For adults with low bone mass or osteoporosis, engage in high-intensity resistance and impact training (HIRT) twice a week for 30 minutes, focusing on compound, weight-bearing free-weight movements like squats and deadlifts at 85% of one-rep max (1RM) to stimulate bone adaptation and improve balance.
Individuals with osteoporosis, especially those at high fracture risk or with co-morbidities, should seek supervision from a clinically trained professional (e.g., physical therapist, accredited exercise physiologist) who understands both strength and conditioning and clinical management to ensure safety and proper execution.
When starting a high-intensity resistance program, especially with osteoporosis, begin with light weights (e.g., a broomstick) to master proper technique, as correct form is crucial for safety and effectiveness, particularly avoiding spinal flexion during lifts.
Understand that high-intensity resistance training not only improves bone density and geometry but also dramatically reduces fall risk by increasing muscle mass, balance, motor control, posture, and grip strength, significantly enhancing overall quality of life and independence.
For supervised, evidence-based training, seek out an Onero-accredited physical therapist or exercise physiologist (via The Bone Clinic website) or contact The Bone Clinic for telehealth advice if an accredited provider is unavailable locally.
Sustain or increase levels of bone-friendly physical activity from early adulthood throughout life to maintain bone density, as bone loss often attributed to aging is largely a consequence of sedentary behavior.
Prioritize exercise and physical loading for bone and muscle health, as no drug can fully replicate its benefits, and drugs likely require exercise to be effective.
Women should proactively address bone health and consider hormone replacement therapy (HRT) during the pre- and perimenopausal stages, rather than waiting until full menopause, to maximize estrogen’s protective effect on bone.
When tracking bone health, consider stabilization of the T-score and improvement in the Z-score (compared to age-matched peers) as a significant win, even if the T-score doesn’t improve, as it indicates effective mitigation of age-related decline.
Focus on helping children achieve their maximum genetic bone potential before growth plates fuse (late teens/early 20s) because osteoporosis is often considered a ‘childhood disease’ where the foundation for future bone health is laid.
Ensure children and grandchildren are outside and active every single day, engaging in ‘bone friendly activities’ to build strong bones.
Encourage children to participate in vigorous, dynamic, and varied high-load activities that involve jumping, landing, and strong muscle movements (e.g., basketball, volleyball, tennis, gymnastics, soccer), as these impart high strain on bone, stimulating adaptation more effectively than swimming or walking.
Allow children to engage in resistance training, as there is no evidence it stunts growth; focus on teaching proper technique (e.g., deadlifts) and making it enjoyable to foster lifelong activity.
Parents can encourage children to lift weights by having them join in home gym sessions, allowing them to naturally pick up weights and copy movements, providing an opportunity to teach proper technique.
Teenagers should aim for about 1,000 milligrams of calcium daily, primarily from bioavailable dairy sources like milk (e.g., three 250ml glasses), yogurt, and cheese, as most kids may not consume enough naturally.
Facilitate safe, regular sun exposure (e.g., before 10 a.m. and after 2 p.m. in Australia) for children to obtain vitamin D, which is crucial for calcium absorption, avoiding sunburn.
Rely on milk, dairy, and sunlight for children’s vitamin D needs, as supplementing kids is less advisable due to difficulties in measuring levels and potential risks of hyperdosing.
Reduce corticosteroid use (inhaled or systemic) as much as possible throughout life, for both children and adults, as they are detrimental to bone health; if medically necessary, use for the shortest duration possible and titrate down when feasible.
If corticosteroids are medically necessary for a child, double down on other bone-building strategies: ensure adequate calcium (e.g., 750ml milk daily), regular sun exposure, and engagement in diverse, load-bearing sports and weightlifting.