Can Osteoporosis be Reversed Without Medication?

Can osteoporosis be reversed without medication such as Fosamax or Prolia? Depending on your situation, osteoporosis is reversible with a combination of therapeutic exercise and good nutrition. However, I advise my clients to carefully consider medications, especially if they have lost a significant amount of bone and are at risk of fracture. This post will discuss how you can use exercise and nutrition to reverse bone loss. I also include a case study of a client who reversed her osteoporosis.

Can Osteoporosis be Reversed?

Osteoporosis indicates a loss of bone mineral density. It is easier to prevent osteoporosis than it is to treat it. However, if your DEXA results suggest that your bone mineral density scores are in the osteoporosis range, there are a number of important considerations to keep in mind. Before we get to far, let’s define the terms osteoporosis and reverse osteoporosis.

Reverse Osteoporosis Definition

The World Health Organization (WHO) defines osteoporosis based on a statistical measure called T-score. A T-score of:

-1.0 or higher indicates normal or healthy bone.
Between -1.0 and -2.5 indicates osteopenia.
-2.5 or lower indicates osteoporosis.

You have osteoporosis if your bone density T-score is two and a half standard deviations below the mean of a 30-year-old woman.

If your T-score is on the edge of osteoporosis (-2.5 to -2.9), you could move into osteopenia territory with the right combination of exercise and diet.

Technically, if you have increased your bone density to the point where your new T-score indicates you have osteopenia, you have reversed osteoporosis. Congratulations!

But keep in mind that if your T-score is lower than -3.0, it might be a considerable challenge to reverse osteoporosis and change your diagnosis to osteopenia.

You can, however, stop the decline and build both bone quality and bone density. The ultimate goal is to maintain your independence and stay fracture free.

There is more to bone health than a high DEXA score. Your exercise and nutrition program should also address fall prevention strategies, posture, flexibility, core strength, weight bearing, and strength training exercises.

Reversing Osteoporosis with Diet and Exercise

Clients consult with me because they:

Experienced a fracture.
Are diagnosed with osteopenia or osteoporosis.
Received a bone mineral density DEXA score that indicates a decline in their bone density

In many cases, their physician advises pharmaceutical intervention. Clients wonder if their physician is prematurely advocating an osteoporosis medication. They want to know if we can work together to reverse osteoporosis naturally without medications like Fosamax, Prolia or Forteo.

I suggest that you try to reverse osteoporosis as much as you can with a combination of therapeutic exercise and diet, whether you need pharmaceuticals or not. Studies have shown that people reversed osteoporosis naturally when they:

Followed a therapeutic exercise program with adequate levels of weight bearing.
Exercised over many years.
Were consistent in their exercise routine.

Further, your diet matters. Later in the blog, we discuss the right combination of nutrients that appear to stimulate the bone building process. A bone building diet includes key essentials that consolidate the stimuli of exercise and impact loading.

Set Realistic Expectations to Reverse Bone Loss

If you are like most people, it probably took a number of years for your bone mineral density to decline to the point where you now have osteoporosis. People exposed to high levels of strong medications or radiation are exceptions to this rule. These individuals have likely experienced an accelerated rate of decline in bone density.

Expect that it will take time and effort to reverse your bone loss. Rome wasn’t built in a day. The same applies to your skeleton. Bone remodeling is a very slow process. Reversing bone loss is a slow process as well. Be patient and persistent. The case study at the end of this post demonstrates this well.

The following influences your rate of bone loss:

Genetic makeup.
Hormonal status.
Current and historical activity and exercise levels.
The pharmaceuticals you may currently be on or have taken.
Current and past diets over the years.

Your risk of bone loss after menopause may increase compared to your friends because of your genes, even if your physical activity and your diet are the same. Your genetic makeup determines how your bone building cells respond to stimuli. (1) Each individual responds differently to the decline of hormones that come with menopause and andropause.

In the first 7 to 10 years following menopause “maintaining is gaining”. In other words, if you are able to maintain your bone mass, consider that a gain!

Why? Because, without an osteoporosis exercise program and good nutrition, you will likely see an ongoing decline in bone density and a worsening of your osteoporosis. This could lead to an increased risk of fracture.

