Why And How You Should Train Bone Density As You Age

A drop in our bone density as we age is inevitable, but research shows, it is not irreversible. According to a study published in Medical Clinics of North America, more than 10 million individuals in the United States are diagnosed with osteoporosis, and more than half of the US population, 50 years old and above have low bone density. The mother of John Jaquish, PhD was one of them. However, in as much as 18 months, she’s reversed it. So, why and how you should train bone density as you age? Let's discuss.

For years, studies have looked at what type of physical activity may be beneficial for improving bone density. Walking, weight training, and whole body vibration plates have been studied, but with very little lasting bone density impact. Results from a population-based study showed that jogging is of little benefit when it comes to bone mineral density. So, we asked Jaquish how he was able to help his mom reverse her osteoporosis.

In an interview with Healthnews, biomedical engineer and best-selling author Dr. Jaquish stated that although he followed the protocol with his mother more strictly than most people, people would still see results every week, and many had even reversed their bone density loss prognosis. All that is done with a technique called osteogenic loading and the specific use of four pieces of equipment once a week.

“Every week, they see their functional bone performance improve. Week by week, the number keeps getting bigger. The nerves within the bone are more encapsulated by having a stronger bone,” he said, adding that people stop taking their medication all the time.

Before diving deeper into the methodology, let’s take a few steps back and explore what bone density is, how it changes as we age, and why women experience a greater loss during menopause.

What is bone density?

Calcium and phosphorus make up the majority of bone density, also known as bone mineral density (BMD), which is the foundation for bone strength, fracture resistance, and osteoporosis. Maintaining optimal bone density is essential for maintaining the integrity of our body's framework, protecting our most important organs, and promoting physical functionality and mobility.

But as people age, their bone density naturally decreases for a variety of reasons, such as changes in hormones, less physical activity, and poor mineral absorption. A sedentary lifestyle, smoking, and some medications are examples of additional lifestyle factors that can negatively affect bone density.

Dr. Jaquish said that generally people reach peak bone density by the age of 30, and then a decline begins at a steady rate dropping each year. This gradual reduction in bone density predisposes individuals to weakened bones, elevated risk of fractures, and the onset of osteoporosis, characterized by brittle and porous bones.

Bone density-induced fractures societal and economic burden

Fracture is the most dangerous side effect of osteoporosis. A study conducted in 204 countries and territories between 1990 and 2019 that examined the global burden of osteoporosis, low bone mass, and fractures related to these conditions found that by 2050, the incidence of hip fractures in men will rise by 310%, while in women it will rise by 240%.

Furthermore, it was mentioned that "big prospective study results indicate that patients with low bone mineral density experience an increase in almost all types of fractures and that adults with one type of fracture already have a 50% to 100% increased risk of having another type of fracture, regardless of the type."

Furthermore, a thorough analysis of 28 publications revealed a sizable financial cost related to osteoporosis. The primary contributors to this burden were the costs associated with fractures. The review states that in Canada, Europe, and the USA alone, the annual direct costs of treating osteoporotic fractures range from $5 trillion to $6.5 trillion. Researchers pointed out that these numbers did not account for indirect costs like lost productivity and disability; as a result, significant cost savings can be realized by making investments in prevention.

Bone density loss in men vs. women

For women, the onset of menopause marks a period of rapid bone loss. Women are more vulnerable to a decrease in bone density because of the direct effect that menopause's lowering of estrogen levels has on bone mineralization and remodeling.

Estrogen plays a pivotal role in maintaining bone density by inhibiting the activity of osteoclasts, cells responsible for breaking down old bone tissue. With declining estrogen levels, osteoclast activity increases, leading to accelerated bone resorption and decreased bone formation.

According to a study that was published in the Journal of Bone and Mineral Research, there is a three to ten times larger reduction in bone mineral density in the femoral neck and trochanter regions in the first six years following menopause than there is in the decade preceding menopause.

Additionally, researchers observed that during this early postmenopausal phase, about 20% of the total BMD loss occurs in the femoral neck and 30% in the trochanteric region. This emphasizes how crucial it is to keep an eye on bone health and take precautions during this crucial time.

In men, though the reduction in sex hormone levels is less dramatic compared to women, age-related bone loss is still a significant concern. Testosterone, a key player in maintaining bone density in men, diminishes with aging, contributing to the gradual drop in bone mineral content.

How to measure bone density

Measuring bone density is typically done through a diagnostic test called Dual-Energy X-ray Absorptiometry (DXA or DEXA). This painless and non-invasive method involves the use of low-dose X-rays to evaluate the mineral content and density of bones, typically in the hip, spine, or occasionally the forearm.

The results of this evaluation are presented as a T-score, which contrasts a person's bone density with that of a young, healthy adult. A T-score of -1 or higher is regarded as being within the normal range; a T-score of less than -1 indicates reduced bone density.

This test helps determine the likelihood of fractures and the possible existence of diseases like osteoporosis. In older people and those who are at risk of bone-related problems, DXA scans are especially useful for assessing bone health, directing treatment choices, and tracking changes in bone density over time.

During follow-up investigations into the effects of the OsteoStrong technology that he developed, Dr. Jaquish and his colleagues also examined two other metabolites: BAP and NTX. According to OsteOstrong's founder and CEO, Kyle Zagrodzky, "These blood tests will tell you that you are building bone but not by how much."

