Exercise, lifestyle, and your bones
Exercise plays a key role in preserving bone density as you age.
Make exercise a regular part of your life. It will help keep your bones strong and lower your risk of osteoporosis and fractures as you get older.
Before you begin an exercise program, talk with your doctor if you are older, have not been active for a while, have diabetes, heart disease, lung disease, or any other health condition.
How Much and What Type of Exercise?
To build up bone density, the exercise must make your muscles pull on your bones. These are called weight-bearing exercises. Some of them are:
- Brisk walks, jogging, playing tennis, dancing, or other weight-bearing activities such as aerobics and other sports
- Careful weight training, using weight machines or free weights
Weight bearing exercises also:
- Increase bone density even in young people
- Help preserve bone density in women who are approaching menopause
To protect your bones, do weight bearing exercises 3 or more days a week for a total of over 90 minutes a week.
If you are older, do not do high-impact aerobics, such as step aerobics. This type of exercise may increase your risk of fractures.
Low-impact exercises like yoga and tai chi do not help your bone density very much. But they can improve your balance and lower your risk of falling and breaking a bone. And, even though they are good for your heart, swimming and biking do not increase bone density.
Other Lifestyle Changes to Help Your Bones
If you smoke, quit. Also limit how much alcohol you drink. Too much alcohol can damage your bones and raise your risk of falling and breaking a bone.
If you do not get enough calcium, or if your body does not absorb enough calcium from the foods you eat,your body may not make enough new bone. Talk with your health care provider about calcium and your bones.
Vitamin D helps your body absorb enough calcium.
- Ask your health care provider if you should take a vitamin D supplement.
- You may need more vitamin D during the winter or if you need to avoid sun exposure to prevent skin cancer.
- Ask your health care provider about how much sun is safe for you.
Osteoporosis – exercise; Low bone density – exercise
Lewiecki EM. In the clinic. Osteoporosis. Ann Intern Med. 2011 Jul 5;155(1):ITC1-1-15; quiz ITC1-16.
National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Washington,DC: National Osteoporosis Foundation; 2010.
Update Date: 5/17/2012
Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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Strength training stops bone loss and builds muscle in postmenopausal breast cancer survivors: a randomized, controlled trial.
School of Nursing, Oregon Health & Science University, Portland, OR 97239, USA. firstname.lastname@example.org
- Breast Cancer Res Treat. 2011 Jun;127(2):457.
Targeted exercise training could reduce risk factors for fracture and obesity-related diseases that increase from breast cancer treatment, but has not been sufficiently tested. We hypothesized that progressive, moderate-intensity resistance + impact training would increase or maintain hip and spine bone mass, lean mass and fat mass and reduce bone turnover compared to controls who participated in a low-intensity, non-weight bearing stretching program. We conducted a randomized, controlled trial in 106 women with early stage breast cancer who were >1 year post-radiation and/or chemotherapy, ≥ 50 years of age at diagnosis and postmenopausal, free from osteoporosis and medications for bone loss, resistance and impact exercise naïve, and cleared to exercise by a physician. Women were randomly assigned to participate in 1 year of thrice-weekly progressive, moderate-intensity resistance + impact (jump) exercise or in a similar frequency and length control program of progressive, low-intensity stretching. Primary endpoints were bone mineral density (BMD; g/cm²) of the hip and spine and whole body bone-free lean and fat mass (kg) determined by DXA and biomarkers of bone turnover-serum osteocalcin (ng/ml) and urinary deoxypyrodiniline cross-links (nmol/mmolCr). Women in the resistance + impact training program preserved BMD at the lumbar spine (0.47 vs. -2.13%; P = 0.001) compared to controls. The resistance + impact group had a smaller increase in osteocalcin (7.0 vs. 27%, P = 0.03) and a larger decrease in deoxypyrodinoline (-49.9 vs. -32.6%, P = 0.06) than controls. Increases in lean mass from resistance + impact training were greatest among women currently taking aromatase inhibitors compared to controls not on this therapy (P = 0.01). Our combined program of resistance + impact exercise reduced risk factors for fracture among postmenopausal breast cancer survivors (BCS) and may be particularly relevant for BCS on aromatase inhibitors (AIs) because of the additional benefit of exercise on muscle mass that could reduce falls.”
A comment from me, Deborah: I know of medical doctors, specialists, oncologists…who are ceasing to prescribe the pharmaceuticals that were developed to be used for osteoporosis and osteopenia yet have turned out to be destructive in the long run, and instead they are recommending weight-bearing exercise to improve bone density. Specific exercise under controlled circumstances is proved to be beneficial for healing of bone after surgery as well.
Bone Mineral Density in Elite Adolescent Female Figure Skaters
Kathy Prelack, Johanna Dwyer, Paula Ziegler and Joseph J Kehayias
: Elite adolescent figure skaters must accommodate both the physical demands of competitive training and the accelerated rate of bone growth that is associated with adolescence, in this sport that emphasizes leanness. Although, these athletes apparently have sufficient osteogenic stimuli to mitigate the effects of possible low energy availability on bone health, the extent or magnitude of bone accrual also varies with training effects, which differs among skater disciplines.
Purpose: We studied differences in total and regional bone mineral density among 36 nationally ranked skaters among 3 skater disciplines: single, pairs, and dancers.
Bone mineral density (BMD) of the total body and its regions was measured by dual energy x-ray absorptiometry (DXA). Values for total body, spine, pelvis and leg were entered into a statistical mixed regression model to identify the effect of skater discipline on bone mineralization while controlling for energy, vitamin D, and calcium intake.