Reversing Osteoporosis Without Drugs

Most people want to know if osteoporosis can be reversed without the use of drugs. I encourage people to pursue that goal when it is realistic. If you are advanced in age and your FRAX score indicates a high fracture risk (as mentioned above), exercise and good nutrition alone might not be adequate. In addition, for many, the amount of impact weight bearing that we do on a daily basis decreases significantly as we age. (2)

An exercise and diet program can take months to affect bone density and the rate of change is slow.

In the meantime, pharmaceutical intervention may be a reasonable option to consider. Having said that, pharmaceutical interventions may increase your bone density but do not improve the quality of your bone.

Another important fact is that pharmaceuticals do not reduce your risk of falling or your quality of life. Unlike exercise and improved nutrition, the side effects of pharmaceuticals are mostly negative.

Is Bone Loss Reversible?

A study by Bassey and Ramsdale (3) found that in women who were more than six years post-menopausal, ground reaction forces from weight bearing exercises had a maintenance effect.

The group did not reverse bone loss but they were able to maintain bone density through appropriate weight bearing exercises. Given that the group was destined to lose bone, this should be considered a success. In this case, maintaining is gaining.

If you want to learn more about a targeted weight bearing exercise, I encourage you to read my heel drop exercise post.

Prevent a Fall, Move Safely, and Build Bone

A 2015 Canadian led international consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral compression fractures (4) concluded that the therapeutic exercise program goals for people with osteoporosis should be:

Fall prevention.
Slow the rate of bone loss.
Safe movement.

Fall Prevention Benefits

A study published at the end of 2017 highlights the benefits of exercise for fall prevention and reducing the rate of bone loss in individuals with osteoporosis.

“Exercise and physical activity (PA) that additionally result in improvements in muscle strength, increased balance, and joint proprioception are likely to reduce the risk of falls and therefore indirectly lower fracture risk. Exercise programs developed for fall prevention have been shown in meta-analysis to reduce falls by up to 39% in community-dwelling older adults.” (5)

Finally, research (5) has shown that increases in bone mineral density from a therapeutic exercise program for osteoporosis “are similar to those seen with antiresorptive drugs (i.e., bisphosphonates, etc) that reduce vertebral and non-vertebral fracture rates.” (5)

A good exercise program delivers additional dividends, including improved cardiovascular fitness and better quality of life. Safe movements are key for preventing compression fractures.

Work With a Qualified Health Professional

A diagnosis of osteoporosis often entails lifestyle changes. You will likely have to change your diet, start a therapeutic exercise program, adjust current exercise routines (including Yoga and Pilates), and modify your activities of daily living. Since time is critical, I encourage you to work with a qualified health professional who has experience dealing with people with osteoporosis.

Many people claim to have expertise in osteoporosis treatment. You should be cautious when you hear these claims. Find someone who you want to work with, who has recognized medical credentials (such as a Physical Therapist or Physician), and who has dealt with many people with your medical condition.

Let’s next address the question: can exercise reverse osteoporosis?

Can Exercise Reverse Osteoporosis?

Can you reverse bone loss with a targeted exercise program and avoid medications altogether? This section will discuss this question in detail.

As mentioned earlier in this post, your diagnosis of osteoporosis is based on your bone mineral density (BMD) scores. However, BMD is only a partial measurement of the health of your bones.

Bone quality, measured with quantitative computer tomography, is critical to successful osteoporosis management.

Exercise has been shown to improve bone quality by altering bone geometry and morphology.
While bone density is important and can be easily measured and tracked, it is bone quality that we would like to see improve.

Unfortunately, bone quality tests are not easily accessible. If you work with a qualified health professional, such as a Physical Therapist trained to treat osteoporosis, your exercise program will be designed with bone quality improvement in mind.

Bone Peak Mass

We know that as you hit menopause, the decline of estrogen in the body reduces your bone mineral density scores. By age 30, most individuals have reached their peak bone mass and gradually lose bone mass over time. If you wait until your bone density declines to the point where you have osteoporosis, you’re going to have to maintain or gradually build from that starting point.

