Strong Bodies, Sturdy Bones

At age 55, Jody was suffering severe hip and groin pain, lack of mobility, and bone loss (osteopenia). As her health care counselor, I suggested she improve her intake of minerals and vitamins that support bone development and add high intensity strength training to her healthy life style. Jody began lifting weights, cautiously but consistently, about a year ago. She has new strength and vitality, her hips move with more freedom, and she's in less pain. Research tells us that she is dramatically lowering her risk of fracture.

Jody has two daughters, Lisa, 24, a skater, and Sarah, 20, a student. Lisa and Sarah started lifting weights this summer. Strength training will develop Lisa's upper body and help her fly on her skates. It will give her a vitality she often lacks. Sarah is taking charge of her health by lifting in her college gym. With the right nutritional support, both of them are developing strong bones for life.

Jody's mother Beth is 90 years old. She led a vigorous life, and until a few years ago, was taking strenuous hikes. This year she began having trouble walking and carrying groceries, so she moved into an assisted living apartment for the elderly.

How can young women like Lisa and Sarah build strong bones for life? What can midlife women like Jody do to prevent bone loss that often accompanies menopause and lower lifetime fracture risk? And what can elderly women like Beth do to strengthen muscles and bones and delay frailty as long as possible?

Some Facts About Bone

Low bone density is one of many risk factors for fracture of the spine or hip. Even women with low bone density greatly lower their fracture risk if they exercise properly and support themselves nutritionally.

By Lisa's age, around 25, a woman has reached her maximum bone density. From 35 until 50, sedentary women tend to lose bone, as much as 1% a year, and in the 5 years after menopause, a woman may loses 2-5% of her bone mass a year. After 55, Jody's age, bone loss in sedentary women slows to about 1% or less a year. (Dr. Miriam Nelson, Strong Women Stay Young, p. 45)

Although our bones are busy remodeling (breaking down old bone and making new) throughout our lives, most women take their bones for granted. They often have diets low in calcium, vitamin D, and other essential nutrients for bone health. They may smoke or drink more than seven alcoholic drinks a week, both of which interfere with bone mineralization. They may be at risk for bone loss because of an interrupted menstrual cycle caused by eating disorders, excessive exercise, or extremely low body fat. They may be lowering their bone density with repeated low calorie weight loss diets. There are many risk factors for low bone density.

Here are some of the major ones.

Medical history: A previously fractured bone. Late onset of menarche (after 15) or early menopause before 45). Use of drugs that lower bone density such as prednisone.

Genetics and Body Type: A family history of osteoporosis. Being Asian or Caucasian. Slender, a slight build, underweight with body mass index under 19, pale skin

Nutritional status: Low caloric intake. History of yo-yo dieting and/or eating disorders

Exercise history: Women who weren’t athletic when they were young. Women who don’t exercise as adults. Exercise that isn’t weight bearing, such as swimming or biking. Aerobic exercise alone, without exercise that builds muscle and bone mass.

Exercise and Bone Density

In 1991, researchers at the Tufts University Center on Aging showed that many of the problems associated with aging came from muscle weakness and inactivity, not age itself. They found that between the ages of 35 and 80, most people lose about 1/3 of their muscle mass. Their book, Biomarkers, recommended strength-building and stretching exercises, in addition to the usual aerobics. Although the exercise routines were inadequate, recommending weight training was revolutionary.

In 1997, another book came out of the research at Tufts, Strong Women Stay Young by Miriam E. Nelson. Nelson found that women of all ages who strength train improve bone density and lower fracture risk. In her study, a group of women over 50 who lifted weights gained 1% bone density a year, while the less active control group lost 2% of their bone a year—a difference of 3% a year. That adds up in 10 years! Even more important, research shows that strength training lowers fracture risk in older adults even more than it increases bone density, and the decrease in fracture risk is what we're really after.

Many women are sedentary or are exercising in ways that don't build strong bone. Because water supports the weight, swimming doesn't help build bone. Neither does biking. High impact walking and running are better, but not nearly as good as strength training Also, all strength training is not equal when it comes to strengthening bone. We need progressive, higher load, lower repetition routines that focus on vulnerable areas such as spine, hips, and wrists. See my article on exercise routines for lowering fracture risk, "Designing Exercise Programs to Lower Fracture Risk in Women."

