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What You Can Do To Improve Your Bone Health

What You Can Do To Improve Your Bone Health

Bettiann Wing, PT


Bone health is not a subject many ever think about.  However, the sequalae of bone disease is associated with a high incidence of morbidity (injury) and mortality (earlier death).  Let us start with some background.

Osteoporosis: What Is It and Who Has It?

Osteoporosis (OP), the most common bone disease, is a progressive loss of bone density and deterioration of the bone microarchitecture weakening the bone tissue leading to an increased risk of fracture.  According to the surgeon general OP is the most common cause of fractures.  OP is almost twice as common in women as in men and is typically asymptomatic until a fracture occurs.  There is an increasing prevalence of OP worldwide with hundreds of millions affected and an estimated 9 million osteoporotic fractures every year, 1 occurring every 3 seconds.  40% of women with fragility fractures will lose the ability to walk, twice that will lose the ability to perform one task of daily living.  Men also experience reduced bone formation and thinning with aging, but at a decreased rate compared with women.

Osteoporosis: How Does It Develop?

Bone is living tissue that is continuously renewing itself, a process that is dependent on many factors including nutrition, hormonal balance, and physical loading.  When this process is upset bone loss can develop.

Osteoporosis: What Are the Risk Factors?

  • Poor diet, including calcium and vitamin D deficiency;
  • Nutritional and hormonal compromise due to unhealthy eating behaviors (ie: self-induced vomiting, binge eating, laxative abuse);
  • Sedentary lifestyle;
  • Smoking;
  • Sequala of other diseases and treatments such as diabetes, hyperparathyroidism and use of glucocorticoids;
  • Hormonal imbalances as occur in menopause;
  • Late first menstruation cycle;
  • Female;
  • Caucasian;
  • Older age;
  • Genetic/familial history

Osteoporosis: What Are the Signs & Symptoms?

OP is primarily asymptomatic until a fracture occurs.  However, bone deformities, kyphosis and loss of height can be a sign that the integrity of the bone is compromised.

 Osteoporosis: How Is It Diagnosed?

OP is diagnosed via X-ray densitometry (DXA) to determine Bone Mineral Density (BMD).  Despite the high prevalence, morbidity and mortality associated with OP screening and treatment rates are low.

“Osteoporosis and the broken bones it can cause are not part of normal aging. There is a lot you can do to protect your bones throughout your life. You are never too young or too old to improve the health of your bones. Osteoporosis prevention should begin in childhood. But it shouldn’t stop there. Whatever your age, the habits you adopt now can affect your bone health for the rest of your life. Now is the time to take action.” (National Osteoporosis Foundation,

Lifestyle Optimization Strategies to Improve Your Bone Health:

  • Weight bearing exercise:
    • High impact exercise such as jumping, multidirectional hopping, jogging, climbing stairs and dancing are best for improving bone health;
    • High impact exercise effects all fracture parameters including fall risk, fall impact, and overall bone strength;
    • Weight training;
    • Low impact exercise including walking provide less improvement in bone health than high impact exercise but is better than a sedentary lifestyle;
    • It is best to exercise at least 30 minutes a day including warm up and cool down, at least 2-3 times / week;
  • Healthy diet:
    • Adequate calcium (best through foods vs pills) and Vitamin D intake;
      • Calcium rich foods including cheese, yogurt, milk, sardines, dark leafy greens (like spinach, kale, turnips, and collard greens), soybeans, fortified soymilk;
      • Vitamin D rich foods: salmon, herring, sardines, cod liver oil, canned tuna, egg yolks, mushrooms.
    • Polyphenol-rich foods including olive oil, fruits and vegetables, tea and soy;
    • Bone Health Recipes:
  • Smoking cessation
  • Limited alcohol consumption
  • Limited caffeine consumption

