Riding for the Rider with Osteoporosis

Medical Issue: I am a 59 year old dressage rider and have been recently diagnosed with osteoporosis. I am in good weight and physically active.  I have no pain or symptoms but my doctor ordered a bone density test due to family history.  I have a fairly reliable, comfortable riding horse and plan to continue riding.  I will also begin to take Boniva.  Is there anything I can do concerning my riding and/or tack that will prolong my bone health and longevity in the saddle?  Would a Thinline pad help?  My horse likes a fleece pad and I tried the one Thinline makes but there is not a spinal relief area in the fleece so it was tight on my horse.

I first heard you on Jane Savoie’s “Dressage Mentor” and also have your book. Thank you so much for any help that you could give me. Sincerely, Debbie Raessler

Dr. James Warson Response:

Osteoporosis is a disease in which calcium is lost from the bones, resulting in weakening, and in severe cases, collapse. It is more common in the bones of the spine, and can result in a hunchback appearance when the vertebrae collapse on each other. Most patients are postmenopausal females, and their osteoporosis is due to estrogen decrease following menopause. Men can contract osteoporosis, but their cases are most often due to myeloma, a malignancy of the bone marrow, or a tumor of the parathyroid glands, which regulate calcium in the body.

Current therapy for osteoporosis consists of two phases. The first phase is chemical, consisting of bisphosphamide medications such as Boniva, Calcium citrate, and vitamin D. These medications when taken correctly stop further calcium loss. The second phase is proper exercise to help restore calcium to the bones. Exercise, specifically in muscles directly attached to the affected bones, stimulates the buildup of calcium. Astronauts in space use specific exercises to maintain sound bone structure. In my spine care career I noted that horse trainers who actually rode horses most of their day did not develop osteoporosis. The reason was obvious.

When muscles function, they only do so by contraction. A muscle cannot push. It can only pull. Our muscles of our trunk that keep us in the saddle are arranged so that there are 2 anterior ones, the rectus abdominus (the six pack muscles) and, more importantly,the iliopsoas. The iliopsoas originates on the spine and ends on the femur, the thigh bone. When it contracts, it pulls us forward. In the back of the spine are 2 muscles, the multifidus and the erector spinae. When they contract, they pull us backward. Feedback to the middle ear produces a sense of balance between the anterior and posterior muscle groups, producing our seat. The iliopsoas, multifidus, and erector spinae all originate on the spine, and their contractions “massage” the vertebrae, resulting in the laying down of bone.

Osteoporotic riders must consider a number of additional things in choosing whether to ride or not. First, the degree of osteoporosis should be considered. For this presentation, I will divide this into mild to moderate, and moderate to severe. A bone density test will categorize you, and this needs to be interpreted by your physician. First let’s consider the horse that you ride. A horizontally gaited horse like an Arabian, walking horse or Paso Fino will exert less upward vertical pressure on the base of the spine than a vertically gaited horse like some Saddlebreds or Morgans, A good test here is a sitting trot. If this gait is comfortable for you, there’s hope for you on that horse. Next is the tack, particularly the saddle pad. I have insisted that riders with osteoporosis use ThinLine pads, because they are the only open cell pads. Open celltechnology transfers recoil off the horse’s back laterally rather than directly up into the base of the rider’s spine.

We all fear being thrown with good reason, but this is a real danger in the osteoporotic rider because they may land on weakened vertebrae. Mild to moderately osteoporotic riders should keep that in mind. Moderate to severely osteoporotic riders may wish to consider the use of an Equicizer as an alternative. These devices were developed by an injured jockey to rehabilitate riders. They may be used in conjunction with, or as an initial alternative to actual horse riding, and are more successful at stimulating bone growth because they can be used many times during the day. If a horse is chosen, it needs to be that dead broke older gelding, and a jumper is out of the question! Osteoporosis increases the risks inherent in riding. The above measures may reduce these to acceptable levels. Whether the rider is osteoporotic or not, the riskiest part of any ride is still the car ride to the stable.