Building Strong Bones With Nutrition

Although nutrition alone cannot prevent osteoporosis, all three generations of women need appropriate nutrients to build strong bones. Women under fifty (unless pregnant) need about 1000 mg of calcium a day. Women over 50 need 1200-1500 mg a day to counteract the tendency to lose bone at this age.

Calculate the amount of calcium in your diet and, if needed, supplement calcium/magnesium (2 parts calcium citrate to 1 part magnesium) to increase your calcium consumption to recommended levels. If you don't get much sun or live in a northern climate, add 1000 IUs of vitamin D.

There are many foods that help build bone and some that are hard on bone health. See my articles under "Nutrition and Bone Health." Susan Brown’s book, Better Bones, Better Bodies, and her website are also helpful.

Strong Muscles Make Strong Bones

Nutrition alone cannot protect you from osteoporosis. To protect your bone and nearly all other aspects of health, make strength training a permanent part of your life. Educate yourself before beginning. You might feel comfortable with a personal trainer or strength training class, but trainers may not be weight lifting experts. They often recommend high repetition, low intensity work with little emphasis on progression, and this does little to strengthen bone. Miriam Nelson's books will help you understand the importance of strength training. Routines that include squatting motions, back work, and compound exercises that strengthen the whole body will help you build strong muscles and bones.

One of the primary reasons women quit strength training is that they "go for it" and wipe themselves out with overly sore muscles or injury. Focus your enthusiasm on learning good exercise technique and developing a lifetime program. Build intensity gradually. Reading the exercise articles on my web site will help you get started.

When You're Between Fifteen and Fifty

If you're young like my friends Lisa and Sarah, your muscles and bones will respond quickly to strength training. Menstrual hormones make it easy to mineralize young bones. If you're already exercising aerobically, devote two exercise sessions each week to strength training. You'll be building dense bones, while developing a strong and beautiful body. If you're extremely out of shape, look at Miriam Nelson's books for beginning weight training routines. After you've mastered these, move on to more demanding and interesting exercises.

When You're Between Fifty And Seventy

If you're in mid life, like Jody, it is crucial to protect your body, since lowering estrogen levels make it easier to lose bone at this age. Jody will gain hip mobility and pain relief with strength training. The right nutrition and exercise program will help her reverse her mild osteopenia. Look at Strong Women Stay Young for information and motivation about strength training for mid life women. Try two sessions of weight training a week and exercise aerobically two or three times a week. Stretching will help you keep a youthful flexibility and mobility.

If you are out of shape or cautious, begin with the simple exercise routine in Strong Women Stay Young. Commit to a two-month exercise experiment and your new strength and vitality will be the only motivators you need to continue. Nelson found that weight training takes years off a woman's biological age, and even the simple program she recommends reverses bone loss. You can move on to a more challenging routine after a few months.

If You’re Over Seventy

If you think Jody's elderly mother Beth is too old and frail to benefit from weight training, you're wrong. A woman is never, and I mean never, too old to benefit from muscle strength. Even though Beth was an avid hiker until she was 89, she hasn't tried strength training. It might help her regain her walking ability.

A small group of women and men aged 86 to 96 lifted weights three times a week. Most used walkers or canes and were frail when they began. Their strength increased an average of 175% in just eight weeks, allowing many to walk without support. Larger clinical trials confirmed the huge benefits of strength training for the elderly. (Strong Women Stay Young, p. 11) As well as increasing muscle and bone strength, weight training improved balance and helped prevent incapacitating falls and fractures.

A 90 year-old woman working out with dumbbells and leg weights or machines? Why not? Every woman begins her program where she is and gradually builds strength. The muscles respond at any age, and so do the bones.

Let's Get Started

If you aren't already strength training, take the plunge. Just a few years ago, I was 54, out of shape, skeptical, and not one bit interested in muscles, but I decided that if elderly people were willing to try strength training, I had no excuse. Now I'm an avid weight lifter with a strong shapely body. I'm lowering my risk of fracture by following a bone-building exercise routine. You'll love becoming a strong woman, too.