We pay a lot of attention to what lies right beneath the surface of our skin…
We all want less fat and more muscle.
But what about what lies beneath our muscles and fat?
I am talking about your bones.
For the first half of our lives most of us think very little about our bones. Perhaps the only time we think about them is if we break them, other than that we usually just take for granted everything is fine with them.
However, ask any person in the second part of their life if they are concerned about their bones and they would probably say “yes”.
Unfortunately after the age of 50 we are at a high risk of losing a lot of our bone mass putting us at greater risk of breaking or fracturing a bone. It is estimated that 50% of women and 20% of men will suffer a fracture after the age of 50 .
The reason for the high prevalence of fractures is a combination of muscle loss and bone loss.
Bone loss is a big problem as we age. Most of us will reach our peak bone mineral density around the age of 20 years old. Most maintain their bone mineral density until around 50 when the pace of bone breakdown outpaces bone growth.
If we don’t maximize the opportunity to reach our peak bone mass earlier on in life it’s hard to add much more after the age of 20, all we can do at that point is combat and slow the eventual loss of bone that will happen around 50. As you can see in the graph above if we fail to maximize our bone mass earlier in our lives, we will almost surely end up with low bone mass (osteoporosis) by the time we reach 50.
Unfortunately for myself I was starting a bit behind the curve when it comes to my own bone mass. I first found this out in 2018 when I had my very first DEXA scan. My primary reason for getting a DEXA scan in 2018 was to find out how much fat and muscle mass I had, however the most concerning result from that scan was that I actually had low bone density compared to the average for my age at the time (I was 33). The DEXA scan showed I had a bone density of 1.015 g/cm3. Average bone density for a male my age was around 1.2 g/cm3.
The sad part was that in 2018 I was nearly 3 years into living a healthier lifestyle, so I am sure that it was worse before that.
When it comes to maximizing bone mass, lifestyle is the primary contributor.
Our nutrition, exercise and movement, vitamin and mineral intake, alcohol intake, and being a smoker all play key roles in our bone growth and formation. Genetics will as well, but to some degree it is hard to control that outside of our lifestyles impact on our genetic expression.
For myself I am not sure what hindered my bone growth in my younger years. It wasn’t smoking or alcohol intake. If I had to guess it was my nutrition and most importantly, lack of physical activity. Yeah my diet was not great…I ate the standard American diet like most kids did growing up in the 80s and 90s. However, probably the biggest difference for me when compared to other kids was physical activity. I never was into sports, I would have much rather played video games.
Physical activity is critical for bone growth because of the signal it sends. Our bodies are very much aware of the environment we are in. If our bodies get a signal over and over again they tend to adapt to that signal in order to increase our chances of survival for the environment we are in. We see this adaptation mechanism play out in our hormones, our muscles, our metabolism, our skin, and yes our bones.
Physical activity puts a load on our body, and if we continuously put that load on our body our body will adapt to counteract that load and be more resilient to it. Most people equate this to muscle growth and/or strength gains and yes, physical activity will make our muscles grow and we will get stronger.
But what do our muscles attach to?
What happens if our muscles get bigger and stronger but our bones don’t?
We will break our bones…that’s no good.
So when we are physically active and our muscles grow and we get stronger we must also make our bones stronger in order to support the additional stress placed on them.
When we are not physically active, our bodies don’t get the signal to increase our muscle mass and therefore increase our bone strength. Since I was not a physically active kid, this is where I probably fell short.
Another good example of how important the demand of being physically active is for bone health is looking at astronauts that spend some time in space. In space there is 0 gravity so when spending time in space there is virtually 0 stress placed on your bones. As a result astronauts will lose a large amount of bone mass while in space. In fact a study showed that even a year after returning to Earth many astronauts did not regain the bone mass they had lost. This is despite exercising in space (yes they can do that, check out this video) and exercising after returning to Earth .
Fortunately for myself, all hope does not appear to be lost. Yeah I was starting out in my mid 30s with lower than average bone mass and I was already well past my peak bone growth phase of life, but at least I was aware of the situation and I knew at that time in 2018 that strength training, my diet, and overall lifestyle could at least prevent additional bone loss and at best I could increase it a bit.
I began putting more of a focus on resistance training as opposed to endurance training and continued to eat a whole foods ancestral diet.
Since 2018 I have been able to increase my bone density in all the DEXA scans I have had since then.
That of course is my own personal experience, and while that’s good to know, it does not mean it will apply more broadly to everyone. Fortunately we have lots of research in this space to help us understand what a wider range of individuals experience when faced with similar challenges.
