Are you fit to the bone?

Dr. Lora Giangregorio is the recipient of the 2015 McGill University Bloomberg Manulife Prize. She receives the prize in recognition of her clinical research on ways to improve the management of osteoporosis through exercise.

Osteoporosis is a condition that causes bones to become thin and porous; it decreases bone strength and leads to an increased risk of fractures.

Giangregorio developed exercise and physical activity recommendations for people with the disease and advocates a multi-component fitness routine that combines aerobic exercise, muscle strengthening and balance training to slow bone and muscle loss with aging, and reduce falls and resulting fractures.

November: Osteoporosis Awareness Month

In Canada, about one in three women and one in five men will suffer a fracture due to osteoporosis. In fact, fractures from osteoporosis are more common than cases of heart attack, stroke and breast cancer combined. Osteoporosis is often called the ‘silent thief’ because in the early stages bone loss is symptom free – the only sign is a fracture.  Signs of advanced osteoporosis include:  loss of height over time, stooped posture and bones that break more easily than expected.

Most bone growth occurs during puberty, with the skeleton’s maximum strength and density achieved by the mid-20s.  Between ages 30 and 40, bone mineral density starts to decrease in men and women.  For women, bone loss accelerates as they approach menopause.

In addition to advancing age, other factors that may increase the risk of osteoporosis include:

  • a family history of the disease,
  • low body weight,
  • a diet low in calcium,
  • low levels of physical activity,
  • vitamin D deficiency,
  • smoking,
  • excessive caffeine intake (more than four cups a day of coffee, tea or cola) or excessive alcohol intake (more than two drinks a day).
  • long-term use of some medications such as cortisone, prednisone or anticonvulsants.

Developing clear guidelines for those at risk

Giangregorio’s interest in developing recommendations on exercise for the management of osteoporosis was sparked almost 10 years ago during a talk she gave to an osteoporosis support group. Members were eager to learn how to exercise safely; and wanted to know if they could continue the physical activities they loved such as gardening, golfing and yoga.

“At the time, information campaigns focused on the prevention of osteoporosis, but there was limited advice available about what physical activities were safe for people with the disease, or what kind of exercise might be effective for preventing fractures,” says Giangregorio.

The Associate Professor in the Department of Kinesiology at the University of Waterloo decided to undertake a research study to help those at risk of osteoporosis.

Exercise to improve bone health

“We recommend a combination of exercises—moderate-to-vigorous aerobic physical activity, muscle strengthening and balance training—to strengthen muscles, slow bone loss and reduce the risk of falls and resulting fractures. The recommendations also outline how health care providers should advise people at moderate or high risk of fractures when it comes to safely performing activities of leisure and daily living,” says Giangregorio.

Giangregorio makes a concerted effort to ensure her research is put into practice. A member of the Scientific Advisory Council for Osteoporosis Canada, she has helped with the development of numerous educational tools including a new video series on exercise for people with osteoporosis, a one page summary for physicians to give to patients, BoneFit, a two-day workshop for physiotherapists and kinesiologists, and an exercise booklet for those with the disease, called Too Fit to Fracture: Managing Osteoporosis through Exercise.

The Too Fit to Fracture Physical Activity Recommendations

Dr. Giangregorio points out that exercise is a key to good health and urges all adults to engage in a minimum of 150 minutes of moderate-to-vigorous aerobic physical activity per week. The recommendations, summarized below, are an ideal way to reduce the risk of developing osteoporosis (no matter how old you currently are) as well as a way for those living with the disease to reduce the risk of fractures. The recommendations also advise people with osteoporosis to learn “spine sparing strategies” to modify activities that involve spine movements that may increase the risk of spine fracture, or avoid them altogether. Injuries to the spine can occur when we bend forward or twist the spine quickly or repeatedly, or if we lift something heavy, bend far forward (e.g., tying shoes) or twist the torso all the way to the side. Bending or twisting while holding a weighted object (e.g., groceries, grandchild) is also risky. A BoneFit trained physiotherapist or kinesiologist can advise on spine sparing strategies.

An example

  1. Strength Training: At least two days/week
    • Exercises working against resistance for legs, arms, chest, shoulders, back
  2. Balance Exercises: Daily
    • Tai Chi, dancing, walking on your toes or heels
  3. Posture Awareness and Exercises: Daily
    • Gently tuck your chin in and draw your chest up slightly, exercises to improve back extensor endurance
  4. Aerobic Physical Activity: At least 150 mins/week
    • Bouts of 10 minutes or more, moderate to vigorous intensity*

Note: If you have a spine fracture, consult a physical therapist or kinesiologist before using weights, and choose moderate, not vigorous aerobic physical activity.

For more about information download the Too Fit to Fracture brochure.



McGill Centre for the Convergence of Health and Economics (MCCHE)

Desautels Faculty of Management

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