The Better Bones Blog

by Dr. Susan Brown, PhD.

2 hours of strength training a week improves bone density

Close-up of blue dumbbell in older active woman's hand

We’ve heard over and over that one of the best ways to build bone is exercise. I can’t tell you how many studies I’ve seen to confirm that. But the question a lot of people ask is, “How much do I need to do?”

And there’s great news for people with limited time: New research from the German scientist Wolfgang Kemmler shows that 2 hours per week of high-impact strength-training exercises done over the years on a regular basis is enough to favorably impact bone density, significantly reducing the rate of aging bone loss.

What a powerful argument for the importance of getting regular exercise – especially when you consider that I have seen research suggesting that, without taking any preventive measures, the average women will lose 45% of her bone and muscle mass as she moves from 35 to 85.

Latest study cuts exercise time needed for bone benefits

I first became aware of Dr. Kemmler’s studies in 2003 when his group published research showing that early postmenopausal women with osteopenia could get actually gain bone mass doing 4 hour-long strength training sessions per week. In this 14 month study the exercise program involved a variety of strength-building activities, including included warm-up/endurance, jumping, strength and flexibility training.

Remember, early postmenopause is a time when women lose 5% or even 10% of their bone mass. These exercising women actually gained bone density as a result of their serious strength training done 4 times a week.

Since I don’t think I could add 4 hour-long workouts into my week at that point without a lot of juggling, I was excited to see Dr. Kemmler’s latest report that bone benefits could be seen with a minimum of 2 hours per week of high-impact strength-training exercises.

Mindful exercise options for building bone

If strength training isn’t your thing when it comes to exercise, remember what we’ve seen about the effect on bone from different types of exercise at different exercise frequencies:

  • My friend, Miranda Esmonde-White, also reports that her Classical Stretch exercise program done on a regular basis has also led to increase in bone density. The same thing has been suggested for tai chi and other more mindful exercise modalities.
  • Studies now document that the regular practice of yoga could halt bone loss and begin to build new bone.
  • For those who love to walk, using a weighted vest is one of my favorite muscle and bone-building exercise options.

For me, it boils down to this: your exercise program will be good for bones if it’s sufficiently strenuous to maintain and even build body strength, and if you do it on a regular basis over the years.



Kemmler, Wolfgang et al., The Erlangen fitness osteoporosis prevention study: a controlled exercise trial in early postmenopausal women with low bone density—first-year results. Archives of Physical Medicine and Rehabilitation , Volume 84 , Issue 5 , 673 – 682,2003

Kemmler, Wolfgang et al. Exercise frequency and bone mineral density development in exercising postmenopausal osteopenic women. Is there a critical dose of exercise for affecting bone? Results of the Erlangen Fitness and Osteoporosis Prevention Study. Bone , Volume 89 , 1 – 6 (

Diabetes and osteoporosis

woman-thinking-about-blood-sugar-levelsWith World Diabetes Day on November 14, this is an ideal time to take a look at what osteoporosis and diabetes have in common. It’s a lot more than you may realize!

High blood sugar and high insulin levels damage bone

Scientists are untangling a multitude of ways in which high blood sugar and high insulin levels damage bone, including:

  • Suppressing bone turnover. Insulin has been known to contribute to the bone remodeling process for a number of years (Rosen & Motyl, 2010). But when insulin is present in excessive amounts (as in type 2 diabetes), bone resorption and circulating levels of osteocalcin both decrease — within hours of an insulin surge, according to a recent study (Ivaska et al., 2015).
  • Increasing inflammation. Hyperglycemia has been found to increase oxidative stress, which in turn promotes inflammation throughout the body (Fiorentino et al., 2015).
  • Weaknesses in collagen that occur when blood sugar is chronically high. This means that bone in someone with diabetes (regardless of type) is more fragile than would be expected for a given bone density, putting them at greater fracture risk. One recent symposium of international scientists even called for recognition of “diabetic osteodystrophy” given how well-known the connection between diabetes and poor bone health has become (Epstein et al., 2016).

Diabetes dramatically increases fracture risk

Even though folks with diabetes often have higher bone densities then their non-diabetic peers, they fracture much more. A recent systemic review of 16 studies confirms that those with type 2 diabetes have nearly 3 times the risk of hip fracture as age-matched non-diabetics. Persons with type 1 diabetes fare even worse, having more than a 6-fold increased risk of hip fracture as they age.

3 steps to manage blood sugar and support bone health

Given these connections, it might not be surprising that many steps you can take to manage blood sugar are the same things we recommend to support bone health:

  1. Get regular exercise. Just as exercise stimulates osteoblasts to build bone, it also makes cells more receptive to insulin — particularly in skeletal muscle. Studies have shown that even short-duration exertion can improve blood glucose levels (Colberg et al., 2013). So every time you walk, hop, or do yoga for bone health, you’re also maintaining your insulin sensitivity and reducing blood sugar.
  2. Try the Alkaline for Life diet. People with diabetes are urged to eat a diet rich in vegetables, legumes, whole grains, nuts and seeds, and lean meats with very limited processed sugars — sound familiar? My Alkaline for Life diet and diabetes-friendly diets such as DASH or the Mediterranean diet (Ley et al., 2014) advocate these foods for good reason, as they reduce inflammation and support stable blood sugar levels, making them good for bones as well as diabetes.
  3. Test your vitamin D. We know that vitamin D is essential for bone health. No surprise, correlations between both types of diabetes and low vitamin D have also been found (Song et al., 2013; Raab et al., 2014), so have your vitamin D level tested and make sure you have a 50 to 60 ng/dL level all year round.

