Bone Biomechanics - Aging

Bone Biomechanics: Aging
November 13, 2006
EXERCISE BIOMECHANICS
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Aging and Bones

Bone mass peaks at age 20
Bone mass and density can be maintained between
20-40
Bones start to lose mass and density at age 40 some athletes may keep bone mass to age 50 Loss of bone mass is greatest between 50-60
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Aging and Bones

spine
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Aging and Bones

forearm
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Aging and Bones

Spine BMD with Age
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Bone and Aging

1% loss per year, 2-3% in osteoporosis
Why?

Changes in calcium regulating hormones Decreased perfusion of bone tissue due to changes in bone blood flow Changes in the properties of bone mineral material Decrease in the number and metabolic activity of cells that produce bone
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Changes in Bones with Aging
Males
Bone mass
Females
Critical bone mass

10
20
30
40
50
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60
70
80
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Age (yrs)

Up to age 40 osteoblast activity = osteoclast activity (bone is absorbed and replaced in a steady state fashion) Ages 40-50 men, women similar in bone mass, density After age 50 women may lose 50% or more of cancellous bone mass (post-menopause) men may lose 25% or more of cancellous bone mass
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Bone and Aging
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Bone and Aging
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Bone and Aging

3 Major Factors lead to bone loss:
Changes in bone-related hormones
Estrogen, testostorone, growth hormone
Dietary deficiencies
Low intake of calcium and Vitamin D rich foods
Decreased physical activity
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Hormonal Changes
Menopausal related Withdrawal of estrogen reduces absorption of Ca2+ in intestine Calcitonin and Vitamin-D metabolites
decrease
Regulate Ca2+ homeostasis
Increase in parathyroid hormone Favor resorption of bone rather than formation
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Hormonal Changes - Treatments

Adding 170mg of Ca2+ daily nearly doubles
bone density over 1yr.

Injection of vitamin D and estrogen show
promise for bone restoration (1991)

Combination of Ca2+, vitamin D and exercise
decrease bone loss
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Diet
Inadequate levels of Ca2+, vitamins and
mineral in diet Elderly eat less and dont include calcium rich foods Lose ability to produce vitamin-D metabolites from exposure to sun
Important in Ca2+ utilization in bone
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Diet Treatments
Meta-analysis (several studies)
Women who didnt take Ca2+ supplements
2% bone loss in early menopause per year
Women who did
0.8% bone loss in early menopause per year
Women should ingest min of Ca2+
1000mg/day Post-menopausal 1500mg/day
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Exercise
Huge body of literature which suggests even
moderate exercise will maintain bone
HAS TO BE WEIGHT BEARING
However too much can lead to bone loss . . . . What are the implications for elderly? Why isnt this happening? Discuss
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Bone and Aging
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Relative strength after age 40 decreases 4-5%
per 10 years
No change in stiffness with aging Strain to failure after age 40 decreases 8% per 10
years
Energy absorbed to failure decreases 7-8% per
10 years
EXERCISE BIOMECHANICS KINE426 KETCHAM
Aging and Bones

Common sites of fractures (1) neck of femur (hip) (2) thoracic vertebrae (3) distal radius
Cancellous bones Affected more than Cortical bone
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Aging and Bone
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Aging and Bones

cancellous bone 50 yrs
80 yrs
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Aging and Bones

cortical bone
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Because of the high bone cartilage content in young bones:

lower strength bones are less stiff lower energy to failure large strain to failure
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BONE
Maturation
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Bone Development and Bone Health

Children need regular exercise (especially pre-
puberty)
Watch overtraining, high impact sports!
Reduces their risk of osteoporosis
Systemic effect/advantage may be reduced if
training stopped
ex. soccer: arm vs. leg
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Bone Injuries
Traumatic - single event or low
frequency

Very High load (low frequency) Unusual type of loads
One which the skeletal structure isnt designed to handle.

shear + bending + torsion + compression, etc.
Combination loads
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Bone Injuries
Materials Fatigue - repeated loads dont give bone chance to recover Materials fatigue or overuse or "stress fracture" Very High frequency (moderate to high loads)
Nutritional and hormonal factors increase risk ex. low Ca2+ intake, low estrogen levels
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Bone Injuries
Fractures
avulsion (tensile) Often accompanies tendon and ligament injuries. spiral (torsion) impacted (compression) fatigue or stress fracture
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Minimizing Risk of Suffering a Stress Fracture