Exercise can help you stave off that decline. This means that if you start the right exercise program, you can maintain (or potentially increase) your bone density.

Many studies show that men and women can increase bone density and reverse bone loss and osteoporosis. (6)

In one study, the exercise participants increased bone density in the 1% to 2% range. The control group, who did not do therapeutic exercise, the bone density decreased in the 4% range. So, technically, the exercise group gained as much as 6%. I discuss this study in detail below.

Start Exercising Early in Life

If you are in your pre-pubertal years, you are the perfect candidate to build bone before your peak bone mass stage. You should exercise hard, play hard, and be sure that you have the nutrition to support the bones. Eventually, you will have a wonderful peak bone mass that you will maintain through your adult life.

A strong reason to play with your children and grandchildren!

Before we discuss the role of nutrition in reversing osteoporosis, let’s look at research that shows how a specific exercise routine can play an important role in building bone.

Exercise Recommendations for Osteoporosis

Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.

But what exercises should you do and which ones should you avoid? What exercises build bone and which ones reduce your chance of a fracture? Is Yoga good for your bones? Who should you trust when it comes to exercises for osteoporosis?

A great resource on exercise and osteoporosis is my free, seven day email course called Exercise Recommendations for Osteoporosis. After you provide your email address, you will receive seven consecutive online educational videos on bone health — one lesson each day. You can look at the videos at anytime and as often as you like.

I cover important topics related to osteoporosis exercise including:

Can exercise reverse osteoporosis?
Stop the stoop — how to avoid kyphosis and rounded shoulders.
Key components of an osteoporosis exercise program.
Key principles of bone building.
Exercises you should avoid if you have osteoporosis.
Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
Core strength and osteoporosis — why is core strength important if you have osteoporosis?

Enter your email address and I will start you on this free course. I do not SPAM or share your email address (or any information) with third parties. You can unsubscribe from my mail list at any time.

Does Weight Bearing Exercise Reverse Bone Loss?

To gain a better understanding whether weight bearing exercise increases bone density, I recently reviewed two studies (6, 7) that looked at exercise and its effect on bone over an extended period of time. I chose these studies because one built on the other and they involved very little equipment that could be accessible to all.

First Study on Weight Bearing and Bone Density

In the first study, the researchers incorporated exercises using the weighted vest. The exercises were:

Squats.
Forward lunges.
Lateral lunges.
Step ups.
Modifications of the squat.

Later during the study, the researchers incorporated jumps. The exercise group started with jumping on the spot and then gradually built up until they were jumping down from 4, 6, and 8-inch heights.

The first study lasted nine months. The researchers found there was not a lot of change shown in the bones of the women in the exercise group versus the control group. Keep this in mind when you go for your DEXA after starting an exercise program. You may not see the results you were anticipating simply because you were not exercising long enough or hard enough.

Physical Condition Before Starting the Study

The women (in both the exercise and control groups) were de-conditioned when they entered the study. The conditioning level of the women in the exercise group improved over the nine months of the first study.

The research team started the exercise group with weighted vests that were low in weight and progressed them gradually by one, two or three pounds at each interval. In addition, the number of repetitions and the number of sets was gradually increased over the nine months.

Weighted vests were not used with the jumps. Sessions were conducted three times per week.

The jumping progression was as follows:

Four months in, the exercise group was doing one to five jumps per session.
Five months into the study, the exercise group was doing six jumps per session.
Up to and including month five, all jumps were divided, with half being performed on a one-inch pad and half from a four-inch step.
By the seventh month, they had built up to twelve jumps per session and a six-inch step.
Nine months into the study, they had increased to twenty-eight jumps per session and increased the step height to eight inches.

Why wasn’t there an increase in bone density during this nine-month study? We know the bone turnover is really slow. Because there was not enough stimulus to the bones throughout the nine-month study period, the exercise group did not experience a material change in bone density.

This might sound discouraging but it opened the door to a new opportunity and a significant finding for the research team.

Second Study on Weight Bearing and Bone Density

The research team realized that the first study gave them access to a group of women who, because of the exercises they did, could easily tolerate an increase in weight bearing activities.

