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Bone Density T-scores do not lie but nor do they tell the whole picture

Two months ago I asked my students about their bones and their T-scores, since the information I received from them would help me design safer and more effective Pilates classes. T-scores are the results of a bone density test, a rating system that describes the density of your bones (hip and spine are tested) as well as your risk of fracture.  Although T-scores of a 70-year-old woman don’t necessarily give a fair estimation of risk because they take as their baseline those of average younger women, we still need to get them checked out every two to five years, depending on our individual risk factors.

The invisibility of osteoporosis and the lack of symptoms make it hard to identify without a test. There is usually no pain. Physical changes, such as a “dowager’s hump” and/or diminishing height may or may not be signs of the disease. Yet it has far-reaching consequences and must be taken seriously. Two grim statistics from Miriam Nelson’s book Strong Women, Strong Bones: ‘One victim in five dies within a year of a hip fracture.’ ‘Complications of this injury kill even more women every year than breast cancer.’  


Even those of us who exercise regularly and have good posture can be in danger of osteoporosis.


I received many responses from my students. Some reported osteopenia, the precursor condition to osteoporosis, where bone is characterized as thin but not yet porous. (Osteopenia does not automatically lead to osteoporosis but it can.) A handful of my female students reported osteoporosis or the beginnings of it. Each of these students attended classes regularly and had good posture. They did not look as if they could break a bone from an extra exuberant hug or that their risk of fractures could be high.

One student sent me her recent T-scores with a little note attached: ‘My mother had osteoporosis bad, so I’m not entirely surprised.’ Having a parent with the disease is a risk factor. Yet there is more to consider. If the mother in question did not exercise, did not do strength or balance training, and/or did not take care with nutrition, her body would deteriorate differently from that of her daughter, who did the exact opposite.

One of my most active and physically strong students, a woman in her 70s, wrote: ‘My doctor told me I had moderate osteoporosis.  Then he told me not to twist or bend. What do I do with that?  Yesterday I drained and cleaned my deep fish pond. During the spring and summer, I am out in my garden all day twisting and bending.’

Osteoporosis is usually divided into mild, moderate, or severe. Each diagnosis means something different and your outcome is also dependent on how active, or not, you currently are. Your doctor will probably tell you “the rules”: forward flexion or side bending of the spine is contraindicated for an at-risk-for-fracture spine. So is spinal rotation. Take care not to take the hip beyond 90 degrees of flexion. (This means when lying on your back a ‘table top’ position of the legs is okay but be very cautious not to pull in one knee close to your chest as this creates extreme flexion of the hip). Also, a simple pelvic tilt where you move the spine into flexion (tipping tail bone up to ceiling when lying on your back) is not recommended with severe osteoporosis. Nor is weight-bearing on wrists. Use forearms instead.

A lot to be cautious of. But if your muscles and core are strong, and your diagnosis is mild not severe, you may be able to do some of these things, albeit never in a rapid, forceful, or jerky way. Even people with a diagnosis of moderate or severe osteoporosis can (and must) do as much exercise as possible though they must proceed with caution, good alignment and body awareness.

Another pattern in the responses I received was a tone of denial. After all, it’s hard to believe in something you cannot see or feel in your body. ‘I wasn’t prepared for this diagnosis,’ said one student. ‘I’m going to get retested soon to make sure the readings are accurate.’

Another response I recognized in myself: I am doing so much already – what more do I have to do?  I remember being told the results of my first bone density test: osteopenia. I was sixty at the time and my diagnosis was given to me not by the doctor but her receptionist. She read the report over the phone and the word osteopenia popped up. ‘Are you sure?’ I asked. She confirmed it. I remember how irritated I felt when she said: ‘You need to do more exercise and weight training.’ She had no way of knowing that I exercised and lifted weights almost every day of my life!


Trying still harder


There are controllable factors for managing bone health and most of us are already addressing them. We are doing posture work, strength training with weights, and balance training.  We are taking our calcium and Vitamin D supplements. We are paying attention to stress reduction and the role of nutrition, and, if appropriate, medication in managing this disease. Yet we can try harder. One student admitted to a previous addiction to Diet Coke and told me she stopped drinking carbonated beverages entirely; and this made a difference in her latest bone density test. Taking charge and keeping up the work are significant ways to do everything we can to reduce the risks of osteoporosis.

The good news is there is much we can do to prevent and manage this disease. Exercise can actually hinder the actions of the bone-degrading osteoclasts—the right kind of weight-bearing exercise, that is.  When bone reacts to muscle contractions or the impact with the ground (little hops, light jogging, stair climbing) the “stress” goes through the bones and creates a sort of electric zap in the bones (a “piezo-electric” charge). This effect, in turn, attracts bone-building osteoblasts to work better to promote bone repair. This is why physical activity is a priority in osteo management.  So are diet, vitamins and minerals, and, where appropriate, medication.

If you do weight lifting, balance training and weight bearing exercises in your exercise routine, you are already doing a lot.  If not, start an exercise program immediately. Next week’s blog will focus on the dramatic story of a 45-year-old woman diagnosed with osteoporosis in her left hip and what she did to reverse this.

Colleen Craig

Colleen Craig

Colleen is the author of Pilates on the Ball, Abs on the Ball, and Strength Training on the Ball, and the producer of the Pilates on the Ball DVD.

Disclaimer: The information and services provided in the blogs, videos, website and classes are provided with the understanding that Colleen Craig is not engaged in rendering legal, medical counselling or other professional services or advice.

We highly recommend that you watch the video first before attempting an exercise. Check with your doctor or health care practitioner to be sure these exercises are suitable for you. Pay attention to modifications and stop if there is any discomfort.

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