The cells called osteoblasts, which are in charge of creating new bone, produce the enzyme BAP. It is a bone formation marker that is generally elevated during active bone remodeling or growth.

On the other hand, NTX is a marker of bone resorption. It measures a fragment of collagen that is released during bone breakdown. Elevated NTX levels indicate increased bone resorption activity.

What is osteogenic loading?

According to Zagrodzky, the osteogenic loading method used by OsteoStrong is founded on the idea of Wolff's Law, which was identified by Dr. Julius Wolff in the late 1800s. According to this law, bones strengthen and increase in density in response to the loads applied to them. OsteoStrong takes this concept to the next level by applying specific loading forces that surpass those experienced in daily activities or traditional weight training.

Dr. Jaqush clarified that the loading she was referring to is mechanical loading, which applies mechanical stress to both bones and muscles. The process of myofiber hypertrophy, in which individual muscle fibers (myofibers) grow in size or cross-sectional area, is dependent upon this stress. Such exercises put stress on your muscles, leading to tiny tears in the muscle fibers, this is known as hormetic stress or good stress.

In response to these micro-injuries, the body initiates a repair and growth process. Over time, the muscle fibers adapt by becoming larger and thicker, leading to an overall increase in muscle size and strength, and, at the same time, it promotes bone density. When muscles contract against resistance, they pull on the bones they are attached to, leading to bone adaptation to withstand the increased forces. This process results in stronger and denser bones.

How to train for bone density

Taking Wolff’s Law a step further, Dr. Jaquish and Zagrodzky pointed out that researchers discovered that the minimum amount of impact force needed to trigger an increase in bone density is 4.2 multiples of body weight. According to the study's findings, "moderate impact activity, like jogging, has little benefit on hip BMD and structure in adolescents, whereas physical activity associated with impacts >4.2g, such as jumping and running (which further studies suggested requires speeds >10 km/h), is positively related to hip BMD and structure."

Zagrodzky explained that the OsteoStrong protocol only takes about 60 seconds once a week. Individuals would train using four modalities, each targeting specific areas of the body: the upper body, the lower body, core strength, and postural growth. “The reason why we do it only one day a week is because bones need seven days to recover from a heavy load,” he said, adding that more frequent sessions would slow down the result.

In addition to increased bone density, clients often experience a decrease in joint and back pain and improvements in balance and functional strength.

People with chronic joint pain notice they cut their pain in half in six months.

"And another six months later, they cut in half again. They go from being unable to walk up and down the stairs. They still feel a little bit of discomfort, but not debilitating at all."

Dr. Jaquish

A study, published in the Journal of Osteoporosis & Physical Activity, investigated the efficacy of osteogenic loading therapy for bone mass density and musculoskeletal bone performance adaptations in 55 both osteopenic and osteoporotic postmenopausal women and found a 14.9% increase in bone density, as measured by the DXA scan, in the hip and 16.6% in the spine.

Zagrodzky emphasized that if you’re under 50 and did OsteoStrong every week for two to three years, you would only have to do it once a month for maintenance. Because the rate at which you lose tissue is so slow—1–2% a year—if you add 10% a year, you’ve effectively added 30 years of life to your bone.

Bone density medications and their limitations

Bone density medications are commonly prescribed to manage conditions like osteoporosis and improve bone health. While these medications can be effective in some cases, they also come with limitations and potential side effects. A first-line medication for the prevention and treatment of osteoporosis that Dr. Jaquish mentioned was bisphosphonates (e.g., Alendronate, Risedronate).

While these may help in the short term, they come with unpleasant side effects, including stomach upset and acid reflux, according to research. According to studies, prolonged use has been linked to atypical femoral fractures and osteonecrosis of the jaw, two uncommon but serious side effects. Additionally, bisphosphonates may lessen bone turnover, which over time may have an effect on bone quality.

Bone density training contraindications

Dr. Jaquish highlighted that “you should always consult with your physician and make sure that high-intensity exercise is okay for you,” adding that “ultimately, it’s a high-intensity exercise.”

For those with future or recent hip or knee replacement surgery, he recommended doing a pre-hab to increase bone density before the surgery to create bone that the implant can attach to. “After the implant is in there, you can improve the attachment point of the implant by building more density around it,” Dr. Jaquish said.

The reason for that is that it’s the interior layer of the bone (trabecular bone density) that determines how well the implant will stay in place. Zagrodzky explained that “pharmaceuticals work on increasing cortical bone density [the external layer of the bone],” adding that “no pharmaceutical increases trabecular bone density, but osteogenic loading does.”

Why you should do bone density training

Understanding the significance of bone density, the impact of aging on bone health, and the correlation between bone density loss and mortality allows us to take proactive steps to optimize our skeletal health.

The economic burden continues to increase, with research showing a total expense for fatal fall injuries amounting to $637.5 million in 2015, while nonfatal fall injuries cost $31.3 billion. Looking ahead to 2025, it is projected that the United States will spend over $25 billion annually to treat more than three million predicted fractures.

Effectively managing osteoporosis and its associated consequences may help enhance the overall quality of life and alleviate the economic burden on the healthcare system.

Incorporating effective and innovative technologies like OsteoStrong may help us maintain robust bones throughout our lives. Remember to prioritize safety and seek professional guidance when needed.

“We see people improve not only their bone density but also their level of joint pain and back pain, which radically improves balance too,” Zagrodzky said.