They offered all of the members of the exercise group the opportunity to do a second study. During this study phase, the research team increased the weight bearing load on their bones. The second study lasted four and a half years.

Exercise and Control Groups

In the second study, the research team created a control group for comparative purposes. The control group matched the exercise group on the following characteristics:

Age.
Height.
Weight.
Number of years postmenopause.
Bone mineral density (BMD) score at the hip (in terms of total hip, femoral neck, and trochanteric).

The control group maintained a normal, active life but did not follow an exercise routine.

The average age of participants in the exercise group was 64 years old. The exercise group met to exercise three times a week and continued to do all the weighted vest exercises that they did during the first study.

Osteoporosis Exercise Routines

They did not add any new exercises to their routine. During the first three months, all of the exercises used the weighted vest. The average weight that the weighted vest participants used was eleven pounds — a reasonable weight for most people to carry.

However, the researchers made one change during the second study: The exercise group increased the number of jumps they did per workout session. Over time, they gradually worked their way up to doing fifty jumps per session, spread out throughout the session.

Study Conclusions

At the conclusion of the five-year study time period, the researchers reported the following results:

There were no injuries.
The women in the control group lost an average 4% bone in the hip.
The women in the exercise group gained almost 2% bone in the hip.

One could argue that had the exercise group not followed the prescribed exercise routine, they would have lost 4% of their bone in much the same way as the control group did. Further, one could conclude that they gained 6% because they had staved off the loss of 4%, plus they added 2% onto their existing bone mass.

This is significant because this improvement happened to a group of women in their late sixties, a time usually associated with bone loss.

The two studies demonstrate that if you are consistent in your exercise and you increase and challenge your conditioning, you can build bone and, potentially, reverse osteoporosis.

Can Walking Reverse Osteoporosis?

For overall health and well-being, walking should never be discouraged. However, as mentioned in another blog post, walking alone is not enough to reverse osteoporosis or even maintain bone density. Introducing more loading to their walking, with a weighted belt or a weighted vest and adding intervals of brisk walking or running are all effective means to increase the weight bearing forces.

For those of you with mild knee arthritis, a 2017 study (8) looking at high-impact training on the strength of the femoral neck showed two exciting findings:

High impact loading had a positive effect on the strength of the femoral neck in as little as 12 months.
In addition, high-impact training did not have “any harmful effect on knee cartilage composition in post-menopausal women with mild knee osteoarthritis”.

Jumping, however, might not be an appropriate exercise for an individual with more serious joint health problems or a weak pelvic floor. In either case, you should attend to medical issues that prohibit you from jumping.

Squat Jump Exercise

As I mentioned in the previous section, jumping can be beneficial for individuals who want to reverse bone loss. However, it is not appropriate for everyone, especially people with joint or pelvic health issues.

Also, jumping has been shown to be effective in the femoral neck area but not effective in the spinal region. If you have low DEXA scores in the vertebral column, you should consider other modalities.

The double squat jump from the Athletic Level in the Exercise for Better Bones program is an excellent example of the kind of exercise that builds bone.

Can You Reverse Osteoporosis with Diet and Exercise?

Nutrition and exercise interact with the bone-building cells.

Two key cells play a major role in building bone.

First are the osteoblasts. They are responsible for producing osteocytes, cells found in the bone.
Then we have osteoclasts. Those are the cleaners and cutters of bone.

Can Diet and Exercise Reverse Osteoporosis?

Researchers have studied (1) if exercise and nutrition can stimulate osteoblasts to increase their production of osteocytes. Further, they have examined if there are things that we can do with diet and exercise to optimize the production of osteocytes.

In a recent article (1) entitled Diet and Exercise: a Match Made in Bone, the authors discuss the important role that both exercise and nutrition play in the health and strength of your bones.

We know from long term studies that high intensity, high frequency exercise will play a significant role in bone preservation and formation. Intense weight bearing over time can reverse osteoporosis.

Osteoporosis Reversal Diet

The following nutrients appear to have a positive affect on the production of osteocytes, and could be the foundation of an osteoporosis reversal diet. Some nutrients have been studied more than others, but the paper encourages further research in the area.

