Osteoporosis is a major cause of morbidity and mortality around the world and is a silent disease characterized by low bone strength that results in an increased risk of fracture. The benefits of being physically active in advanced ages to reduce the loss of bone mineral density (BMD) and improve functional capacities are well known. Quantitative ultrasound (QUS) is a peripheral bone densitometry technique that is rapidly gaining in popularity for the assessment of skeletal status, along with fall risk assessment. This chapter consists of a brief review of the literature on osteoporosis and describes ongoing activities on bone density and fall risk prevention in Algarve, Portugal as part of EIP AHA´s action group on fall prevention with the presentation of a preliminary study. This study aimed to demonstrate that the postmenopausal female seniors who adhere to the recommendations for the regular program of physical activity after osteoporosis screening one year later show a slower decrease in BMD.
TopIntroduction
Osteoporosis is a major cause of morbidity and mortality around the world (Melton III et al., 2013; Sözen, et al., 2016) and is a silent disease characterized by low bone strength that results in an increased risk of fracture (Lippuner, et al., 2006), particularly in elderly (Cauley, et al., 2007).
The term elderly refers to any individual aged 65 or over. Individuals aged between 50 and 64 years who have physical or clinical limitations that prevent the practice of physical activities or affect the ability to move are also considered elderly people (Riebe, et al., 2018).
There has been an exponential increase in the elderly population in recent years and it is expected to continue to increase in the coming decades (Werner, 2010). During aging, marked changes can occur, at a physiological, psychological or mechanical level, which can manifest themselves in the state of health, function and quality of life. An inherent characteristic of the aging process is sedentary behavior that tends to increase with age (Instituto Nacional de Estatistica, 2020).
Demographic changes in Europe (figure 1) as in all over the world are a difficult challenge to solve for younger generations than the previous ones, as they will take care of the aging population with the decrease in their quality of life.
Figure 1. Source Eurostat (online data code: demo_pjangroup; Note Break in series 2017: estimate, provisional)
Most elderly people spend about 65 to 85% of their day in a sitting position, making them the most sedentary population. This chronic sedentary lifestyle leads to negative repercussions on metabolic functioning, cardiovascular and musculoskeletal health, body composition and mechanical functionality in daily life tasks. In this way, the independence of the elderly is severely compromised (Wultems, et al., 2016).
It is not yet known why calcium and exercise together have a greater osteogenic effect than any of them alone. It is generally accepted that growing bones have the ability to adjust to an increased load through various mechanisms (Bielemann et al., 2013).
Therefore, the increased load stimulates bone modeling that results in changes in the shape of the cortical bone and increased trabecular BMD which, in turn, causes an increase in bone strength. (Hemayattalab, 2010).
Adolescence is a critical period for the acquisition of bone mass, and epidemiological studies have suggested that obtaining a high peak of bone mass during growth may decrease the risk of suffering osteoporosis and osteoporotic fractures, therefore, later in life (Gómez-Bruton, Gónzalez-Agüero, Gómez-Cabello, Casajús, & Vicente-Rodríguez, 2013).