Osteopenia & Osteoporosis
(low bone mineral density, BMD)

"It was a real shock to discover I had osteoporosis. I feel like my body has let me down"

Jean, 63

Everyday, hundreds of peri and postmenopausal women receive the news that they have low bone mineral density (BMD), either in the early osteopenic stage, or late osteoporotic stage. It can be a devastating blow after years of good health and doing 'all the right things'. Distressingly, our body's don't give us any early warning signs. Sometimes, a diagnosis comes after a low trauma fracture sustained from a fall, typically to the forearm, and a DEXA scan is performed.

A DEXA scan measures your BMD, an important measure of bone health. Your DEXA (or QCT) scan will provide you with a range of T scores at the hip and lumbar spine, and indicates how many standard deviations your BMD is from a reference woman in her late 20s (when our BMD peaks). Osteopenia is indicated with a T Score between -1 and -2.5, and osteoporosis with a T Score less than -2.5. There are many risk factors for low BMD, some of which you have no control over (called non-modifiable risk factors) and some of which you do (called modifiable risk factors).

One of the biggest non-modifiable risk factors is declining estrogen associated with menopause, particularly in the first 5-8 years post menopause. Here, some women can lose up to 25% of their BMD by age 60, with the typical rate of loss between 1- 2% per year. During this time, slowing down the accelerated rate of loss becomes crucial; in other words, you need to get out in front of it by taking strong action.

Taking Strong Action

Exercise is a well-established modifiable risk factor for osteoporosis and can increase BMD. In fact, exercise is one of the most effective tools for improving your BMD and reducing your risk of fracture. However, not all exercise is equal. Walking, swimming, gardening, and cycling will not result in robust changes to BMD. We know that two types of exercise, 1. progressive resistance training (using weights, and getting progressively harder over months - years), and 2., moderate to high impact exercise, is superior. These types of exercise can be so effective in your 40s to 60s that they have the potential to actually restore some of your BMD. But by how much, and is it worth the effort?

Research studies conducted over the past 15 years have consistently shown that progressive resistance training can significantly increase BMD in peri and postmenopausal women. For example, the LIFTMOR randomised controlled trial conducted in 2018 in Australia found that progressive resistance training combined with moderate to high impact exercise improved BMD in postmenopausal women with osteopenia and osteoporosis by an average of 2.9% at the lumbar spine and 4.9% at the hip after 8 months of training (Watson et al., 2018).

Another study published in the Journal of Bone and Mineral Research in 2016 found that progressive resistance training increased BMD at the femoral neck by 3.5% and at the lumbar spine by 2.5% in postmenopausal women with low bone mass after 12 months of training (Martyn-St James et al., 2016).

Finally, a meta-analysis published in the Journal of Bone and Mineral Research in 2021 included 73 randomised controlled trials with a total of 4,274 participants and found that exercise interventions, including progressive resistance training, were associated with significant increases in BMD at multiple skeletal sites in postmenopausal women, with a mean percentage increase in BMD of 1.4% at the lumbar spine, 1.1% at the femoral neck, and 0.9% at the total hip in postmenopausal women. Recall that in the first 5-8 years post menopause a women can lose over 2% of her BMD per year.

This means the right type and frequency of exercise can effectively slow the rate of loss down, and may even improve a woman's BMD.

Progressive resistance training is not only effective in increasing BMD, but it can also improve muscle strength, power, and balance. Research has shown that muscle strength and power are critical determinants of physical functioning in older adults and are strongly associated with fall prevention (Reid & Fielding, 2012). Additionally, improving muscle strength and power can help maintain an active and independent lifestyle as we age.