Table of Contents

This strength training guide is for people who want to age well, with a special emphasis on individuals concerned about osteoporosis, osteopenia, or low bone density. Strength training is a critical component of a bone building exercise program. We cover:

  • Strength training lessens bone loss.
  • How strength training benefits bone.
  • The difference between strength training and weight bearing.
  • How to combine weight-bearing and strength training.
  • Resources you can access on this site.
strength training for osteoporosis exercise guidelines

Strength Training and Your Health

Strength training is crucial for good health. A regular strength training routine has been shown to benefit your:

  • Cognitive health.
  • Bone health.
  • Muscle health.
  • Independence.
  • Quality of life.
  • Longevity.

Some people refer to strength training as resistance training or weightlifting. We will use all three terms throughout this guide.

If you do not regularly strength train, you will begin losing as much as 3% of your muscle mass per year. Many are surprised to know that muscle loss starts in the mid-’30s. The older we get, the faster the rate of muscle loss. The expression “use it or lose it” applies very well to our muscles and bones.

Strength training is the solution, and it is available to each of us. It improves the strength of our muscles, bones and our retirement options!

Leading health organizations recommend strength training for older adults. Adding resistance training exercise to your weekly routine goes far beyond your muscle and bone health.

How Strength Training Benefits Your Bones

Strength training for osteoporosis is critical if you want to age with strong bones. This class of exercise has been shown to protect your bones in the following ways:

  • Lessens bone loss by suppressing the osteoclast activity level. (1)
  • Improves bone building by stimulating the osteoblast cells and the pre-osteoblast cells. (1)
  • Improves bone strength by making the bone more resilient to strains. (1)
  • Helps prevent falls. (2,3)
  • Protects your spine from degenerative changes, including compression fractures. (4)
  • Accelerates healing and recovery after a fracture. (5,6)
  • It improves your chances of returning to independence one year after a hip fracture. (7,8)

In the video below, I explain how strength training improves bone health and increases bone density.

Strength Training Lessens Bone Loss

Does strength training reduce bone loss? Strength training for osteoporosis can help lessen bone loss by providing stress to the bones. Gradual, progressive strength training stimulates the production of new bone. 
 
The process of bone remodelling is ongoing. Through strength training, we can slow the rate of bone loss and, in some cases, even reverse it. 
strength training benefits | squat with kettlebell

Strength Training for Osteoporosis

Strength training can help maintain or increase muscle mass. When you lift a heavy load, more muscle fibres are recruited. Some muscles attach directly to bones, while others attach via tendons.  (As illustrated in the image below.) The contracting muscle sends mechanical signals to the bone. This mechanical signalling stimulates osteoblasts (bone-building cells) and calms the osteoclast activity (bone-cutting/cleaning cells). (1)

muscle and bone

Strength Training for Muscle and Balance

As we age, we lose muscle mass and muscle-nerve connectivity. Both lead to weaker muscles. Weaker muscles produce weaker muscle contractions and weaker bones. This, in turn, increases our risk of falls and fractures. Strength training can help slow down muscle loss and preserve muscle mass. All of this can be delayed with strength training.
 
Strength training also helps improve balance, coordination, and overall fitness levels.  These fitness parameters help reduce the risk of falls and fractures. (2, 3)
strength training and muscle loss

How Often Should You Strength Train for Osteoporosis?

Leading health organizations, such as the National Strength and Conditioning Association and the American College of Sports Medicine, recommend strength training exercises at least twice weekly. They suggest that you target all major muscle groups. 
 
As we age, most of us do not have the energy to do all major muscle groups on the same day.
 
My clients over the age of 50 find it much easier to either do shorter routines daily or three times a week.  
 

This is how I designed the exercise schedules in my book, Exercise for Better Bones, and the Stronger Bones, Stronger Body Video streaming series. 

Examples of strength training exercises for an active adult include squats, lunges, push-ups, and modified back extensions. Start with a manageable weight.  Increasing the weight and intensity over time allows you to build muscle and bone safely.   

Strength Training for Osteoporosis, Osteopenia and Low Bone Density

Strength training exercises are beneficial for people with osteoporosis and osteopenia. Several major studies confirm this.

