Exercise is key in preventing osteoporosis in women

By: Dr Tan Chuey Chuan, Dr Goh Yet Ching, Assoc Prof Dr Daniel Lim Khim Hock

As we celebrate Mother’s Day, it’s a time to honor the incredible women who have shaped our lives with their love, strength, and resilience. Amid the festivities, it’s also an opportunity to raise awareness about an often-overlooked aspect of women’s health: osteoporosis and its potential complications, including medication-related osteonecrosis of the jaw (MRONJ)

Osteoporosis is a common condition characterized by low bone density and deterioration of bone tissue which leads to an increased risk of fractures, particularly in the spine, hips, and wrists. The Asian Federation of Osteoporosis Societies study projected that the number of hip fracture cases in Malaysia would increase from 5880 in 2018 to 20893 cases in 2050. This directly affects the estimated medical cost of hip fractures would increase from RM 167.3 million in 2018 to RM594.3 million in year 2050 which without including the cost of rehabilitation and prolong nursing care service after injury. While osteoporosis can affect both men and women, postmenopausal women are at a significantly higher risk due to estrogen hormonal changes that occur during menopause with the prevalence of 42.4% compared to 11.1% in premenopausal woman in Malaysia.

For many women, the management of osteoporosis involves non-pharmacological and pharmacological measures. The non-pharmacological treatments such as adequate weight-bearing exercise, vitamin D, Calcium supplement, healthy lifestyle modification and prevention of fall. Whilst for high-risk groups, the use of anti-resorptive medications called bisphosphonates and denosumab are recommended. These medications help to strengthen bones and reduce the risk of fractures by inhibiting bone resorption. However, like all medications, they carry potential side effects, one of which is MRONJ—a rare but serious condition characterized by the death of jawbone tissue. The risk of developing MRONJ might be low among the osteoporosis group (<1%) but for those involved with the disease, the consequences are devastating.

MRONJ typically presents persistent jaw pain, swelling, or infection which is often triggered by dental procedures or trauma to the jaw. While the exact cause of MRONJ is not fully understood, it’s believed that bisphosphonates may interfere with the normal healing process of the jawbone, particularly in individuals with poor dental health or those undergoing invasive dental procedures. The prevention is better than cure, hence the early detection of MRONJ can be treated conservatively with antibiotic, antiseptic mouthwash and pain relief medications. Advanced cases of MRONJ may necessitate surgical intervention for wound debridement.

Why exercise?

In the 19th century, German orthopedic surgeon Julius Wolff proposed the famous “Wolff’s Law”: as the load on bones increases, they naturally become thicker and stronger. Conversely, if bones bear too little load, they become thinner and more brittle, making fractures more likely to occur.

Exercise is the simplest and cost-effective way that women can take to protect their bone health. Engaging in regular physical activities can regulate bone maintenance, stimulate bone formation, and improve balance and coordination, which helps in reducing the overall falls and fractures.

Suitable types of exercise include weight-bearing exercise like brisk walking, jogging, dancing, and climbing stairs (for those without joint problems), which apply tension from muscles and tendons toward the bone and stimulate new and denser bone formation. Resistance training exercises, such as weightlifting with dumbbells/weight machine and working with resistance bands, stimulate increased bone density.

Balance exercises like yoga, step-ups, walking on an unstable surface (wobble board), walking backward, and tai chi can help improve the balance and coordination of the body, reducing the risk of falls. Flexibility exercises, such as yoga and stretching exercises, can assist in maintaining the suppleness and agility of your muscles and joints to prevent falls.

Performing regular exercises at least 2.5 hours a week is particularly important for improving bone density and prevention of osteoporosis. For older adults, the 150 minutes of exercise should include the mix of the above moderate-intensity exercises as their health allows.

As mothers, grandmothers, sisters, and daughters, women play a pivotal role in their families’ well-being. By prioritizing their own health, women can better care for those they love. In this Mother’s Day, let’s empower women with the knowledge and resources they need to safeguard their bone health and reduce their risk of osteoporosis and MRONJ.

Together, we can raise awareness, promote prevention, and ensure that every woman can enjoy a life of strength and vitality.

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The authors are from the Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya.