Women’s Health: Osteoporosis and the Optimal Resistance Training Method to Strengthen the Bones

There is always a pattern to our physiological functions. Nothing is random. Non-stop functions occur throughout our body during the entire lifespan. These functions are very complex and equally fascinating. As a coach I have dived into the deep waters of this ocean of complex systems. I’m still learning. I do not know everything and I will never know everything, but whatever I’ve learnt over all these years may help you with your health and fitness. My aim is to keep learning the most optimal solutions to health and fitness concerns, keep applying it to mine and my clients’ training programs and to keep sharing it with those looking for such solutions.

Throughout our body we have many functions going on. When one type of cell or process increases something, another cell or process decreases it. Our physiological systems are always working towards maintaining a balance. And as long as these two processes are in balance, everything is fabulous. However, when one of these processes becomes more than the other or less than the other, our physiological systems go out of balance and that causes a problem to our body. Examples of physiological imbalances are Hypertension/ Hypotension, Hyperglycemia/ Hypoglycemia, Hyperthyroidism/ Hypothyroidism, etc.

In this article I will address an imbalance that causes osteoporosis in women and the benefits of resistance training to strengthen the bones. I will try to explain it in the best and simplest possible manner I can.  

When a woman reaches menopause, i.e., end of childbearing ability (normally between the ages of 46 and 54), the functioning of the ovaries declines. This decline results in decreased production of the primary female sex hormone called estrogen. This decrease in estrogen results in all kinds of other changes in the body, such as atrophy (shrinking) of the uterus. Now, let’s understand how the decrease in estrogen affects bone density.

There are two different bone cells that maintain the balance of the mineral calcium in the bone. These are osteoblasts and osteoclasts. Osteoblasts extract calcium from the blood and deposit it in the bone to maintain bone density, while osteoclasts remove calcium from the bone and release it into the blood to maintain the calcium levels in the blood.  

Estrogen is responsible for osteoblasts depositing calcium in the bone. Therefore, a decrease in estrogen during menopause lowers calcium absorption of the bone. While there is less calcium being deposited in the bone, osteoclasts continue breaking down the bone as fast as usual to maintain the level of calcium in the blood. Clearly, the rate of breakdown of the bone now surpasses the rate at which calcium is deposited. The osteoblasts and osteoclasts are no longer working in balance and this causes the problem. This imbalance between the calcium deposit and calcium resorption from the bone during menopause explains why women develop what is known as osteoporosis. Osteoporosis literally means that the bone becomes more porous, less dense due to less calcium mineral in the bone than before. With decreased calcium in the bone, the bones become brittle and weak. This is considered more serious than any other changes that occur during menopause, even the shrinking of the uterus. 

Now, let’s discuss how resistance training benefits women by maintaining density and strength of bones. Over the past 10 years, a dozen studies have shown a direct and positive relationship between the effects of resistance training and bone density. Research suggests that resistance training stimulates the activity of osteoblasts cells and hence maintains bone density. Loading the exercise movement with incremental increase in weight (resistance) promotes changes in the bone metabolism through direct effect, via mechanical force, or indirect effect, promoted by hormonal factors. The mechanical force when applied over the bone tissue forms endogenous signs that interfere in the processes of bone remodelling. Here are the links to a few of these studies if you want more details; Study 1 , Study 2, Study 3, and Study 4 .  In these research articles you will come across the terms “weight-bearing” and “resistance training” as the means to achieve increased bone density. These two terms are misinterpreted by too many in the fitness industry for commercial gain. In this article I will present to you the optimal resistance training method that is also the optimal weight-bearing activity to achieve increased bone density, and hopefully clear out the dirt created by the so called “professionals” of this commercially growing industry.

Resistance training is a training method that uses added resistance in an exercise. In the context of fitness, resistance training means adding resistance to an exercise movement via barbells, dumbbells, resistance rubber bands, exercise machines, etc. Do not get misled by those who promote increase in bone density and bone strength with body weight exercises or any other method using just 10 kilograms of weight for the rest of your life.  (Read this article if you are interested in understanding the purpose of training: “The Sole Purpose of Physical Training”). The purpose of resistance training is to gradually increase the resistance/weights in each exercise. For e.g., if you’re starting out at lifting 10 kilograms, you must gradually keep increasing the resistance/weight on that particular exercise, and someday you will able to lift as much as you weigh, and even more. And if that increase in resistance hasn’t occurred, understand that you’ve wasted your time and energy because there is no long-term benefit beyond the initial improvement.

Don’t be shocked or worried by that statement. I’m not telling you to lift 60 or 70 kilograms in a month’s time. I am talking about progressively increasing weights on the exercises over a period of years. During Olympics you will witness female weightlifting athletes setting records of lifting weights more than their own body weight. They are able to lift that much weight because they have been training for years. That is exactly what makes a woman strong and her bones very dense. Lifting weights! However, you do not need to perform Olympic lifts (although you can if you are interested in doing so!) to achieve high bone density. I will talk about the most optimal exercises as we progress through this article.

Women have the potential of being physically very strong. However, cultural restrictions, societal norms, misleading fitness information/trainers, etc. are limiting most women from achieving absolute strength. And as a coach I really hate to see women not being made aware of this.  The women I train are some of the strongest in this world. And I’m very proud of them.

A woman who found it difficult to lift 10 kilograms, trains consistently and someday is able to lift 70 kilograms. This is a simple and logical assessment of her strength, and hence the bone density (if you read the research studies you will notice that this logical bone density assessment correlates very well with the bone mass density (BMD) dual-energy x-ray absorptiometry (DEXA) scan). She is able to lift 70 kilograms because her bones are now strong and dense enough to support that heavier weight. As she progressively lifted heavier weights, her entire system (body) adapted to that weight. This means, she not only improved her bone density but also her muscle mass, joint strength (tendons & ligaments), blood glucose balance, normal blood pressure, etc. Do not worry, you will not increase your muscle mass like that of a man. You’re a female and your hormonal endowment is different from a male’s. The normal range (it’s different for different ages) of testosterone levels in healthy adult males is between 280 to 1,100 nanograms per deciliter (ng/dL), and normal testosterone levels  (it’s different for different ages) in healthy adult females is only about 15 to 70 ng/dL. Do you see the difference in the levels of testosterone? You will never increase your muscle mass like that of a man with just 70 ng/dL of testosterone. By the way, it takes a lot of time (years) for a man with normal testosterone levels who trains to gain a lot of muscle. I’m not talking about the competitive bodybuilders (men and women) who administer additional synthetic testosterone to build muscle and drop body fat quickly.     

You ought to understand that not all exercises allow one to systemically load the bones. And although many exercise equipments and exercises are categorized under resistance training protocol, the results are mediocre for the energy and time spent in doing those exercises. The following equipments don’t allow a systemic increase in the resistance (load) on the entire skeletal system: dumbbells, kettle bells, medicine balls, resistance bands, battle ropes, exercise machines, functional trainers, etc. None of these equipments load the entire body systemically. The only exercises that will positively affect the entire skeleton and also allow you to progressively lift heavier weights for the rest of your life are the Barbell Squats, Barbell Deadlifts and Barbell Shoulder Press. These exercises mimic normal human movements. Barbell Squat movement pattern is the same as sitting down and getting up from a chair. A deadlift is like picking up something from the floor, and a shoulder press is the same as lifting something overhead. Incidentally, the barbell squat and barbell deadlift are the only two exercises that optimally load the spine and hip bones, thereby making them strong and resistant to injuries and fractures. No other exercise can help you do that. These are normal human movement patterns. Gradually loading these movement patterns with added weights/resistance results in the entire physiological system adapting to this load. The loading of the entire system with progressively heavier weights is what makes these exercises weight-bearing exercises and this progressive weight-bearing (additional weight-loading) is what is required to maintain the bone density.

