One thing we know about bone is that it responds to increased weight load by getting stronger. So the recent findings of an Australian bone clinic that studied women doing high-intensity weight lifting really shouldn’t surprise us. But just look at these results!
What happens when older women weight lift?
The clinic studied 101 postmenopausal women with a T score below –1; 44 were classified as having osteoporosis and the remaining 57 were considered to have osteopenia. A bit more than one-fourth of them had already had a fracture.
The women were divided into two groups, experimental and control; they exercised twice a week for at least 8 and up to 12 months, but the kinds of exercise they did were different. For the control group, a low-intensity, home-based exercise regimen that emphasized balance and mobility, but not heavy weight loading, was used. They did lunges, calf raises, and stretches with no more than 3-kg weights in their hands — common types of exercises recommended for older women seeking to maintain fitness and bone strength.
The experimental group, on the other hand, underwent supervised, 30-minute sessions of high-intensity resistance training at 80–85% of the “1 rep max” weight — that being the weight they could only lift only once with maximum effort. The exercises included deadlift, overhead press, and back squat along with jumping chin-ups with drop landings. These types of exercises are not usually recommended for older women, and prior studies of weight-bearing exercise for bone mass improvement used moderate loads rather than high loads, as in this study.
The bigger the load, the stronger the bone
The study’s results were striking:
• The high-intensity group gained an average of 2.9% BMD in the lumbar spine, while the control group lost an average of 1.2%.
• The high-intensity group gained on average 0.3% BMD in the femoral neck, while the control group lost on average 1.9%.
• The high-intensity group gained 13.6% femoral neck cortical thickness, while the control group lost 6.3%.
Some of the individual outcomes were truly amazing. One 59-year-old-woman who trained for a total of 12 months saw an increase of 10.5% in the hip and 8.8% in the lumbar spine!
I just heard about even more record-breaking gains from “C.F.” — one of our clients. Motivated to find a way to reverse her ongoing bone loss, C.F. — a 69-year-old woman — combined our Better Bones, Better Body Program with supervised high-intensity strength training. In just 1.5 years she gained a whopping 21.5% in the neck of the hip, 10% the total hip and 5.6% in spine — moving her totally out of the osteoporosis category! Her doctor was so astonished she called me to ask what we were doing. This is a bone density gain that is unprecedented and we will soon be make available to you the details of our client’s full program.
The benefits of high-load weight lifting for older women
Given that we’ve known for years that bone responds to the load placed on it, why hasn’t high-load weight lifting ever been looked at before in women?
As the authors of this study point out, it’s a common misconception that women with low bone mass risk developing spinal fractures if they use heavy weights or free-weight exercises — but this study shows that isn’t true. Only one woman in the study had any sort of injury — a mild muscle strain in her lower back that probably occurred from an error in technique (which is very important in free-weight lifting) rather than the amount of weight she used. Keep in mind, these women were carefully taught the proper form for lifting and highly supervised. Should you try a high-intensity resistance program yourself, be sure to work with a qualified training.
What all this tells us is that even in women who are actively losing bone, high-intensity weight-bearing exercise offers more benefits in reversing the trend than low- or moderate-load weight-bearing exercise.
At the Center for Better Bones, we view exercise as an important part of a natural approach to building and strengthening bone. Learn about our Better Bones, Better Body Program to find out how you can start building serious bone naturally.
Watson SL, Weeks BK, Weis LJ, et al. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: The LIFTMOR Randomized Controlled Trial. Journal of Bone and Mineral Research 2018; 33(2): 211–220. DOI: 10.1002/jbmr.3284
There are so many foods that boost nutrient intake and improve bone health, but one food that’s captured my interest lately is actually an herb — stinging nettle. Though many of us in North America tend to regard stinging nettle as an irksome lawn weed, the plant has a long history of use as a multi-purpose medicinal herb. Dried or wilted, and prepared in a simple infusion, stinging nettle is a fascinating option for women with osteoporosis.
Nettle is a nutritional powerhouse for bones
One of the important facets of this plant is its amazing nutrient content — including many key nutrients for bone health. Herbalist Susan Weed says that “[there] is no denser nutrition found in any plant, not even bluegreen algae” and after looking at the nutritional studies of this herb, I believe it!
Stinging nettle is rich in a multitude of amino acids, carbohydrates, proteins, flavonoids, and is a terrific source of many bone-building minerals (iron, calcium, magnesium, silicon, potassium, manganese zinc, copper, and chromium) and vitamins, including vitamin K (an important bone builder), vitamin C (a key antioxidant shown to reduce fracture risk) and most of the B vitamins (Ait Haj Said et al., 2015; Segneanu et al., 2017).
Scientists have started to take a closer look at this nutritional powerhouse, and the number of potential medicinal benefits range from anti-tumor and anti-inflammatory action to immune boosting, blood pressure reduction, relief of rhinitis, arthritis and rheumatism, and diabetes and cardiovascular disease prevention (Di Virgilio et al., 2015; Ait Haj Said et al., 2015; Segneanu et al., 2017). And, of course, its many nutrients have value for osteoporosis and bone health — but unfortunately, there’s very limited research in this area. What little there is does suggest that nettles might help maintain bone density during menopause (Gupta et al., 2014), so hopefully more studies will be undertaken.