Female gymnasts are at particular risk of having weak bones due to their high amount of energy expenditure and demands both from a sporting point of view and social point of view to be lean. Many female gymnasts severely undereat and as we will discuss below this can lead to fragile bones because the body doesn’t have the fuel it needs to maintain or build bone.
Researchers performed a study on young female gymnasts (13-18 years of age) where one group did 2 days a week of whole body resistance training. Exercises included squats, deadlifts, lunges, pressing, rowing…basically all the primary full body exercises you would expect to see in any resistance training program. When compared to the control group, who was not doing any resistance training, the intervention group increased their bone mineral density by 3.78% !
In another study done on post-menopausal females with an average age of 65, researchers illustrated the importance of using the propert amount of load when resistance training in maintaining and building bone mass. Participants in this study did strength training two times a week for 12 months. One group did a “high intensity” resistance training program where they did compound exercises like squats, deadlifts, and overhead presses for 5 sets of 5 reps at 80-85% of their one rep max. The other group did low-load resistance training for 10-15 reps at less than 60% of their one rep max in addition to stretching. In the low-load group participants could not use more than 6 lb hand weights while doing these exercises.
At the end of the 12 months the high intensity group was able to INCREASE their bone density in their spine and neck while the low intensity group lost bone density .
This is quite astounding considering the demographic in this study was post menopausal women with an average age of 65! This is important not only because these women were well past 50 so their bone loss rate is pretty high to begin with but also due to the lack of estrogen due to menopause females have a quicker decline in bone density than males. This demographic should struggle the most with bone loss and these females were able to GAIN bone mineral density!! That is super inspirational in that there is certainly hope for at least holding off bone loss as we age regardless of the demographic.
I have talked a lot about resistance training and bone health up until this point, but you might be wondering if cardio can have the same effect?
It really depends on the modality, but ultimately resistance training is going to be better in general. Remember the stimulus for bone maintenance and growth has to do with the stress you are putting on your bones. Cardio modalities like swimming or cycling are going to have less stress on your bones, so most likely it’s not going to be the best option. Now compared to someone who is largely sedentary, swimming and cycling will be better than sitting on your butt but pale in comparison to resistance training. Cardio modalities that load your bones more will be better. Running or rowing would be examples of cardio that would put more load on your bones but in general you are limited by your body weight.
Perhaps the best form of cardio for bone health would be rucking. Rucking involved wearing a weighted backpack or weight vest and going for a long hike or walk with it on. The additional weight in the backpack or vest puts more stress on your bones and could be superior to many other forms of cardio.
The other big factor when it comes to bone growth and health is your diet. Along with the stimulus from loading your body, your body needs the building blocks to form new bone.
You probably already know this, but calcium is very important for bone growth and formation. In fact, bone is the primary place where calcium is stored in your body. When you think of where you get calcium in your diet you probably think dairy. However there are lots of whole foods that contain calcium. Here is a list of sources
According to Dr. Chris Kresser we should be shooting to get at least 600 mg and up to 1000 mg of calcium a day. As you can see you can do that fairly easily with a mixture of whole foods throughout the day.
The other nutrients which are important in bone formation are copper, zinc, magnesium, vitamin C and K, and protein. Copper and zinc are found in red meat as well as vegetables and oysters (zinc). Vitamin C is found in vegetables and fruit. Protein is protein, get an adequate amount from animal sources and/or a mixture of plant sources.
Nearly 70% of American adults do not meet the recommended daily allowance for magnesium. It seems that magnesium levels in our foods have dropped over the past several decades . Most people need to supplement with magnesium to reach optimal levels. I encourage you to talk to your doctor about supplementing with magnesium to make sure you are getting the proper amount and type.
Vitamin K can be found in grass fed dairy including ghee and butter as well as fermented vegetables and liver. If you don’t eat any of those products you again might talk to your doctor about supplementing.
Finally the other vitamin that is critical in bone formation is vitamin D. You should primarily be getting vitamin D from spending time in the sun. If however you live in colder climates during the winter time you may need to supplement to keep your levels high enough. Again work with your doctor to get on the right supplementation protocol.
Like I said at the beginning of this post, many of us don’t think about our bone health until it’s too late. If you are concerned about your longevity, your bone health should be top of mind. Breaking a bone when you are young is generally not a life threatening injury. However, breaking a bone when you are older can result in a cascade of health issues that oftentimes results in death. The earlier you act to address your bone health the better!
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