Since there is an added weight to these normal human movements, it is advisable to learn the proper lifting method to avoid injuries, to plan your progression and to plan your nutrition. I advise you to learn this from an experienced coach who is a lifter, not a fancy personal trainer who makes women jump from one exercise to the other. Lifting weights is not a joke. It’s a serious task that has to be completed with 100% seriousness. It’s not for entertainment. Comedy shows are for entertainment, not physical training. The one you want to learn from has to be an experienced lifter for years and capable of teaching you the intricacies of the lifts. An experienced lifter will be a lifter who himself/herself is lifting heavy, who has taught lots of people the same movement patterns, who understands the anatomy of the joints and physiology of the body, who understands the forces acting upon the joints and the biomechanics in that given movement pattern (exercise).

Women will benefit from a well planned weight-bearing resistance training program. There are no different training methods for different women to increase bone density. There is only one optimal training method, the rest are suboptimal. The training method I mentioned above is the most optimal training method (barbell training) of all to achieve this goal. If you want to have strong bones as you age and don’t want to waste your valuable time and energy doing the wrong exercises, do yourself a favor and do what I advised you to do. Women with health limitations such as diabetes, hypertension, hypothyroidism, etc., can do them too. All you have to do is work with a knowledgeable and experienced coach. You don’t have to do 8 different exercises or workout on some sophisticated fancy exercise equipment or some special program meant for your ailment. You can do the three movement patterns mentioned above and master them as you keep reaping the benefits for the rest of your life.

My aim is to educate women about the functions of the physiological systems with reference to physical training, and the benefits of a sensible resistance training program. And remember, the only thing that will make your bones stronger is gradually lifting heavier weights. If not earlier, at least at menopause, there is no question that resistance/weight training ought to be an important part of a woman’s life. The only thing that is required is to program your training (lifting technique, adequate weight, and rest) with a complementary balanced nutrition plan (nothing fancy here).

How to assess the bone strength of a woman who has been resistance/weight training? Ask the woman who has been training by lifting 10 kilograms for 15 repetitions, to lift 70 kilograms for 1 repetition; she can’t. Ask a woman who has trained to lift 70 kilograms for 1 repetition to lift 10 kilograms for 15 repetitions; she lifts it easily. Now tell me, who has stronger bones?

Fractures to the bones occur when the impact to the bone is more than what the bone is capable of handling. A stronger bone is harder to break and will have a greater resistance to the impact. Strong bones are built by gradually lifting heavier weights, someday as heavy as you weigh and even more. That’s when you know your bones have become stronger. Incidentally, the “daily 45 min walk” that your doctor recommended to you (women & men) doesn’t increase your bone density and hence can’t protect your bones. Other physical activities that don’t increase your bone density: swimming, cycling, running, zumba, yoga, elastic rubber resistance bands/tubes, floor exercises (abs & lower back), fancy gym workouts with tiny weights, stretching, slamming medicine balls on the floor, swinging battle ropes or any other sport (other than power lifting and Olympic weightlifting). In short, when it comes to optimally “increasing bone density” it is actually the weight-bearing (weight-loading) resistance training (barbell training) that gets the job done.

We use our time and energy for exercising to improve our health, and it makes no sense to waste these valuable resources on training methods that will never give optimal results. And since we can’t get our lost time and energy back, we might as well use our time and energy efficiently.   

Those who think this article may help somebody you know, please share it with them. If you’re a woman and have any questions or want to understand how to train efficiently, drop me an email or meet me at the gym. I’ll be glad to guide you. I would also like to invite corporate offices, gyms, and womens groups interested in having me address their women employees/members as a whole about resistance training for bone density, to contact me.

This article is dedicated to the first woman I coached — my mother, and all the women I coached after. They are my inspiration and pride.



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5 thoughts on “Women’s Health: Osteoporosis and the Optimal Resistance Training Method to Strengthen the Bones”

  1. Hello Macy! Thank you for sharing such an important information on Osteoporosis. Most women have such a busy lifestyle and it’s important to know the right process towards good health. Your article has always benefited and motivated me to do the right stuff. Thanks for the lovely piece of advice on health.

    1. Thank you Rin. I appreciate your feedback. My aim is to put out great content and reach out to as many people as possible.

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