Use proper protective equipment (i.e., helmets, footwear, etc.) Be careful exercising when fatigued Avoid coming back too soon after an injury Proper off-season or pre-season training (pre-hab) Avoid switching sports or events without proper training Take occasional days off Start slowly when initiating training
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Stages of Rehabilitation after Bone Fracture

When bone fractures, soft tissue must absorb released energy exacerbating damage
Immediate Treatment (RICE)

Rest Ice Compression Elevation
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Therapeutics after Fracture

GOAL: quick restoration of normal
function Set fracture, limited immobilization

Reconditioning

Passive, ROM exercises Active exercises (involves muscle contractions)
Mod high reps; low mod intensity
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Rehabilitation after Connective Tissue Injuries
Reconditioning
Increase blood flow increase mechanical action Protection of joint cartilage from atrophy, loss of cushioning decrease scar tissue Some mechanical stress needed to promote healing
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Immobilization
Reduces mechanical stress around area of
bone which has suffered fracture

However, plaster and fiberglass casts
(non-removable) weaken bone overall
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Immobilization - 8 wks
normal
stress
immobilization
strain
Osteoporosis
Critical reduction in bone mass to the point that fracture vulnerability increases Affects cancellous bone more than cortical bone
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Osteoporosis
A disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures of the hip, spine, and wrist.
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Osteoporosis- Health Implications

Affects 10 million Americans Estimated cost of $17 billion annually Estimated that these #s will triple by 2060 ~ 32% of women and ~ 17% of men will suffer hip fracture by age 90 12-20% w/ hip fracture die because of complications

Blood clots Bed ridden

Underlying chronic diseases (heart disease) pneumonia
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Osteoporosis- Health Implications

55% of the people 50 years of age and older,
have low bone mass: risk of developing osteoporosis and related fractures Often thought of as an older persons disease, it can strike at any age. Responsible for more than 1.5 million fractures annually including:

300,000 hip fractures 700,000 vertebral fractures 250,000 wrist fractures 300,000 fractures at other sites
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Risk Factors For Osteoporosis

Risk Factor
Family history Ethnic background Frame size Gender Amenorrhea Menopause Given birth Age over 50
High Risk
yes Caucasian small female yes early no yes
Low Risk
no African-American large male no late yes no
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Risk Factor
Weight Physical activity Smoking Calcium intake Vitamin D intake Soft drink intake
High Risk
underweight sedentary yes low low high
Low Risk
overweight regular no high adequate low
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Risk Factor
Fiber intake Alcohol intake Caffeine estrogen parathyroid hormone
High Risk
high high high low low
Low Risk
moderate low/moderate low or none normal normal
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Exercise and Osteoporosis in Female Athletes??

15 yrs ago: scientist found some young female athletes
had bone loss (osteopenia) in the spine

some had bone mineral content similar to elderly women
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OSTEOPENIA in Young Female Athletes

Female Athlete Triad (poor nutrition,
amenorrhea, bone loss)
occurs in small # but significant % of population of athletes, active instructors
most common in running, gymnastics, aerobics instructors

associated with disturbances in menstrual cycle Greater reduction in estrogen
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Exercise and Osteopenia in Female Athletes

Poor overall nutrition
caloric restriction and eating disorders; decrease in

dietary Ca2+
Overtraining
Low % body fat.
Set point below which normal menstrual cycle is disturbed
varies from person to person, nutritional status, etc
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Exercise and Osteoporosis in Female Athletes

140 120
% sedentary
100 80 60 40 20 0
sedentary athletes amenorrheic athletes
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Intervention for Female Athlete Triad

If nutrition, low caloric intake, overtraining, and
low % body fat issues are addressed, normal menstrual cycle usually resumes
Partial recovery of bone mass noted (long-term
effect unknown?)
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Intervention for Female Athlete Triad

Education of coaches, athletes to this
problem while the athletes are teens is absolutely critical.