We have listed, where appropriate, foods that are rich in these nutrients. These are best obtained organically.

Arganine: A semi-essential amino acid. It is essential (your body cannot make it) when you are young and nonessential (your body can make it) as you grow older. Amino acids are the building blocks of proteins, which is why foods that you associate as protein rich are also rich in arganine. Turkey, pork loin, chicken, pumpkin seeds, peanuts, spirulina, soybeans, chickpeas, lentils and dairy are all good sources of the amino acid arganine.
Calcitriol: The man-made version of Vitamin D or cholecalciferol.
Lactoferrin: A protein found in body secretions. A popular supplement for boosting the immune system.
Daidzen and Genistein: Isoflavanoids naturally found in foods such as soybeans and soy products, as well as a number of plants and herbs.
Fluoride: An element derived from fluoroine.
Strontium: A mineral found in sea water and soil. Seafoods are rich in strontium. Whole milk, meat, poultry, wheat bran, and root vegetables contain smaller amounts.
Oleuropein: A compound found in olive oil and olive leaves.
Retinoic Acid: A compound derived from Vitamin A. All dark green, yellow and red vegetables, as well as red or yellow non-citrus fruits, are rich in Vitamin A. It is also in sardines, cod, liver and fish oils.
Vitamin D: The natural form of Vitamin D made in our liver as a product of sunlight (UVB light) on our skin.
Vitamin K2: Bovine liver, chicken liver, butter, curd cheese, edam cheese, egg yolk, and Natto (a Japanese fermented dish). I have written an article that discusses Vitamin K2 and bone health.
Protein: Protein plays a critical role in bone and muscle strength. You can read more about protein in this post.

Prunes are a proven bone-building powerhouse food. Consider making them part of your daily diet.

Does Vitamin K2 Reverse Osteoporosis?

Does vitamin K2 reverse osteoporosis? Vitamin K2 can play an important role in your bone health and deliver many other health benefits. However, it is only one component of a bone healthy diet.

Osteoporosis and Genetics

Finally, your genetics plays a key role in bone health. Your genetics influence the stimulation of osteocytes and how they respond ultimately to exercise and nutrition. However, you cannot control your genetics but you can control your choice of exercise and nutrition.

Exercise Recommendations for Osteoporosis

Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.

I cover important topics related to osteoporosis exercise including:

Can exercise reverse osteoporosis?
Stop the stoop — how to avoid kyphosis and rounded shoulders.
Key components of an osteoporosis exercise program.
Key principles of bone building.
Exercises you should avoid if you have osteoporosis.
Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
Core strength and osteoporosis — why is core strength important if you have osteoporosis?

Can You Reverse Bone Loss With a Vibration Plate?

I work with many clients who use low intensity vibration therapy to improve bone health. Recently, I have seen a number of these clients reverse bone loss. The key is consistent use of the vibration plate, supplementing the use the plate with a strength training and weight bearing exercise program, and following a bone-healthy diet program. Debi explains her program below.

How Martha Reversed Her Osteoporosis

The following case study is representative of many of the people who get osteoporosis. Her name is Martha, and, like many people, she lives an active life but was surprised when she received the diagnosis of osteoporosis.

For the past several years, I have been seeing a patient, Martha, who is concerned about her bone health. In 2018, she completed her third bone mineral density (BMD) DEXA test and her results were disappointing. Her T-score in her hips was 2.5 standard deviations below that of a healthy 25- to 30-year-old, and the diagnosis was osteoporosis.

She is one of a number of clients who have asked me, How can I reverse my osteoporosis? Until they modify their current exercise program to incorporate exercises and movements that benefit their bones, they will not reverse osteoporosis.

Here is the history of Martha’s T-scores:

2012: Hip [-1.6] Spine [-1.8]
2015: Hip [-1.7] Spine [-2.0]
2018: Hip [-1.85] Spine [-2.5]

Bone Loss: 2012 to 2018

Martha contacted me in 2015 about her bone health and asked me to advise her on what she could do at that time to avoid osteoporosis. I gave her my recommendations. Unfortunately, she did not follow them.

