Exercise and Osteoporosis: A Primer on Tomorrow’s Therapy

Perhaps the worst health epidemic in this country is one that few people recognize as an epidemic at all. It will affect more people than heart disease, stroke, or cancer. One in every two women over the age of 60, and one in every two men over the age of 80 is at risk. This epidemic is osteoporosis.

Osteoporosis is defined as a a reduced density of the bone. The causes seem to be multiple, but inadequate storage of calcium during the younger years, and a rapid loss of calcium after middle age are the main culprits.

A net loss of calcium occurs in many adults, especially women after menopause or hysterectomy suggest that hormonal changes may be responsible. Many minerals and vitamins are required to form and stabilize the structure of bones, including magnesium, fluoride, vitamin A, and others. Any of these may be essential for preventing osteoporosis. One obvious line of defense is to maintain a lifelong adequate intake of calcium.

Although calcium seems to be one of the most talked-about types of therapy, most medical practitioners are touting HRT (hormone replacement therapy) to keep the regulation of hormones constant in the system. After a hysterectomy, the hormones estrogen, progesterone, and to a lesser extent, testosterone, which are normally secreted by the ovaries to influence general health, bone strength, sexuality, and reproduction, no longer secrete. It is then prescribed medically to mimic these levels.

However, many women are concerned about the association of hormone therapy and the increased incidence of cancer, and some of hysterectomy in general. A logical question to ask is: what, if any measure may be taken to prevent the decline in hormones later in life, and help with a decline in overall function after menopause. One measure may be exercise. It has been shown to have profound effects on overall health, reduction of cardiovascular disease, increase in bone strength, reduction in body fat, increases in self esteem, improvement in muscle mass Ð even after 80 years of age.

With all of these positive benefits, why aren’t more people taking advantage of exercise as both a preventive and therapeutic avenue for improved health for osteoporosis. One – there is simply not enough information about the benefits that filters down to the general population. In many physician’s offices, there is a lack of information that is dispensed to patients. The results of many sports medicine studies are not reported on a regular basis, and perhaps the most important Ð the correct type of exercise program may not be provided to the general population.

Most people are convinced after 20 years of reports that aerobic conditioning is the most beneficial type of exercise for most conditions, whether they are cardiovascular, or orthopedic. Aerobic training does produce many important physiological changes in the body. However, the specific needs of many individuals, especially those over 60 years of age have to do with functional ability Ð or the need to perform day to day tasks without undo effort. Strength training is coming into its own as an important aspect of overall health, and not just to improve sports performance.

In almost everyone with osteoporosis, the density of the bone in the lower lumbar, and femoral neck regions are most affected by mineral loss. The effect of strength training is to enhance the uptake of minerals by the bone to handle the stress imposed by the increased stress of lifting weights. This increased stress must produce some physical change in the muscle, tendon, and bone, or else injury will occur. Therefore, a properly designed program will avoid injury, and strength the musculature while adding density to the bone over time.

This portion of our article will concentrate on the most important areas of the body to strengthen, what types of exercises to perform, and the proper progression to perform them in to enhance muscular and bone development.

Section #1 is the hip area. Comprised of the largest muscles in the body, the hip area is the foremost section of the body to train. The most important types of machines to condition this area are the leg press, and total hip machine, shown in photos 1 and 2. The leg press is a compound machine, working the muscles of the hip and thigh during each push. The hip machine is an isolation machine, concentrating on one muscle group at a time (in this case, the gluteus maximus). Working the upper body major muscles (chest, shoulders, back) comprises section #2, and provides resistance to the bones of the upper vertebrae, long bones of the arms, and ribs. Photo 3 illustrates a weight-assisted machine for working the chest area (dip exercises), and the back (pull up exercises).

The most important element of exercise for this group is training progression, as the goal is to strengthen weak and porous bone to its natural density. A beginning program would start with low intensity, and more repetitions. It would look something like this:

PHASE I:IntensitySetsReps
Chest DipsLow2-310-15
Lat PullsLow2-310-15
Hip ExtensionsLow/medium3-410-15
Leg PressLow/medium3-410-15

After a period of adaptation (phase I), it is time to increase the intensity, and change the number of sets and reps.

PHASE II:IntensitySetsReps
Chest DipsMedium310-10-8
Lat PullsMedium310-10-8
Hip ExtensionsMedium-high4-(5)10-8-6-4
Leg PressMedium-high4-(5)10-8-6-4

The goal is to progress to a level that is is perceived as difficult, strengthens the musculature, and over time (4-8 months), has a positive effect on the bone density (as seen by DEXA scan). Medically, the density should improve from -10% loss to normal (0% loss in bone).

Both of the phases of training can be manipulated by the therapist/trainer depending on the initial conditioning level of the participant. Training should proceed in phases, as staying with the same level of resistance will not improve bone density or muscle strength.

This beginning program should give some hope to those who have not thought of strength training as a method of therapy for their osteoporotic condition. It is “good medicine” that can be performed, and enjoyed for a lifetime.


1. Greenwald, S. Menopause, Naturally. Volcano Press, Volcano, CA, 1984.

2. Whitney, E.N., Hamilton, E.M.N. Understanding Nutrition, 3rd Edition. West Publishing Company, St. Paul, MN, 1984.

3. Bompa, T.O. Periodization of Strength: The New Wave in Strength Theory. Veritas Publishing, Toronto, Canada 1993.

About the Authors

Eric Durak is the director of Medical Health and Fitness, a research and consulting firm based in Santa Barbara. He specializes in exercise programs for special population groups, and has published scientific articles in: The American Journal of Obstetrics and Gynecology, Diabetes Care, and The Somatics Journal. He is the author of Exercise, Cancer, Wellness, and Rehabilitation, published this year.

Charles Staley is Vice President for Program Development at the International Sport Sciences Association. A former martial arts competitor and current top-ranked master’s discus thrower. Charles has written over 50 articles on the topics of sports training, fitness, body building, and nutrition. He serves as a faculty for ISSA seminars across the nation.

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Written by Eric P. Durak MSc

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