Easy ways to give nettles a try
So how do we unlock the benefits of this multi-faceted herb? Susun Weed recommends making an herbal infusion using about 1 ounce of dried nettles (about 1 cup of dried nettles) added to 1 quart of boiling water and allowed to brew for at least four hours (or overnight) to extract the bone-supporting nutrients from the herb. Once it’s done steeping, you’d strain it, making sure to squeeze the soaked herbs to get every bit of goodness out of them, and then refrigerate it to use over the next few days.
Simply drink the nettle infusion cold or warm (reheat infusion to temperature of your liking) all on its own, or, as Susun Weed suggests, mix the infusion with a little fruit juice for sweetness.
There are abundant recipes online for using nettle or nettle infusion in soups, stir fry, or pasta dishes — cooked, the nettle compares in flavor to spinach. Here are some nettle-infused dishes one of our clients shared to give us all some inspiration:
Arugula salad with 1 cup kidney beans, avocado, hemp seeds, olive oil, lemon juice and ground red pepper; nettle infusion; watermelon.
Kale salad with apples, almonds, olive oil and apple cider vinegar; watermelon; nettle infusion
Tossed salad with blackened catfish, hard boiled egg and balsamic vinaigrette; nettle infusion.
Recently, Sarah came to my office reporting that her doctor wanted her to take the bone drug raloxifene (Evista™). She wanted to know if I thought this medication would benefit her, so I sat down to take a fresh look at the first and largest controlled study on this drug.
The short version of what I discovered: there is limited benefit and substantial risks with this bone drug. But to understand why, you need to know the long version: what this drug does, and what it doesn’t do.
What is raloxifene (Evista™)?
Raloxifene is a “selective estrogen receptor modulator (SERM),” which puts it in the same family as the breast cancer drug tamoxifen (it was studied for breast cancer, but proved less effective than tamoxifen). SERMs bind to estrogen receptors and mimic estrogen’s effects; the idea is that you can get estrogen’s beneficial impacts on bone, but without the negative estrogen effects of on the uterus endometrial and breast tissue.
What raloxifene’s fracture prevention trial reveals
Back in the late 1990s, researchers conducted the first (and largest) placebo-controlled fracture prevention trial to determine what raloxifene might offer for osteoporosis. This trial involved 6,828 postmenopausal women divided into two treatment groups: One that was given a placebo, and the other given raloxifene in either 60 or 120 mg daily doses.
All of the study subjects had osteoporosis as determined by bone density measurement (–2.5 T score), and some of the women had already experienced a spinal fracture. The study was three years in duration.
Fracture reduction at three years:
- Of the 6,828 women in the study, 503 (7.4%) experienced at least one new vertebral fracture during the study period.
- In the placebo group, 10.1% experienced a vertebral fracture visible on x-ray (not necessarily symptomatic) during on the 3-year study.
- In the treatment group using 60-mg doses of raloxifene, 6.6% experienced a new vertebral fracture. This represents an absolute risk reduction of 3.5% — that is, among those using raloxifene, 3.5 fewer vertebral fractures occurred per 100 women as compared to those not taking the drug.
- Importantly, there was no significant reduction in hip fracture or other non-vertebral fractures with the use of raloxifene. While spinal fractures are a key warning sign for osteoporosis, they don’t affect quality of life nearly as much as hip fractures do.
All in all, this very large study showed that this drug had a small effect on reducing vertebral fractures and no significant effect on reducing hip or other non-vertebral fractures.
The risks of raloxifine lead to FDA black box warning
Unfortunately, even this very first study on raloxifene reported serious adverse effects, most notably a three-fold increase in the risk of potentially life-threatening venous blood clots (thrombosis).
Ten years after the drug was approved, the FDA issued a black box warning about this side effect — which is the most serious notification of potentially life-threatening adverse effects the FDA can require, short of withdrawing the drug from the market. I’ve reproduced it here so you can see what it says.
Is there a better way?
After looking at this information and comparing the mild possible benefits to the significant potential harms, Sarah and I have to ask the question: Is there a better way?
Currently, there are number of bone drugs prescribed to intervene with the mechanisms of skeletal weakening, and many more are in the pipeline. Given that up to half of the women 50+ in this country will be told to take a bone drug at some point, it’s a great idea to take a look at what these drugs do, the degree to which they really prevent fracture, and their potential risks, and what other avenues might be available to you.
Then make up your own mind.
Cranney A, Adachi JD. Benefit-risk assessment of raloxifene in postmenopausal osteoporosis. Drug Saf. 2005;28(8):721-30.
Duvernoy CS1, Yeo AA, Wong M, Cox DA, Kim HM. Antiplatelet therapy use and the risk of venous thromboembolic events in the Raloxifene Use for the Heart (RUTH) trial. J Womens Health (Larchmt). 2010 Aug;19(8):1459-65. doi: 10.1089/jwh.2009.1687.
Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 1999;282(7):637-645.