She has a busy life and liked her routines. She enjoyed her exercise classes but did not take the time or make the effort to integrate the changes we discussed into her routine. I believe if she had followed the recommended modifications, she could certainly have held her BMD scores in the -2.0 range at her spine and -1.7 range in her hips and avoided osteoporosis.

Martha's Exercise Routine: 2015 to 2018

After her recent diagnosis of osteoporosis in 2018, we sat down to reevaluate what she had been doing over the past three years. She liked her group exercise classes that she attended three times a week for about ten months of the year. Her exercise classes included a step class and a flow class.

She also walked when she was in Europe two months of the year but admitted that, although her walks were occasionally as long as ten kilometres, she only walked two to three times per week.

She was not doing any upper body strength training. The weights she used in her exercise classes helped her maintain some tone in her arms but did not challenge her bones enough to make a difference. I told her that she could easily do twenty or more repetitions with the five pound dumbbells.

How Martha Reversed Her Osteoporosis: 2019

What does her BMD scores tell us about her exercise choice? Walking and exercise classes had a positive impact on her hip BMD but were not intense or frequent enough for her spine. She was not losing bone density in her hips as fast as her spine, but she was still losing bone. Her spine BMD showed that she definitely needs to up her game in this area.

Hip Bones: For her hip bones, we discussed the option of doing two step classes versus a step and a flow class. As well, I recommended that she could progressively build up to doing fifty jumps (sets of ten jumps, five times a day spread out throughout the day) on the days that she did not attend a class. Her pelvic floor is strong, she does not experience leaking with jumps, and she does not have prolapse or incontinence.
Spine: She committed to doing strength training for her back and upper body.

After implementing this program, Martha reversed her osteoporosis and bone loss. I encourage you to look at your past score and assess your exercise choices based on what your scores are telling you. It can make all the difference in the world.

Osteoporosis Success Story Without Drugs

Sarah is another client who made great strides and changed the direction of her bone health. You can learn ore about her story of dedication and persistence in my post, Osteoporosis Success Story Without Drugs.

Is It Possible to Reverse Osteoporosis?

Can osteoporosis be reversed? Yes, it can, depending on your circumstances. This article identifies what you can achieve, given the health of your bones. The nutrition and exercise choices you make dictate whether osteoporosis can be reversed.

References

Willems H, et al, Diet and Exercise: a Match Made in Bone, Curr Osteoporosis Rep, 2017; 15(6): 555-563
Hannan K, et al. A novel accelerometer-based method to describe day-to-day exposure to potentially osteogenic vertical impacts in older adults: findings from a multi-cohort study, Osteoporosis Int. 2017; 28(3): 1001–1011
Bassey J, Ramsdale S. Weight-bearing exercise and ground reaction forces: a 12-month randomized controlled trial of effects on bone mineral density in healthy postmenopausal women. Bone, 1995 Apr;16(4):469-76
Giangregorio, L.M., et al, Too Fit To Fracture: outcomes of a Delphi consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral fractures, Osteoporosis International, 2015 Mar; 26(3): 891-910
Review Prescribing Physical Activity for the Prevention and Treatment of Osteoporosis in Older Adults Lachlan B. McMillan 1,* ID , Ayse Zengin 1 , Peter R. Ebeling 1 and David Scott, November 2017
Shaw, J., Snow, C., Weighted Vest Exercise Improves Indices of Fall Risk in Older Women, Journal of Gerontology, 1998, Vol 53, No. 1, M53-M58
Shaw, J., Snow, C., et al, Long-term Exercise Using Weighted vests Prevents Hip Bone Loss in Postmenopausal Women, Journal of Gerontology, 2000, Vol 55A, No. 9, M4893-M491
Multanen J., Rantalainen T., Kautiainen H., Ahola R., Jämsä T., Nieminen M.T., Lammentausta E., Häkkinen A., Kiviranta I., Heinonen A. Effect of progressive high-impact exercise on femoral neck structural strength in postmenopausal women with mild knee osteoarthritis: A 12-month RCT. Osteoporos. Int. 2017;28:1323–1333. doi: 10.1007/s00198-016-3875-1.

Can Osteoporosis be Reversed?

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