The skaters had a mean body mass index of 19.8 +/- 2.1 and % fat mass of 19.2 +/- 5.8. After controlling for dietary intakes of energy, calcium, and vitamin D, there was a significant relationship between skater discipline and BMD (p = 0.002), with single skaters having greater BMD in the total body, legs, and pelvis than ice dancers (p < 0.001). Pair skaters had greater pelvic BMD than ice dancers (p = 0.001).
Single and pair skaters have greater BMD than ice dancers. The osteogenic effect of physical training is most apparent in single skaters, particularly in the bone loading sites of the leg and pelvis.
Exercise training in obese older adults prevents increase in bone turnover and attenuates decrease in hip bone mineral density induced by weight loss despite decline in bone-active hormones.
J Bone Miner Res. 2011; 26(12):2851-9 (ISSN: 1523-4681)
Shah K; Armamento-Villareal R; Parimi N; Chode S; Sinacore DR; Hilton TN; Napoli N; Qualls C; Villareal DT
Division of Geriatrics and Nutritional Science, Washington University School of Medicine, St. Louis, MO, USA.
Weight loss therapy to improve health in obese older adults is controversial because it causes further bone loss. Therefore, it is recommended that weight loss therapy should include an intervention such as exercise training (ET) to minimize bone loss. The purpose of this study was to determine the independent and combined effects of weight loss and ET on bone metabolism in relation to bone mineral density (BMD) in obese older adults. One-hundred-seven older (age >65 years) obese (body mass index [BMI] ≥ 30 kg/m(2) ) adults were randomly assigned to a control group, diet group, exercise group, and diet-exercise group for 1 year. Body weight decreased in the diet (-9.6%) and diet-exercise (-9.4%) groups, not in the exercise (-1%) and control (-0.2%) groups (between-group p < 0.001). However, despite comparable weight loss, bone loss at the total hip was relatively less in the diet-exercise group (-1.1%) than in the diet group (-2.6%), whereas BMD increased in the exercise group (1.5%) (between-group p < 0.001). Serum C-terminal telopeptide (CTX) and osteocalcin concentrations increased in the diet group (31% and 24%, respectively), whereas they decreased in the exercise group (-13% and -15%, respectively) (between-group p < 0.001). In contrast, similar to the control group, serum CTX and osteocalcin concentrations did not change in the diet-exercise group. Serum procollagen propeptide concentrations decreased in the exercise group (-15%) compared with the diet group (9%) (p = 0.04). Serum leptin and estradiol concentrations decreased in the diet (-25% and -15%, respectively) and diet-exercise (-38% and -13%, respectively) groups, not in the exercise and control groups (between-group p = 0.001). Multivariate analyses revealed that changes in lean body mass (β = 0.33), serum osteocalcin (β = -0.24), and one-repetition maximum (1-RM) strength (β = 0.23) were independent predictors of changes in hip BMD (all p < 0.05). In conclusion, the addition of ET to weight loss therapy among obese older adults prevents weight loss-induced increase in bone turnover and attenuates weight loss-induced reduction in hip BMD despite weight loss-induced decrease in bone-active hormones.
Exercise and Bone Mass in Adults
Sports Med. 2009; 39(6):439-68 (ISSN: 0112-1642)
Guadalupe-Grau A; Fuentes T; Guerra B; Calbet JA
Department of Physical Education, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Canary Islands, Spain.
There is a substantial body of evidence indicating that exercise prior to the pubertal growth spurt stimulates bone growth and skeletal muscle hypertrophy to a greater degree than observed during growth in non-physically active children. Bone mass can be increased by some exercise programmes in adults and the elderly, and attenuate the losses in bone mass associated with aging. This review provides an overview of cross-sectional and longitudinal studies performed to date involving training and bone measurements.
Cross-sectional studies show in general that exercise modalities requiring high forces and/or generating high impacts have the greatest osteogenic potential. Several training methods have been used to improve bone mineral density (BMD) and content in prospective studies. Not all exercise modalities have shown positive effects on bone mass. For example, unloaded exercise such as swimming has no impact on bone mass, while walking or running has limited positive effects. It is not clear which training method is superior for bone stimulation in adults, although scientific evidence points to a combination of high-impact (i.e. jumping) and weight-lifting exercises. Exercise involving high impacts, even a relatively small amount, appears to be the most efficient for enhancing bone mass, except in postmenopausal women.
Several types of resistance exercise have been tested also with positive results, especially when the intensity of the exercise is high and the speed of movement elevated. A handful of other studies have reported little or no effect on bone density. However, these results may be partially attributable to the study design, intensity and duration of the exercise protocol, and the bone density measurement techniques used.
Studies performed in older adults show only mild increases, maintenance or just attenuation of BMD losses in postmenopausal women, but net changes in BMD relative to control subjects who are losing bone mass are beneficial in decreasing fracture risk. Older men have been less studied than women, and although it seems that men may respond better than their female counterparts, the experimental evidence for a dimorphism based on sex in the osteogenic response to exercise in the elderly is weak. A randomized longitudinal study of the effects of exercise on bone mass in elderly men and women is still lacking. It remains to be determined if elderly females need a different exercise protocol compared with men of similar age.
Impact and resistance exercise should be advocated for the prevention of osteoporosis. For those with osteoporosis, weight-bearing exercise in general, and resistance exercise in particular, as tolerated, along with exercise targeted to improve balance, mobility and posture, should be recommended to reduce the likelihood of falling and its associated morbidity and mortality. Additional randomized controlled trials are needed to determine the most efficient training loads depending on age, sex, current bone mass and training history for improvement of bone mass