Osteoporosis and osteoarthritis are like the evil twins of bone related aging concerns. We’re gonna talk about them today because too many times I have heard clients say some wild things to me about these diseases (e.g. I can't have that, I'm too young; it's one or the other, you can't have both, and my personal favourites; exercise isn't safe if you have osteoporosis/osteoarthritis!) . Let’s clarify what they are, rectify some myths, and discuss the implications of both of them.
Let’s get into: What exactly are these two diseases?
As we age, it’s normal to have some “wear and tear” on the tissues within our joints. This wear and tear may or may not cause pain; it is common to find signs of degeneration in joints of people who do not have any symptoms. It is when this degeneration starts to cause pain or loss of function, often due to inflammation, that we are more likely to get a diagnosis of osteoarthritis.
Osteoarthritis (OA) refers to degeneration of the cartilage and bone of a given joint. Signs and symptoms of OA can include pain, tenderness, swelling, crepitus (i.e. feeling of crackling/grinding within the joint) and/or decreased range of motion at a joint. Inflammation may or may not occur with OA.
Osteoporosis (OP) on the other hand refers to the degeneration of the bone itself. Thing of Your bone tissue like a dense hard sponge. It is strong and structurally sound, but porous. With osteoporosis, the density of the bone decreases and the pores become larger, therefore the structure of the bones become weak and brittle. When bone density is measured, we are given a t-score; this is a statistical measurement based on the average bone density of the population. A t-score between 1 and 2.5 standard deviations away from the population average indicates osteopenia, referring to bone loss. If the t-score is above 2.5 standard deviations away from the average, this indicates osteoporosis, referring to bone degeneration.
How Does It Happen?
What makes someone more likely than someone else to develop osteoarthritis? There are many factors here, but ultimately boil down to biomechanics and lifestyle. Let’s start with biomechanics:
Our bodies are beautifully designed; our bones and joints fit perfectly together to be able to move and move us around. Our radius and ulna twist around each other to allow the fine movements of our wrists and hands; our feet are made up of more that twenty bones that move together to allow for force absorption. However, if we do not move these joints in their proper alignment, or if we do not allow for proper build up of intensity of exercise, or proper recovery from exercise or movement, this can lead to an accelerated breakdown of our tissues.
An example of this is if someone is a regular exerciser, but they cannot maintain the alignment of their hips, knees, and feet while they do their squats and lunges, then in each rep, there is excessive force being place on one side of the joints as opposed to distributed equally through the joints. This unequal distribution of force can lead to an accelerated rate of degeneration within the joint on the affected side.
This same principle can apply not just for exercise, but for activities of daily living. So, if someone is an avid bread baker, and they knead their dough a few times a week using mostly their thumbs and the bottom side of their hand. Over time, the repetitive force through the thumb and side of the hand can lead to and increased rate of degeneration of the cartilage and bone of those joints compared to other joints of their hands and fingers.
Now even if someone has the most perfect alignment and technique that we can dream of, if there is consistent relatively high loads, and especially without appropriate time for recovery between the loads, then there is an increase risk of developing OA. Think of someone working in a factory where they have to lift heavy loads day in and day out; their body can lift the load safely, but it is still getting that consistent wear on the body, without much time in between work days to recover. This can increase one's risk of developing OA. This is the same situations for athletes who have to complete the same movements in every training session, think runners, paddlers, or skaters.
Lastly, if there is a history of injury, especially sprains (injury to the ligaments holding the bones together) and fractures (injury to the bones themselves), there is an increased risk of developing OA, specifically if mechanics or joint alignment are effected during or after the healing process.
So now let's consider lifestyle factors that can increase one's risk of being affected by OA. Being inactive or overweight are in this category. While we just spoke about how different kinds of activity can increase your risk for OA, being inactive can actually be worse! Our joints generally don't have a lot blood flowing through them and through to the cartilage lining them, therefore they rely on synovial fluid to provide nutrients and lubrication. Movement and impact through the joint is what allows for movement of this fluid and the exchange of waste and nutrients, and therefore health of the joint. If we are inactive, that fluid, and therefore that waste, is stagnant and cannot be replaced. Going along with inactivity, being overweight or obese can increase one's risk of developing OA due to the consistent increased load on the joints.