by Bettiann Wing, PT


Berry, M. E. (2019). Preventing and Treating Osteoporosis. Radiologic Technology, 90(3), 286–293.
French, K. D., & Emanuele, D. (2019). Osteoporosis: Increasing Screening and Treatment for Postmenopausal Women. Journal for Nurse Practitioners, 15(5), 347–350.
Howe TE, Shea B, Dawson LJ, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. 2011(7):CD000333.
Kalkim, A., Daghan, S., Ercan, E., & Ibci, S. (2018). Use of Complementary and Alternative Medicine by Osteoporosis and Osteopenia Patients. International Journal of Caring Sciences, 11(3), 1546–1556.
Matzkin, Elizabeth G. MD; DeMaio, Marlene MD; Charles, Julia F. MD, PhD; Franklin, Corinna C. MD, Diagnosis and Treatment of Osteoporosis: What Orthopaedic Surgeons Need to Know, Journal of the American Academy of Orthopaedic Surgeons: October 15, 2019 – Volume 27 – Issue 20 – p e902-e912
McCance, K. L., & Huether, S. E. (eds.). (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th ed.). St. Louis, MO: Elsevier/Mosby.
Nuti, R., Brandi, M. L., Checchia, G., Di Munno, O., Dominguez, L., Falaschi, P., … Isaia, G. C. (2019). Guidelines for the management of osteoporosis and fragility fractures. Internal & Emergency Medicine, 14(1), 85–102.
Orr, Sarah BSN, RN, Osteoporosis, Otterbein University, Ohio
Tabatabaei-Malazy, O., Salari, P., Khashaya, P., & Larijan, B. (2017). New horizons in treatment of osteoporosis. DARU, 25, 1–16.
Polyphenol-Rich Foods and Osteoporosis, Current Pharmaceutical Design, Volume 25, Number 22, 2019

No excuses. Lift weights at any age! Advice from a 65 year old.

No excuses. Lift weights at any age! Advice from a 65 year old.

A post by Abby Halpin, DPT

 Yes, we are physical therapists, but we don’t just help people get back to where they were before an injury. We also help people level up after rehab.  As experts of the human movement system, we pay attention to what is good for it, and we teach it.  Muscle loss as we age is a huge problem. It affects our mobility, confidence, puts us at risk for falls, and decreases our longevity.  I recently came across this article in the New York Times, and thought, why not have a client tell her story.

Kristin, a participant in Movement Systems fitness programming, was interviewed to share her experience with weight training as a 65 year old. 

(Abby) What is your favorite strength training exercise and why?
(Kristin) “Deadlifting is my favorite.  That’s been a vast surprise to me since I never thought I’d do free weights, let alone deadlift. Being the age I am (65), I grew up thinking  deadlifting was for hunky guys in sweaty, competitive gyms. So wrong! I’ve found that I love how deadlifting makes me concentrate totally, both physically and mentally. It is thrilling to feel myself getting stronger, and to measure my progress by the increasing weight I can lift.” 
What led you to begin your strength training program?
“I was in a serious car accident and started physiotherapy with Abby in early 2017.  I’ve always been physically active, but I lost a lot of strength during my recovery so when physiotherapy ended I started doing physical training with her. I also needed to do more weight-bearing exercise to prevent bone loss as I age. Training one-on-one with Abby,  who knows my body quirks and can cheerfully push and encourage me,  has been immensely helpful. I started my physiotherapy with two-pound weights.  Now I can deadlift 145 pounds!” 
Have you noticed a change in how you move about your day since beginning your weightlifting routine?
“I love feeling stronger. And lifting things in everyday life  – from heavy shopping bags to suitcases and boxes of books – is much easier. I’m more conscious about my overall posture/alignment and it has improved.  And I’m less afraid of injuring myself.” 
What has surprised you the most about strength training?
“What has surprised me most about deadlifting in particular is how almost meditative it can be since it needs such  physical and mental focus. As I lift heavier weights, I’m working on and appreciating the mental/emotional side of it,  how it fosters the need to be positive and believe you can do it. It’s wonderful to talk positively to one’s self.” 
Is there anything else about your lifting life you’d like to share?
“It’s a cliche, but you truly are never too old to start.  Your body and brain will thank you.”
If you are interested in learning how you can safely and confidently begin strength training, consult a physical therapist. We are equipped to perform health screening prior to beginning a program, and we are experts in exercise prescription for the human movement system.

