How to boost your bone strength - with exercise

A new treatment for osteoporosis will assist millions. Here are other ways to help yourself.

Women are most at risk of developing the bone-thinning condition osteoporosis. Picture: IStock

One in three women and a fifth of men over the age of 50 will suffer a fracture caused by the bone-thinning condition osteoporosis, and an announcement this week that a new drug treatment for the condition has been approved by the National Institute for Health and Care Excellence has been welcomed by experts who say it could benefit as many as 14,000 women in England.

Abaloparatide, the new anabolic drug treatment that is marketed as Eladynos, will be available on the NHS in three months’ time for women who have not responded to other treatments. It works by stimulating the cells that are needed for bone formation and has the potential to prevent life-changing spinal fractures and broken hips.

Osteoporosis affects 3.8 million people in the UK, with women most at risk. In early adulthood, bones are kept strong and healthy with the continual turnover of new bone cells and the removal of old ones. However, once we hit peak bone health at the age of 30 the strength of our bones starts to decline, especially in women around the menopause when levels of the bone-protective hormone oestrogen drop. By middle age the body’s bone-building capacity has become markedly less efficient, with old cells being broken down faster than new ones can be formed.

NICE has recommended abaloparatide for treating osteoporosis post-menopause, for those with a very high risk of fracture.

With over 14,000 eligible, abaloparatide increases bone density by stimulating new bone making cells and reduces risk of fracture.https://t.co/2sQzPNnupgpic.twitter.com/xma6jiaweD

— NICE (@NICEComms) August 7, 2024

While the arrival of abaloparatide is good news for sufferers, Sarah Leyland, a specialist osteoporosis nurse and clinical adviser to the Royal Osteoporosis Society (ROS), says that maintaining bone health remains a priority. “Thinning bones are not an inevitable part of ageing, and exercising in the right way can help to preserve our skeleton.” Here’s how to do it.

RUN EVERY DAY - FOR JUST ONE MINUTE

Brief bursts of 1-2 minutes of high- impact weight-bearing activity such as running is enough to boost bone health in women, according to a joint study by researchers at the Universities of Exeter and Leicester. In their review of 2,500 British women published in the International Journal of Epidemiology, the team found that those who managed 60-120 seconds of running a day had 4 per cent stronger bones than those who did less than 60 seconds. The intensity required was equivalent to a medium-paced run for pre-menopausal women and a slow jog for post-menopausal women. “A few minutes of running a week is better for bones than lots of walking,” Leyland says.

INVEST IN EXERCISE BANDS

Strength training is hugely beneficial for bones, but if you are new to it, it is worth investing in some elastic exercise bands to get started. Designed to stretch and strengthen muscles as they work against the tension of the fabric, bands are available as rubber tubes with handles, mini-band loops, luxury fabric bands or basic stretches of cheap latex cut to different lengths. They are generally colour coded, with yellow as the easiest resistance, red and green in the middle, and blue, grey and black as the hardest, meaning you can progress as you get stronger. “You can also increase the resistance of bands by shortening them,” Leyland says. In July a review involving 108 older women published in the Journal of Orthopaedics found that training with bands on three or more days a week produced “notable improvements in bone density” after 12 weeks.

If you are new to strength training it is worth investing in some elastic exercise bands to get started. Picture: Supplied

MOVE ON TO WEIGHTS WHEN YOU ARE STRONG ENOUGH

When you feel you have progressed to your strength limit with exercise bands, it is time to pick up dumbbells or a kettlebell. In a UK consensus on exercise for osteoporosis, published in the British Journal of Sports Medicine two years ago, experts concluded that “progressive muscle resistance training” should be performed at least twice a week for optimal bone health. Ideally, exercises that target the whole body, including weighted lunges and squats, hip abduction and adduction, leg press, back extension and abdominal exercises, should be included.

“Weight training causes tugging and pushing on bone that helps to instigate bone formation with the result being stronger, denser bones,” Leyland says. “Even if we haven’t used them before, we should all be working towards lifting weights as we age.”

PLAY TENNIS (OR BASKETBALL OR VOLLEYBALL)

When it comes to bone-boosting, the ideal exercise is one that involves both changes in direction and some resistance in the form of jumping and landing. “From middle age, bone health is supported by exercise that loads the skeleton in a multidirectional way,” says Dr Nicky Keay, an honorary clinical lecturer in medicine at University College London and author of Myths of Menopause. “Any ball sports, including football and netball, are a great way to achieve this.” According to the ROS, basketball and volleyball are among the highest impact activities - and the best bone builders - although all racket sports are also helpful.If you are a cyclist or swimmer, aim for 50 high-impact ‘jolts’ every day.

Swimming and cycling are great activities for strengthening muscles but, because your body weight is supported by water or a bike, they are less effective for building bones than weight-bearing exercise. “The higher the impact of an activity, the better it is for your bones,” Keay says. “Putting extra load through the skeleton with jumps and hops provides a direct mechanical bone-building stimulus.”

Aim for 50 high-impact bone jolts a day in the form of hops, skips, star jumps or running strides. “These extra jolts are essential for bone health if you favour swimming, cycling or low-impact activity, such as walking”, Leyland says.

Swimming is a great activity for strengthening muscles but less effective for building bones. Picture: iStock

HOP IN DIFFERENT DIRECTIONS

If ball sports are not your thing, then a simple alternative is to add multidirectional hopping - diagonally, backwards and forwards and not just on the spot - to your routine.

“In one of my studies, I asked middle-aged cyclists to add simple multi-directional hopping to body weight and resistance exercises for a total of 15 minutes, three times a week,” Keay says. “When combined with sound nutritional strategies such as sufficient vitamin D intake, the cyclists saw a clinically significant improvement in bone mineral density [BMD] over six months.” Those who didn’t do the hopping and resistance work lost BMD in the same time period.

Aerobics can improve muscle and bone strength. Picture: News Corp

DANCE OR PRACTISE HIGH-IMPACT AEROBICS

Both dance and high-impact aerobics are excellent ways to strengthen muscles and provide medium-impact bone-strengthening effects. “There are lots of changes of direction and with more energetic dance forms there are jumps that are beneficial for bones,” Keay says. A study of post-menopausal women with low BMD in the journal Medicine showed that a 60-minute aerobic dance class performed three times a week resulted in stronger leg and hip bones after 24 weeks.