Stop Osteoporosis After Weight Loss Body weight is strongly associated with bone mineral density (BMD). Obese individuals generally have a higher bone mineral density and are less likely to develop osteoporosis than their lighter-weight counterparts who have a lower bone mineral density. Although weight loss certainly reduces comorbid conditions often associated with obesity, as an obese individual loses weight, they also lose BMD and the protection obesity offers against osteoporosis. Risk Factors Are you at risk for osteoporosis? • Female gender (especially postmenopausal women age > 50 years old) • Caucasian or Asian ethnicity • Small frame • Old age • Smoking • Excessive alcohol consumption • Sedentary lifestyle • Poor nutrition (for example, insufficient calcium or vitamin D) • Family history of osteoporosis While normal weight loss itself is not associated with osteoporosis, some of the risk factors mentioned above may present themselves as obese individuals lose weight, possibly increasing the risk of those individuals developing osteoporosis. Whether weight loss occurs with or without the assistance of surgical intervention, successful long-term weight loss certainly involves caloric restriction. As a result of caloric restriction, nutrients important for the maintenance of BMD, such as calcium and vitamin D, are also restricted. In the case of surgical procedures like Roux-en-Y gastric bypass, caloric and nutrient consumption is not only restricted, but malabsorption occurs as well; calcium and vitamin D supplementation are therefore needed to compensate for the nutrients lacking in the diet. Recent data has pointed to a rapid loss of BMD in individuals who have undergone Roux-en-Y weight loss surgery. Whether or not this bone loss represents more than normal bone loss over the long term is yet to be determined, but further lifestyle changes may combat associated bone loss. A sedentary lifestyle certainly contributes to obesity and, as listed above, is also a risk factor for the development of osteoporosis. Exercise Intervention In addition to the most widely recognized benefits of regular exercise, such as weight loss and improved cardiovascular health, exercise may also minimize BMD changes associated with surgically or non-surgically induced weight loss. Although an ideal exercise program aimed at increasing BMD or at least minimizing BMD losses has yet to be established, several modes of exercise have been shown to positively impact BMD. Osteogenic or “bone building? exercises: 1. are load bearing 2. are performed at a relatively high level of force 3. permit long-term intensity increases 4. challenge the musculoskeletal system in unfamiliar ways Cardiovascular, agility and balance training may meet the criteria for “bone building? exercise and should certainly be included in an osteogenic exercise program; resistance or weight training best meets the “bone building? criteria. Basic Osteogenic Resistance Training Guidelines Resistance training exercises with the highest priority are “complex movements,? or those where movement and force generation occur across more than one joint. An example of a complex movement would be the bench press, which involves movement across the shoulder and elbow. An example of a single joint exercise would be a bicep curl with movement only occurring across the elbow joint. Although most exercise programs will not entirely consist of complex movements, complex movements should be priority, followed by simple or single joint exercises. While all individuals should attain medical approval prior to beginning an exercise program, individuals who are obese or already have osteoporosis should follow a lower-volume, lower intensity and lower-impact exercise program than those who are trying to prevent osteoporosis and are near or at goal weight. Guidelines for obese individuals or those who have osteoporosis: One set of eight to ten exercises, with each set consisting of 12 to 15 repetitions, at least two days a week. Guidelines for individuals at or near goals with no preexisting osteoporosis: One to three sets of eight to ten exercises, with each set consisting of 8 to 12 repetitions, The American College of Sports Medicine recommends all individuals perform some form of moderate to intense physical activity for at least 30 minutes five days a week, but it is preferable to engage in physical activity every day of the week if possible. Your exercise should include cardiovascular, flexibility and resistance training components to ensure well-rounded fitness and maximize bone health.