Osteoporosis and Whole Body Vibration
Osteoporosis is a disease of the bones that results in a loss of bone mineral density (BMD). An imbalance between bone resorption and bone formation occurs, resulting in a change of the micro architecture along with the amount and type of protein found in the bone. When an individual’s BMD becomes too low there is an increased risk for bone fractures. The wrist, hip and spine are the areas that are at greatest risk for fracture. Osteoporosis typically affects post menopausal women but it can also affect men or individuals earlier in life due to certain health conditions and medications. Menopause is considered a major risk factor of osteoporosis due to a decrease in estrogen. A lack of estrogen leads to an increase in bone resorption, along with decreases in the amount of new bone deposited. There are no symptoms associated with osteoporosis, but an individual with osteoporosis is more likely to suffer from fractures where a healthy person would not. This is known as a fragility fracture. Osteoporosis may impact an individual’s life expectancy as well as effecting quality of life. Lifestyle modifications along with medications may be used to both prevent and treat osteoporosis. Smoking, excessive consumption of alcohol and poor nutrition are all modifiable risk factors for osteoporosis. The addition of calcium and vitamin D supplements as well as other medications including bisphosphonates may be used to help prevent bone loss and increase bone mass.
Exercise is essential for both the prevention and treatment of osteoporosis. When an individual performs weight bearing exercises it produces a load on the bones. This load causes the bone to produce new, stronger bone cells. Another important aspect of exercise is to improve balance and coordination which in turn helps to decrease an individual’s risk of falling. A Cochrane Database Review found that aerobic, weight bearing and resistance exercises were all effective at increasing or maintaining BMD in the spine 1. Walking was also shown to improve BMD in the hip 1. Another review article recommended high impact and resistance exercises for preventing osteoporosis and weight bearing and resistance exercises for individuals with osteoporosis 2. It was recommended that individuals with osteoporosis also incorporate exercises to improve balance, mobility and posture 2.
Research looking at the effects of Whole Body Vibration (WBV) on BMD has consistently shown improvements in BMD in the hip and femur bones in women 3-5. With respect to low BMD one study evaluated the effectiveness of WBV in young women. They found increases in BMD in this population in the femur and spine with short bouts of WBV at 30 Hz 6. Other research has shown that WBV improves postural steadiness and balance in the elderly population 7, 8. A review article looking at the effectiveness of WBV in the elderly population noted improvements in bone density, balance and muscle power but cautioned the benefits of the findings due to poor methodology in much of the research reviewed 9. Overall the research into WBV is positive with respect to improving or maintaining BMD as well as other risk factors associated with falls. It is important to note that this research has been done on specific populations so it is difficult to determine if the benefit s would translate to other populations.
It is important to note that severe osteoporosis is considered an absolute contraindication to WBV. This is due to the fragility of the bones at this stage of the disease and the potential risk for fracture. It is essential that anyone diagnosed with osteopenia (low BMD) or osteoporosis discuss the use of WBV with a physician before adding it to her/his exercise program. Due to the potential risk for fracture with any physical activity it is important that a physician understands WBV to help determine if the potential benefits outweigh any risk or contraindication.
Once cleared by a physician or if using WBV for preventative reasons, WBV should be initiated at a reduced intensity and duration. As an individual adjusts to the machine and no pain or discomfort is felt the intensity and duration can be increased, and exercises at an appropriate level can be added. In general, if an individual experiences any pain, dizziness, or shortness of breath while using the WBV platform, it should be discontinued immediately.
References
1. Bonaiuti D, Shea B, Iovine R, Negrini S, Welch V, Kemper HHCG, Wells GA, Tugwell P, Cranney A. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews 2002, Issue 2.
2. Guadalupe-Grau A, Fuentes T, Guerra B, Calbet JA. 2009. Exercise and bone mass in adults, Sports Medicine, 39(6), 439-68.
3. Gusi N, Raimundo A, Leal A. 2006. Low-frequency vibratory exercise reduces the risk of bone fracture more than walking: a randomized controlled trial, BMC Musculoskeletal Disorders, 7.
4. Humphries B, Fenning A, Dugan E, Guinane J, MacRae K. 2009. Whole-body vibration effects on bone mineral density in women with or without resistance training, Aviation Space and Environmental Medicine, 80(12), 1025-31.
5. Verschueren SM, Roelants M, Delecluse C, Swinnen S, Vanderschueren D, Boonen S.2004.Effect of 6-month whole body vibration training on hip density, muscle strength, and postural control in postmenopausal women: a randomized controlled pilot study. Journal of Bone Mineral Research, 19(3), 352-9.
6. Gilsanz V, Wren TA, Sanchez M, Dorey F, Judex S, Rubin C.2006. Low-level, high-frequency mechanical signals enhance musculoskeletal development of young women with low BMD. Journal of Bone Mineral Research, 21(9), 1464-74.
7. Rees SS, Murphy AJ, Watsford ML. 2009.Effects of whole body vibration on postural steadiness in an older population, Journal of Science and Medicine in Sport, 12(4), 440-4.
8. Rittweger J. 2010. Vibration as an exercise modality: how it may work, and what its potential might be, European Journal of Applied Physiology, 108(5), 877-904.
9. Merriman H, Jackson K. 2009. The effects of whole-body vibration training in aging adults: a systematic review, Journal of Geriatric Physical Therapy, 32(3), 134-45.
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