When I think of bones, I envision the massive skeletons on exhibit at the Museum of Natural History in Chicago. These unbreakable bones supported large, muscular animals weighing over 10,000 pounds. In sharp contrast to these prehistoric bones is the skeleton of the average adult. The human skeletal system is nearly fully developed by age 20 and begins demineralizing (i.e., weakening) in our late 30s. Bone loss continues at a rate of up to 1 percent per year for all of us. However, during and after menopause, women lose bone at 2 percent per year.
While breaking a bone is medically significant, it can be catastrophic later in life. Given that we’re living longer, fractures of the hip and spine have become increasingly common in the United States. Most people are surprised to hear that osteoporosis kills more women than breast cancer.[1] Surviving a hip fracture can often be the first stage of failure. Half of all women who fracture a hip will never walk again unaided (i.e., without using a cane or walker), while 20% will die within one year! Despite advances in the treatment of osteoporosis, most therapies focus on slowing the rate of bone resorption (i.e., bone breakdown) while nearly ignoring the bone-building process. Here's what you should know and do to avoid life-threatening fractures.
In the late 1800s, a discovery by German anatomist and surgeon Julius Wolff changed how we think about bones forever. Dr. Wolff's work revealed a link between muscle strength and bone density, known as Wolff's Law [2]. According to Wolff's Law, bones adapt to the stress placed on them. When you Strength Train your muscles, they impose stress on your bones, which in turn become stronger and healthier. In addition, Strength Training (loading your muscles and bones) stimulates specialized bone-building cells within your skeleton, called osteoblasts. Osteoblasts are also activated with high-force activities like running and jumping; however, these activities can be too risky for older adults with low bone mass because they can exceed the fracture threshold (i.e., the point where a bone fractures).
Early this year a meta-analysis and systematic review of 49 randomized controlled trials reveals that combining safe weight-bearing physical activity (think brisk walking) with Strength Training yields the most significant gains in bone mineral density of the spine and hip when compared to other mixed programs (i.e., Tai Chi, impact alone, walking alone, Strength Training alone, etc.).[3] In addition, a 2020 meta-analysis showed that both high load (heavier weights) and low load (lighter weights) can positively affect bone mineral density if low load programs are progressive and intense (performed at high levels of effort).[4].
Not surprisingly, the benefits of Strength Training go beyond building bones. While strong bones are essential, reducing fall risk is also crucial. Strength Training prevents falls by strengthening balance muscles in the spine and lower body. As you age, you lose balance and coordination. Reversing this process decreases the likelihood you will fall. However, Strength Training also increases survival rates. If you fall, you are much less likely to experience a fracture due to the increased bone mineral density and protective muscles you have built around your joints. My 88-year-old mother is a good example. Last year, she fell in the middle of the night and survived with only a nasty bruise. Thankfully, she's been doing Strength Training for many years.
Given that your muscles are approximately 75% water, insufficient water intake can leave them dehydrated and underperforming. Dehydration can also contribute to lightheadedness, increasing your risk of falling. The National Academy of Sciences, Engineering, and Medicine recommends fifteen cups of liquids daily for men and eleven cups for women. These recommendations include all fluids (i.e., water, tea, coffee, tomato juice, etc.) and food. A healthy diet centered around whole foods can provide up to 30 percent of daily fluids. Non-caloric liquids, including water, unsweetened tea, and black coffee, are generally good choices because they are calorie-free.
Consuming adequate protein is also necessary to optimize the muscle-building effects of Strength Training. However, older adults may require more protein than younger adults due to the decreased sensitivity of muscle to protein (i.e., anabolic resistance) [5]. There is growing evidence that the Recommended Dietary Allowance (RDA) for protein does not support optimal health in older adults. The PROT-AGE Study Group, an international group commissioned to study protein needs with aging, recommends 1.0 to 1.2 grams of protein per kilogram of body weight per day [6]. This group has also recommended 25 to 30 grams of protein per meal to offset anabolic resistance. See the MEDFITNESS Protein Guide to help calculate your protein requirements. In the end, there is no magical anti-osteoporosis program. Your bones will only be as strong as the consistent, safe challenges you place upon them!
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Stay Strong,
Richard J. Wolff, RDN
References
1. Crowley C., Lodge H. 2016. Younger Next Year. New York, NY. Workman Publishing Co., Inc.
2. Wolff's Law: An Overview for Clinicians. https://pubmed.ncbi.nlm.nih.gov/8060014/
3. Effect of different types of exercise on bone mineral density in postmenopausal women: a systematic review and network meta-analysis. Sci Rep. 2025 Apr 5;15(1):11740.
4. Experimental Gerontology, Volume 138, September 2020, 110973.
5. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences. 2015;70(1):57-62.
6. PROT-AGE Study Group. J Am Med Dir Assoc. 2013:149(8):542-559.