Women are more likely than men to develop OA, as well as older adults are more likely to develop OA than middle aged adults. Certain diseases, such as diabetes and diseases affecting joints and bones can also increase one's risk of developing OA. As well, people with poor Vitamin D status seem to be at an increased risk.
Now Back to Osteoporosis, How Does It Happen?
Our bone cells are in a constant state of breakdown and build up; when the equilibrium of breakdown and build up shifts, and there is more breakdown than rebuilding, our bone density will decrease. If there is enough breakdown, then we can be classified as having osteopenia and eventually osteoporosis.
This shift to an increased rate of breakdown can be influenced by several factors. Firstly is age; as we grow older there is a decreased rate of bone reformation. Certain nutrition factors can be greatly influential as well, such as vitamin D status and certain minerals such as calcium, magnesium, and phosphorus. As there minerals are the main constituents of bone, a lack of them in the diet can hinder our bodies' ability to build up bone, and/or our body will pull these minerals from our bones if they are needed elsewhere in the body. Issues affecting nutrient absorption can therefore also increase one's risk of developing osteoporosis, such as anorexia, IBS, celiac disease, or certain liver pathologies. Other diseases that can increase the risk of developing OP include diabetes mellitus, multiple myeloma, and rheumatoid arthritis.
Next we need to talk about estrogen. Estrogen plays a key role in stimulating bone formation. When we lose estrogen during perimenopause and menopause, we also lose a key stimulus for maintaining our bone mass. This is why it is more common to see older women develop osteoporosis than older men.
Some lifestyle factors that can increase one's risk of developing OP include a history of smoking, steroid use, history of RED-S, competitive participation in endurance sports, physical inactivity, and underweight or obese BMI (especially in older males). All of these things ultimately impact the availability of nutrients in our body, and even if they are present, our bodies' ability to utilize these nutrients.
So What Do We Do About It?
Someone with OA can still live a normal life and do the things they love as long as steps are taken to manage their pain and mitigate the progression of the joint degeneration.
Pain management can include using oral analgesics as recommended by your doctor, or using topical analgesics. Certain supplements have shown to be beneficial in managing OA pain, including curcumin, and glucosamine. Depending on the joint affected, bracing may be an option to decrease pressure through the joint or limit offending movement at the joint during activity. Compressive sleeves (not compression socks, think more like this) and manual therapies have as well been shown to reduce perception of arthritis pain. Activity modification, such as decreasing the length of time spent on an activity, taking more breaks during an aggravating activity, or decreasing the amount of impact during an activity (e.g. you love to play pick up basketball, you limit your jumping to twenty times per session) can also help to manage pain and symptoms.
Consistent movement and exercise have also been shown to be one of the best ways to manage symptoms of OA. As we spoke about before, movement is super important for joint health in general. Exercise, i.e. structured, intentional movement, can also be very helpful in managing OA symptoms, but we'll talk more about that in our next blog post.
Different Disease, Different Treatment
Osteoporosis on its own is unlikely to cause pain or affect one's quality of life, but it can be a huge contributing factor to a fracture that then leads to disability. Fear of movement or activity due to the increased risk of fracture can be limiting. It is important to get bone density tested regularly for women after the age of 65 and for men after the age of 70. If you are someone with more risk factors, you should consider talking to your doctor about starting to screen earlier.
It is important to work with your doctor to decide on a treatment plan if you are diagnosed with OP. This can include medication, lifestyle modification, and/or exercise. To mitigate the risk of developing OP despite risk factors, or to mitigate the rate of bone breakdown even once OP is diagnosed, resistance training is one of the most effective tools we have. Focusing on developing strength and power has been shown to be able to even increase bone density in people who have already been diagnosed. We'll talk all about exactly how to do this is in our next blog post.
Osteoarthritis and osteoporosis are two very different but very common diseases, and one of the most important aspects of treatment, management, and prevention of them, (as with any disease), is proper education and understanding of the risk factors and of the treatment options. Exercise can be appropriately applied in the management of both these diseases and you'll be able to read all about that in our next blog post. Any other questions we didn't answer here? Drop a comment below!
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