High Intensity Resistance Training for Osteoporosis: Are we playing it too safe?

High Intensity Resistance Training for Osteoporosis:

Are we playing it too safe?

By Carrie Hall PT, MHS


The CDC and Surgeon General, along with many researchers1 have proposed that exercise plays a role in prevention and treatment of osteoporosis, but the effect has been perceived to be moderate at best. Debunking this myth, a preliminary study in Australia has shown that high-intensity resistance and impact training (HiRIT) may improve bone and muscle strength in healthy postmenopausal women with osteoporosis.2

Maybe we have been playing it too safe?

It is known that bones respond preferentially to high magnitude weightbearing loads, but most physical therapists prescribing exercise are hesitant to apply high loads to persons with osteopenia (thinning bones) or osteoporosis (low bone density) for fear of risk of injury or fracture. This study aimed to demonstrate that high intensity resistance and impact loading is both safe and effective in improving bone mass and overall physical function.

What did this study do differently?

Researchers analyzed data from the larger Lifting Intervention for Training Muscle and Osteoporosis Rehabilitation (LIFTMOR) Trial on 101 postmenopausal women age 58 or older. For eight months, half of the women did twice-weekly 30-minute sessions of supervised HiRIT that included deadlifts, overhead presses, squats and jumping chin ups with drop landings. The other half formed a comparison group, and for eight months they did unsupervised, twice-weekly 30-minute low-intensity exercise at home.

The graduated loading, close ongoing supervision, and focus on correct technique were key to safety and overall adherence to the program (low drop-out rate). The 2 time per week dosage was also very appealing to this demographic leading to high compliance (participating with expected dosage).

All the participants had bone mineral density testing with a special type of X-ray called a DXA scan before and after the eight-month training program to assess changes in their bone mineral density (BMD), or bone health, at the spine and the femoral neck at the very top of the thigh bone that connects the long bone to the head of the femur.

By the end of the study, the HiRIT participants increased BMD in their spines by an average of about 3 percent and increased hip BMD by 2.2 percent. In the comparison group, women lost an average 1.2 percent of spinal BMD and lost more than 2 percent at the hip, researchers report in the Journal of Bone and Mineral Research.

The benefits of bone density improvements at the femoral neck and spine translate into stronger hips and backs. Women in the resistance group also had a 40 percent improvement in back and leg extensor strength, which helped improve their posture and reduce their risk of falls.

Close ongoing supervision is key!

The researcher of this study felt this demographic has traditionally been held back from high intensity resistance training for fear of fracturing fragile bone with heavy loading, but that this overly conservative approach has led to stagnation in the field. This study demonstrates preliminary evidence for safety and effectiveness of a HiRIT program for otherwise healthy postmenopausal women with low to very low bone mass.

Key to the success of this program is that HiRIT training should be supervised by adequately trained and educated professionals such as a physical therapist, to ensure correct technique and appropriate progressions, as well as to minimize injuries.

WE DO NOT RECOMMEND INDIVIDUALS WITH LOW BONE MASS TO UNDERTAKE THIS PROTOCOL IN AN UNSUPERVISED ENVIRONMENT, even after notable training, because it is not possible to self-monitor technique or self-prescribe dosage.

Despite misconception to the contrary, high intensity resistance training can be safe and has proven to be effective in improving bone mass.

Consult your PT if you are interested in beginning a program such as this.

Happy lifting!


  1. Howe TE, Shea B, Dawson LJ, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. 2011(7):CD000333.
  2. Warson SL, Weeks BJ, Weis LJ, et al. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: The LIFTMOR Randomized Controlled Trial. JBMR. 2017.


Carrie Hall PT, MHS – President