“I’ve been exercising like crazy but my bone density is no better! It didn’t work!”

I’ve heard that from patients over the years. An April 2022 article by Dr. Belinda Beck in Exercise and Sport Sciences Reviews helped me understand why that is the case.

Osteoporosis concerns patients and doctors because patients with osteoporosis are more likely to break a bone. But in studies about osteoporosis treatment, it takes more participants and a lot more time to demonstrate a change in fracture risk than it does to see a change in bone mineral density (BMD), which makes studies much more expensive to run. That is why so many studies focus on BMD instead of fracture incidence.

BMD does not necessarily correlate with bone strength. In her article, Dr. Beck discusses how bone cortex becomes thicker with exercise and so the bone becomes stronger, without necessarily increasing BMD. Most studies of the effect of exercise on bone do not have enough participants to demonstrate prevention of fractures, but Dr. Beck also reports that a meta-analysis (a combination of data from a number of small studies) showed fracture prevention as good as any medication.

Finally, many studies of exercise and bone looked at forms of exercise that are not as effective, and also excluded the people who might be most likely to benefit – those with severe osteoporosis. A 2017 study by Dr. Beck and her colleagues aimed to correct that.

The LIFTMOR study compared a supervised high-intensity resistance and impact training program with a home-based, low-intensity exercise program in patients with osteoporosis. The high-intensity group had both improvement of BMD and increased bone thickness. The low-intensity group lost BMD but increased bone thickness – so while the high-intensity approach (which requires supervision to prevent injury) is better, the low-intensity approach is better than nothing.

A YouTube video by Dr. Beck explains much of the above and discusses which exercises are best for bone health.

Another YouTube video by a physical therapist goes into more detail about the high-intensity training program. It would be useful for a physical therapist or personal trainer to review to know how to advise a patient. It is important to work with a knowledgeable professional and use proper form with the high-intensity program of exercises.

It is my hope that many physical therapists and exercise physiologists will pick up on this important work and make it easily accessible.