One of the most extensive studies specific to bone health began before the year 2000 in Germany.  Dr. Wolfgang Kemmler conducted a 16-year study of the benefits of exercise. His study focused on post-menopausal women with osteoporosis.

Dr. Kemmler found that post-menopausal women strengthened their muscles.  The same exercises could stop bone loss. (8)

A 2020 meta-analysis of the effects of high-intensity exercise on postmenopausal women. The study showed high-intensity exercise to be more effective for the spine than the hip. (9)

How Does Strength Training Prevent Osteoporosis and Osteopenia, and Increase Bone Density?

Strength training can help prevent osteoporosis and osteopenia. It increases bone density through remodeling.

Bone remodeling involves two major activities:

  • Resorption: Removing or resorbing old or damaged bone tissue.
  • Formation: Replacing it with new bone tissue. 

The balance between bone resorption and formation is vital for maintaining bone health. (11)

Unfortunately, things can get out of balance. After menopause, the resorption cells outnumber the formation cells. This can speed up bone loss and cause osteoporosis.

Strength training helps to inhibit the bone-resorbing cells and stimulate the bone-building cells. 

How Does Strength Training Differ from Weight Bearing Exercise?

Strength training involves the progressive loading of muscles. The goal is to fatigue them within 5 to 12 repetitions.

Weight bearing exercises usually involve more repetitions and a longer duration.  Activities such as running, brisk walking, basketball, and soccer are weight bearing.

Earlier, I mentioned exercise guidelines from leading organizations. These health organizations also recommend 30 minutes of aerobic activity daily. The aerobic activities can include weight-bearing exercises such as brisk-walking, running, or jumping-rope.

Both weight bearing exercise and strength training stimulate bone building. Whether you bear weight or strength train, your muscles vibrate. This vibration, in turn, pulls on the bone, stimulating bone growth.

Strength Training for Osteoporosis Products

I offer several strength training for osteoporosis products. The first product is my book, Exercise for Better Bones, and the other is a workout series in streaming video format.

Exercise for Better Bones

Exercise for Better Bones is a comprehensive exercise program for individuals who want to improve their bone health. It includes strength training exercise programs for people at different levels of fracture risk and activity level. Exercise for Better Bones is available on Amazon in print and Kindle format.

Exercise for Better Bones Book

Stronger Bones, Stronger Body Video Workouts

Stronger Bones, Stronger Body is an online video series designed for people who want to follow me through a structured workout. 

Learn More

Strength Training and Muscle-Nerve Communications

Our nerves’ ability to send messages to muscles decreases as we age. But it need not be the case. Strength training improves the nerves’ ability to talk to muscles.

In 2021, Dr Walker reviewed evidence from studies of resistance training-induced neural adaptation in older adults. (11)

A 2022 study further supported the positive effect that intense strength training could enhance muscle-nerve communication. The study included 38 healthy men in their late 60s and 70s. After just 16 weeks of heavy resistance exercise, there was evidence that increased nerves could communicate better with muscles. (12)

You’re Always Young Enough to Get Stronger

Researchers conducted a small study with healthy older adults over the age of 85. All individuals were living independently and the age ranged from 86 to 96 years old.

Eight weeks of strength training generated significant results. The residents added almost 10% muscle mass to their thighs and improved their strength by 174%. (13)

This study proved that you’re always young enough to make strength gains. You need not be competing in the Masters.

The Power of Protein When Strength Training

Protein is essential to building muscle and bones. At any age, protein is critical for supplying the amino acids necessary to build bone and muscle.

Around 50 years of age, we need to increase the protein in our diets to maintain muscle mass. Regular exercisers should eat more protein than the recommended daily intake of 1.0 to 1.2 g/kg of body weight. (14)

Most adults can generally meet this intake level through diet alone. But supplement as needed.

Consume protein within an hour of completing your strength training and with each meal throughout the day. 