Improvement - last 10 years - college + Concern now - teens, youth sports
Luteinizing hormone (LH; pituitary hormone needed for
ovulation) 6 months before disturbances in menstrual cycle. Screening/prevention tool???
Blood draws over 24 hours, expensive
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Intervention for Osteoporosis

Prevention - maximize bone growth during
growth phase, maintenance phase; some bone loss with age appears inevitable.
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Exercise - both weight bearing and weight training; however, avoid overtraining
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Calcium supplementation Good overall nutrition
Watch out for:

yo-yo diets rapid weight loss
Hormone Replacement Therapy Estrogen: post-menopausal, amenorrheic women "designer estrogens" - raloxifene (68% reduction in fractures) calcitonin (nasal spray) parathyroid hormone
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Ensure adequacy of vitamin D Biphosphonates increased used, builds bone mass; reduces osteoclast activity; popular Studies have shown that a combination of
these therapies is more effective than one alone!
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Studies have shown that a combination of these therapies is more effective than one alone against osteoporosis!
Notelovitz et al., 1990
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Changes in Mechanical StressBone Adaptations

Wolff's Law - Bone remodels according to functional
demands
Not tested until the 1960s

Exercise as a health therapeutic agent Spaceflight
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Bone and Spaceflight
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Bone loss with Spaceflight

Exposure to the spaceflight causes men and women of all
ages to lose up to 1% of their bone mass per month due to disuse atrophy. (height increases by 2+ in! - swelling of vertebral discs)
It is not yet clear whether losses in bone mass will continue as
long as a person remains in the microgravity environment or level off environment or level off in time.
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Comparing Spaceflight and Inactivity

Changes in Spaceflight rapid - similar initially to immobilization.
Slower with inactivity, but progressive.

Decreases in loading, growth factors, decrease in osteoblast activity
(decreased formation), increased osteoclast activity (resorption)

Reduced physical activity is characteristic of aging and could well be a
factor in the loss of bone, but researchers have not yet determined how much of a role disuse plays on Earth.
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Exercise in Space
In order to exercise on this ergometer, the astronaut must be held down with shoulder pads.
Strategies
Compression - Exercises Vibration Electrical Stimulation Vitamin D Ca2+
Exercise and Bone Health

Wolff's Law - Bone remodels according to functional
demands Exercise increases mechanical stress and strain, growth hormone levels which contribute to increasing bone mass and density Stronger, stiffer, and able to store more energy However, overtraining, especially in children and older adults is counterproductive.
KINE426
KETCHAM
Benefits of exercise are optimized or enhanced by:

adequate caloric intake adequate Ca2+ in diet adequate Vitamin D intake
adequate levels of hormones Estrogen Testosterone Growth hormone
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Bone Biomechanics - Aging

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Bone Biomechanics: Aging

November 13, 2006

Aging and Bones

Bone mass and density can be maintained between

Aging and Bones

Aging and Bones

Aging and Bones

Bone and Aging

Changes in Bones with Aging

Critical bone mass

Changes in Bones with Aging

Bone and Aging

Bone and Aging

Bone and Aging

Changes in bone-related hormones

Estrogen, testostorone, growth hormone

Low intake of calcium and Vitamin D rich foods

Decreased physical activity

Regulate Ca2+ homeostasis

Increase in parathyroid hormone Favor resorption of bone rather than formation

Hormonal Changes - Treatments

bone density over 1yr.

promise for bone restoration (1991)

decrease bone loss

Important in Ca2+ utilization in bone

Women who didnt take Ca2+ supplements

2% bone loss in early menopause per year

Women who did

0.8% bone loss in early menopause per year

Women should ingest min of Ca2+

1000mg/day Post-menopausal 1500mg/day

moderate exercise will maintain bone

HAS TO BE WEIGHT BEARING

Bone and Aging

Changes in Bones with Aging

Aging and Bones

Cancellous bones Affected more than Cortical bone

Aging and Bone

Aging and Bones

Aging and Bones

Because of the high bone cartilage content in young bones:

Bone Development and Bone Health

Systemic effect/advantage may be reduced if

ex. soccer: arm vs. leg

Very High load (low frequency) Unusual type of loads

One which the skeletal structure isnt designed to handle.

Minimizing Risk of Suffering a Stress Fracture

Stages of Rehabilitation after Bone Fracture

Immediate Treatment (RICE)

Therapeutics after Fracture

function Set fracture, limited immobilization

Passive, ROM exercises Active exercises (involves muscle contractions)

Mod high reps; low mod intensity

Rehabilitation after Connective Tissue Injuries

bone which has suffered fracture

(non-removable) weaken bone overall

Osteoporosis- Health Implications

Blood clots Bed ridden

Underlying chronic diseases (heart disease) pneumonia

Osteoporosis- Health Implications

Risk Factors For Osteoporosis

Risk Factors For Osteoporosis

Risk Factors For Osteoporosis