Many of my new patients ask: can osteoporosis be reversed without Fosamax or Prolia? My answer to them is yes. Depending on their specific circumstances, osteoporosis can be reversed with a combination of therapeutic exercise and good nutrition.
I think a good place to start this discussion is with a case study of a real patient — someone who I believe is representative of many of the people who get osteoporosis.
Reverse Osteoporosis Naturally: A Case Study
For the several years I have been seeing a patient who is concerned about her bone health. Recently, 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 the many clients who have asked me: can osteoporosis be reversed? Sadly, I know many clients like her. They know that their bones are weakening and that they will likely have osteoporosis. However, they decide not to modify their current exercise program or daily activities to incorporate exercises and movements that benefit their bones.
Here is the history of her T-scores in tabular format:
|L1 – L4 (Spine)||-1.8||-2.2||-2.5|
|Femoral Neck (Hips)||-1.6||-1.8||-1.9|
Here is the same data in chart format:
The Decline in Bone Density: 2015 to 2018
She originally contacted me in 2015 about her bone health and asked me to advise her 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.
Evaluating Her 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 to Reverse Osteoporosis: 2018
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 gradually build up to doing fifty jumps (ten jumps spread out throughout the day) on the days that she did not attend a class. Her pelvic floor is strong and she does not experience leaking with jumps, and she does not have prolapse or incontinence.
- Spine: She committed to doing spinal extension exercises and strength training for her back and upper body.
If she is consistent, I believe she will be able to reverse her osteoporosis and stop the gradual decline of her bone mass. 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.
- Can Exercise Reverse Osteoporosis?
- Does Weight Bearing Exercise Increase Bone Density?
- Osteoporosis Diet and Exercise
- Osteoporosis and Genetics
Osteoporosis cannot be cured and it is easier to prevent the condition than it is to treat it. However, if you have been diagnosed with osteoporosis, there are a number of important considerations to keep in mind. Let’s cover these now.
Osteoporosis Diet and Exercise
Patients come to me because they experience a fracture or receive 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.
My advice is that the best way to reverse osteoporosis naturally is with a combination of therapeutic exercise and diet. 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.
Establish Realistic Expectations
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. Your rate of bone loss is influenced by the following individual factors:
- Genetic makeup.
- Hormonal status.
- Current and historical activity and exercise level.
- The pharmaceuticals you may currently be on or have taken.
- Current and past diet 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 the exercise and diet program, you will likely see an ongoing decline in bone density, a worsening of your osteoporosis, and an increasing risk of fracture.
Clearly Define the Term Reverse Osteoporosis
The World Health Organization (WHO) defines the criteria for osteoporosis based on a T-score. A T-score of:
- -1.0 or higher is normal.
- Between -1.0 and -2.5 is osteopenia.
- -2.5 or lower is osteoporosis.
Your physician will advise you that you have osteoporosis if you have a T-score that indicates your bone density is two and a half standard deviations below the mean of a 30-year-old man or woman. If you are sitting on the edge of osteoporosis (-2.5), you can move into osteopenia territory with the right combination of exercise and diet. Technically, you have reversed osteoporosis. But keep in mind if your T-score is -4.0, it might be a considerable challenge to change your diagnosis to osteopenia.
Reversing Osteoporosis Without Drugs
Most people want to know can osteoporosis 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, 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 years 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 intervention(s) may increase your bone density but they do not reduce your risk of falling (which can be achieved through better strength and balance), aid in your recovery or your quality of life. Unlike exercise and improved nutrition, the side effects of pharmaceuticals are all negative.
Balance Exercises and Perfect Posture
Your exercise program needs to do more than build bone. In fact, an international consensus (3) states that the therapeutic exercise program goals for people with osteoporosis should be:
- Fall prevention.
- Safe movement.
- Slow the rate of bone loss.
Your exercise program should include not only strength exercises but also exercises that improve your balance and perfect your posture (to reduce the risk of compression fractures).
A study published at the end of 2017 emphasizes these benefits for individuals with osteoporosis:
“Exercise and physical activity (PA) that additionally result in improvements in muscle strength and 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.” (4)
A good exercise program delivers additional dividends including improved cardiovascular fitness and better quality of life.
Finally, research (4) 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.” (4)
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. I encourage you to be cautious with these claims and do your home-work. Find someone who you want to work with and who has dealt with many people with your medical condition.
Let’s next address the question: can exercise reverse osteoporosis?
Bone quality, measured with quantitative computer tomography, is critical to successful osteoporosis management. (I discuss bone quality in my article on Bone Quality and Osteoporosis.)
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 can 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 osteoporosis. (4)
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 Exercise Early in Life
Exercise is not a strong enough stimulant on its own to bring you back to where you were at your peak bone mass. Your best chance to build and maintain your peak bone mass is if you start vigorous and regular exercise before or when you achieve your peak bone mass.
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 would maintain through your adult life.
Share this important information 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.
First Study on Weight Bearing and Bone Density
In the first study, the researchers incorporated exercises using the weighted vest. The exercises were:
- 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 that were 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 increases 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 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 with the exercise group on the following characteristics:
- Number of years post menopause.
- 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 vests 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 #1 Conclusions
At the conclusion of the five-year study time period, the researchers reported the following results:
- There was 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 2% 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 2% plus they added 4% 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, that you can build bone and osteoporosis can be reversed.
McMillan Study Conclusions
Another study (4) arrived at similar conclusions. The McMillan study states that “trials to date have typically demonstrated that high-impact activity is associated with improvements or maintenance of bone mineral density. Furthermore, a recent randomized control trial (RCT) demonstrated that high-impact exercise can improve bone health without any detrimental effects on knee cartilage composition in post-menopausal women with knee osteoarthritis, suggesting that this form of exercise does not increase the risk of musculoskeletal injury.”
The authors also note that “current evidence suggests walking does not generate gains in BMD (bone mineral density), but may nevertheless maintain bone homeostasis during ageing, particularly when performed at higher intensities.”
I have many clients who are walkers, but I have to let them know that walking is likely not enough to reverse osteoporosis or even maintain their bone density. They should introduce weight bearing to their walking (such as walking with a weighted belt or a weighted vest) or consider running.
I want to add that although the study mentioned above indicated that the high impact exercises were done “without any detrimental effects on knee cartilage composition in post-menopausal women with knee osteoarthritis” (2), jumping might not an appropriate exercise for an individual because of either joint health problems or a weak pelvic floor. In either case, you should attend to medical issues that prohibit you from jumping before trying that exercise.
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 there things that we can do with diet and exercise to optimize the production of osteocytes.
In a recent article 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.
The following nutrients appear to have a positive affect on the production of osteocytes. Some nutrients have been studied more than others but the paper encourages further research in the area.
We have listed off, where appropriate, foods that are rich in these nutrients.
- Arganine: A semi-essential amino acid. It is essential (your body cannot make it) when your 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 such as human milk, bile, mucus and tears. 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 fluroine.
- 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 sunshine (UVB light) on our skin.
- Vitamin K: Leafy green vegetables are the richest source of Vitamin K. Kale, spinach and collard greens score the highest. The next best sources are prunes, turnip greens, brussel sprouts, asparagus, lettuce, sauerkraut, soybeans and edamame. Pumpkin, pine nuts, pickles and blueberries, cranberries, figs and apricots contain lesser amounts.
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 can control your choice of exercise and nutrition.
Can Osteoporosis be Reversed Conclusion
Can osteoporosis be reversed? Yes, it can. 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.
- 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, Osteoporos Int. 2017; 28(3): 1001–1011
- 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
For more information, check out my Osteoporosis Guidelines.