The type of protein matters. In 2022, a study of 1,570 older men and women looked at this issue.  It found a positive association between animal protein and bone mineral density scores. (15)

In contrast, plant protein eaters had lower BMD scores.

protein and strength

Conclusion

The objective of this guide was to discuss the importance of strength training for osteoporosis and the role it plays in improving your bone health, reducing your risk of a fall and fracture, and helping you manage your osteoporosis, osteopenia and low bone density.

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References

  1. Rubin J, Styner M. The skeleton in a physical world. Exp Biol Med (Maywood). 2022 Dec;247(24):2213-2222.
  2. Wong RMY, Chong KC, Law SW, Ho WT, Li J, Chui CS, Chow SKH, Cheung WH. The effectiveness of exercises on fall and fracture prevention amongst community elderlies: A systematic review and meta-analysis. J Orthop Translat. 2020 Jun 1;24:58-65.
  3. Adjetey C, Karnon B, Falck RS, Balasubramaniam H, Buschert K, Davis JC. Cost-effectiveness of exercise versus multimodal interventions that include exercise to prevent falls among community-dwelling older adults: A systematic review and meta-analysis. Maturitas. 2023 Mar;169:16-31.
  4. Kang S, Chang MC, Kim H, Kim J, Jang Y, Park D, Hwang JM. The effects of paraspinal muscle volume on physiological load on the lumbar vertebral column: a finite-element study. Spine 2021;46:E1015–21
  5. Ikchan Jeon, Sang Woo Kim, Dongwoo Yu. Paraspinal muscle fatty degeneration as a predictor of progressive vertebral collapse in osteoporotic vertebral compression fractures. The Spine Journal Volume 22, Issue 2, February 2022, Pages 313-320
  6. Eastlack M, Miller RR, Hicks GE, Gruber-Baldini A, Orwig DL, Magaziner J, Ryan AS. Thigh Muscle Composition and Its Relationship to Functional Recovery Post Hip Fracture Over Time and Between Sexes. J Gerontol A Biol Sci Med Sci. 2022 Dec 29;77(12):2445-2452
  7. Chen YP, Kuo YJ, Hung SW, Wen TW, Chien PC, Chiang MH, Maffulli N, Lin CY. Loss of skeletal muscle mass can be predicted by sarcopenia and reflects poor functional recovery at one year after surgery for geriatric hip fractures. Injury. 2021 Nov;52(11):3446-3452
  8. Kemmler W., Bebenek M, Kohl M, von Stengel S. Exercise and fractures in post-menopausal women. Final results of the controlled Erlangen Fitness and Osteoporosis Prevention Study (EFOPS). Osteoporos Int 2015 Oct;26(10):2491-9.
  9. Kistler-Fischbacher, M. et al. The effect of exercise intensity on bone in post-menopausal women (part 2): A meta-analysis. J.bone.2020.115697. Epub 2020 Dec 24.
  10. Kenkre JS, Bassett J. The bone remodelling cycle. Ann Clin Biochem. 2018 May;55(3):308-327.
  11. Walker, S. Evidence of resistance training-induced neural adaptation in older adults. Experimental Gerontology. Volume 151, August 2021, 111408
  12. Soendenbroe C, et al. Human skeletal muscle acetylcholine receptor gene expression in elderly males performing heavy resistance exercise. American Journal of Physiology-Cell PhysiologyVol. 323, No. 1
  13. Gabriel Nasri Marzuca-Nassr, Andrea Alegría-Molina, Yuri SanMartín-Calísto, Macarena Artigas-Arias, Nolberto Huard, Jorge Sapunar, Luis A. Salazar, Lex B. Verdijk, and Luc J.C. van Loon. Muscle Mass and Strength Gains Following Resistance Exercise Training in Older Adults 65–75 Years and Older Adults Above 85 Years. International Journal of Sport Nutrition and Exercise Metabolism. Volume 34: Issue 1. 24 Oct 2023
  14. Doyeon Kim ,Yongsoon Park. Amount of Protein Required to Improve Muscle Mass in Older Adults. Nutrients. 2020 Jun; 12(6): 1700.
  15. Groenendijk I, et al.Protein intake and bone mineral density: Cross-sectional relationship and longitudinal effects in older adults. J Cachexia Sarcopenia Muscle. 2023 Feb;14(1):116-125.

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