIUMFood first, then supplement.

Hijiki, kelp, kale & almonds!

~~ 600 mg at a time, do notexceed 2,500 mg (stones).

Liquid minerals ↑ absorption.

Dosage? 1000-1200 daily.Postmenopausal?

KALE

Sedatives, Laxatives & Diuretics decrease calcium & Vitamin D absorption. Need D! 2000-4000IU daily.↑ doses of Vitamin A decrease absorption & bone!

DRUGS ↓CALCIUM ABSORPTION

LACK OF VITAMIN B12?Deficiency can = anemia & ↓ BMD. Dosage: ~~ 2.5 micrograms daily. Stomach acid & aging ↓ absorption.

Vegan Sources: Algae, nuts, seeds & yeasts.

FDA THERAPUTIC MEDSReclast: (2007) Yearly IV treatment for post menopause osteoporosis.Side effects? ↓↓ blood calcium, ↓↓ kidney function,↑ jaw decay (osteonecrosis), ↑ muscle & joint pain.

FDA THERAPUTIC MEDSEstrogen Replacement Therapy: ↑ risk of endometrial cancer. Risk ↓ taken with progestin.

Fosamax, Actonel & Boniva are bis-phosphonates.They ↓ bone loss from gucocorticoid meds.

Evista: is a Select Estrogen Receptor Modulates.SERM’s ↑↑ BMD without the side effects of ERT.

Miacalcin: Deposits calcium were needed.

Forteo: Takes calcium from bone to blood.

MEDICATION SIDE EFFECTS

BISPHOSPHONATES Fosomax, Actonel & Boniva.

Nausea, & irritation of the esophagus.↓↓ magnesium & potassium absorption.↑↑ joint pain, diarrhea, skin irritation, kidney damage & jaw decay (osteonecrosis).

MIACALCIN ↑ joint pain, diarrhea, nnausea & rashes.Can’t take with certain allergies.

EVISTA (SERM’S) ↑ joint pain, diarrhea, urinary infections.

FORTEO Can cause small holes in your bones.

ERT ↑ risk of endometrial cancer.

WHAT TO DO WITH TYPE 2?Type 2: OLDER woman (men?) diagnosed with osteoporosis, their need is to maintain function. Emphasize multi joint “fixed range of motion”movements. (open chain vs. closed)↑↑ muscle strength & BMD to preserve bone mass.

TYPE 2 PROTOCOLSExtensive focus on balance & mobility.Assess Functional Squat. Using hands indicates weak hips & knee flexion.

Create a circular pathCreate a circular pathor cone path.or cone path.

FUNCTIONAL STEPPING ON VARIOUS HEIGHTSPlace stable objects side by side.

Assess stepping up with both feet then down.

66””44””

44””22””

66””

ASSESS NEUROMUSCULAR FUNCTIONAssess Weak Muscles: Quads,Hams,Gluets,etc.Check pliability & ROM for program design.

Assess Balance: ~10 seconds, wide & narrow.

FRACTURE OF THE VERTEBRAEA vertebrae fracture = kyphosis. An ↑ risk of falling.Lower intensity cardio. Weak lower back.Caution with floor work. Swiss balls can be unstable.

ACTIONS TO AVOIDNO forward flexion.NO spinal rotations.

↓↓ eccentric actions.Monitor for back pain.

PREVENTION PROGRAM

YOUNGER woman's goal ↑BMD & ↓ risks.

Strength correlates to ↑ BMD.

High load training increasesBMD at the hip & spine.

High load training provides much better BMD than low.

B.E.S.T. PROGRAM FOR BMDB= Bone Mineral Density E= Estrogen S= StrengthT= Training…….weight bearing & core.7-8 repetitions at 60-80% of the 1RM is moreeffective than 15-20 reps at 20-40% of the 1RM.ACSM (2006) Exercise with Chronic Disease, International J SportACSM (2006) Exercise with Chronic Disease, International J Sports Vol 2 p.116s Vol 2 p.116--125. 125.

TRAINING FOR INCREASED BMDProgressive weight bearing ↑ BMD & osteoblasts.Increase upper body strength. 5 up & 1 down.Exercises standing, (recruits) & ↑ bone loading. Flexibility ↑ tendon strength. Use confusion principle!

ADD HIP & SPINE BONE LOADING

Squat Close Stance

HIP & SPINE BONE LOADING

Lunges Walking Lunges

HIP & SPINE BONE LOADING

Heel Drop Plie, Position 2.

HIP & SPINE BONE LOADING

Static Contraction

DEAD LIFTSNeutral spine & scapula retracted works lower back, glutes & hamstrings.

Dead lifts work multiple muscles & mimic movements we do all day!

“Bending over to pick things up”.

BENEFITS OF REBOUNDING↑ blood & oxygen in the body. blood & oxygen in the body. ↑ immune system.immune system.↑ lymphatic system (eliminate toxins & waste)lymphatic system (eliminate toxins & waste)↓ varicose veins by strengthening vein walls.varicose veins by strengthening vein walls.

K’s BURNED REBOUNDING VS. JOGGING

Body Wt Jogging 1 Mile (12 mins) Rebounding (12 mins)

100 47 58110 52 63120 56 72140 66 77150 71 82160 75 86170 80 91180 85 96 190 89 100200 94 105

Research: Victor L. Katch, Ph.D., Department of PE Univ of Michigan.

Core stability recruits the trunk muscles to “control the lumbar spine” during movements.

Core Moves

CORE FOR SURE!

PLYOMETRICSTranslation from Greek meaning more measure.Quick powerful movements using a pre-stretch.

Impact jumps are absorbed by the neck of the Femur.

FEMUR

NECK

PLYOMETRICS PHYSIOLOGYMuscle energy is ↑ with a stretch, followed by a concentric action. The energy is released ↑ the force.

Simple Explanation:

PLYOMETRIC EXERCISES

TWO FOOT HOP BOX JUMP TWO FOOT ANKLE

JUMP SQUATS STEP FROM BOX

PLYOMETRIC EXERCISES

SPLIT SQUAT JUMP

LEG PUSH OFF