And should you be among the nearly 10% of our population that already has diabetes, or if you have been told you are “pre-diabetic,” now is the time to get serious about both controlling your blood sugar and implementing my comprehensive Better Bones Program.

So in honor of World Diabetes Day, I urge everyone to remember that taking care of your blood sugar is taking care of your bones — and vice versa!


Colberg, SR, Hernandez, MJ, and Shahzad, F. Blood Glucose Responses to Type, Intensity, Duration, and Timing of Exercise. Diabetes Care 2013 Oct; 36(10): e177-e177.

Epstein S., Defeudis, G., Manfrini, S., Napoli, N., and Pozzilli, P on behalf of the Scientific Committee of the First International Symposium on Diabetes and Bone. (2016). Diabetes and disordered bone metabolism (diabetic osteodystrophy): time for recognition. Osteoporosis International 27: 1931–1951.

Fiorentino TV, Prioletta A, Zuo P, Folli F. Hyperglycemia-induced oxidative stress and its role in diabetes mellitus related cardiovascular diseases. Curr Pharm Des. 2013;19(32):5695-703.

Ivaska, K.K., Heliövaara, M.K., Ebeling, P., et al. The effects of acute hyperinsulinemia on bone metabolism. Endocr Connect 2015; 4(3): 155-162.

Janghorbani,M., et al. Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol. 2007;166 (5):495–505.

Ley, S.H., Hamdy O., Mohan V., Hu F.B. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. The Lancet 2014; 383(9933):1999–2007.

Raab, J., Giannopoulou, E.Z., Schneider, S. et al. Prevalence of vitamin D deficiency in pre-type 1 diabetes and its association with disease progression. Diabetologia (2014) 57: 902. doi:10.1007/s00125-014-3181-4

Rosen, C.J., Motyl, K.J. No bones about it: Insulin modulates skeletal remodeling. Cell 2010;142:198–200.

Song, Y., Wang, L., Pittas, A.G., Del Gobbo, L.C., Zhang, C., Manson, J.E., Hu, F.B. Blood 25-Hydroxy Vitamin D Levels and Incident Type 2 Diabetes. Diabetes Care 2013 May; 36(5): 1422-1428.


Onions — a fall favorite and bone superfood

When I was a kid, my family had a root cellar that was loaded up each fall with apples, squashes, potatoes and onions to draw upon all winter long. While I loved having fresh apples in February, my mother always wanted onions on hand for a welcome flavor boost.  Little did she know her recipes were helping us protect our bones too.

How onions protect bone

Onions are rich in highly anti-inflammatory anti-oxidant flavonoids, such as quercetin, that protect us from free-radical damage to bone. They also inhibit the development and differentiation of bone breakdown cells (osteoclasts), which prevents some of the osteoclasts from maturing and starting to break down bone. As a result, bone mass is preserved and even built.

And if this isn’t enough, onions are also high in bio-available sulfur compounds that the body needs to produce glutathione, our major intracellular antioxidant, and prevent excessive homocysteine accumulation, which damages collagen in the bone and arteries.

New study shows benefits

A recent Chinese study asked postmenopausal women to consume 3.4 ounces of onion juice a day for 8 weeks. The control group was onion juice-free. Women drinking the onion juice showed a significant decline in free radical levels and actually gained a bit of bone mass in only 8 weeks.

I know not everyone is ready to chug down half a cup of onion juice. (I’ve tried it straight-up, and it’s tough on the taste buds and stomach!) But most of us can add more onions to our diet, and not just as a seasoning. For example, I love roasted onions and indulge in French onion soup once in a while. The truly brave could try adding ½ cup raw onion juice to their finished soup or other dish.

Try this roasted root vegetable recipe with onions
From the Amazing Acid-Alkaline Cookbook by Bonnie Ross
Yield: 8 servings

6 large cloves garlic, whole
5 medium-sized parsnips, diced into 1-inch cubes
4 medium-sized potatoes, unpeeled and diced into 1-inch cubes
2 large sweet potatoes, unpeeled and diced into 1-inch cubes
2 large onions, sliced lengthwise
1 medium-sized butternut squash, diced into 1-inch cubes
½ cup light olive coil
1 tsp sea salt

1.    Preheat the oven to 400 degrees F. Light coat two 9-x13-inch baking dishes with vegetables oil and set aside.
2.    In a large bowl, combine the garlic, parsnips, potatoes, onions, squash and oil. Toss well.
3.    Add the sea salt to the vegetables and toss again.
4.    Transfer the vegetables to the prepared baking dishes, spreading them out in a single layer.
5.    Roast the vegetables for 35 minutes or until lightly-browned and fork tender, and serve.

Law YY et al., Consumption of onion juice modulates oxidative stress and attenuates the risk of bone disorders in middle-aged and post-menopausal healthy subjects. Food Funct. 2016 Feb;7(2):902-12. doi: 10.1039/c5fo01251a.

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