How to Increase Bone Density

If you’re over the age of 50, bone density is probably something your doctor has discussed with you, or at least, it should be something that’s been discussed.

While you may know it’s important to increase bone density, or at least maintain it, with age, do you know how to achieve that?

This article will explore bone density, how it changes with age, and what can be done to improve it.

How is Bone Density Measured?

Measuring bone density is actually a measurement of “bone mineral density” often written as BMD.

If you’ve gone to your local pharmacy and placed your hand or finger in a scanning machine, you’ve done what’s called a peripheral bone density test.¹

Peripheral tests (called that because they are measuring BMD in the periphery versus the spine) are primarily used as screening tools. If this test indicates that you may have lower bone density, then the clinician conducting the test will likely refer you to get a central DXA scan (pronounced dexa).

DXA stands for central dual-energy x-ray absorptiometry. This test is painless and is similar to getting an x-ray done. This test scans the BMD in the spine and the hips and helps determine if you have low bone density and/or osteoporosis.

T Scores

The results of a DXA are given in the form of a T score. A T score is a scale which compares your BMD to that of a healthy young adult.

On this scale, zero represents the healthy young adult BMD and then scores are given in terms of standard deviations from zero. The lower the number, the lower the bone density.²

Scoring:

• -1 to +1: Normal bone mineral density
• -1.25 to -2: Osteopenia (also known as low BMD)
• > -2.5 : Osteoporosis

What’s the Difference Between Osteopenia and Osteoporosis?

Osteopenia is low bone mineral density, whereas osteoporosis is a more serious condition of bone weakness and increased risk for fracture.

Having osteopenia puts you at risk for developing osteoporosis.

How Does Bone Density Change with Age?

It’s (unfortunately) a normal part of aging for BMD to decrease. Why that occurs is best explained through how bone density is created.

In our bones, there are cells that build bones (osteoblasts), cells that breakdown bone (osteoclasts), and cells that maintain bone balance (osteocytes).

Now, the most obvious question is why do we have cells that breakdown bone if we want highly dense bones? Good question.

Osteoclasts are important for bone growth. They remove the old bone and then osteoblasts can lay down the new bone. This is needed for healing, increasing strength, and proper calcium absorption.³

In order for new bone to be created, osteocytes receive signals from things like movement, weight bearing, muscle activation. The osteocytes recognize the need for bone to be built, so they send signals to the osteoblasts to start laying down new bone, thereby increasing bone density.³

So there needs to be the proper amount of bone formation compared to bone “breakdown” in order for higher BMD to be sustained.

Peak bone density occurs around age 25 and from 25-50, we pretty much maintain that BMD (this is very generalized here and depends on the individual). Another way of thinking of it is that osteoblast production is overpowering or at least balancing osteoclast activity.

After 50 (for women this can happen even as early as 35), there appears to be a shift in this balance, and therefore, we have to work harder to maintain osteoblast productivity.

In order to do this, we need to make sure we are getting the signals (through activity and exercise) to our bones that we want more bone density!

Is Osteoporosis a Normal Part of Aging?

The short answer is no! Not all seniors have osteoporosis and it isn’t a requirement of aging.

Osteoporosis is a major health concern and does impact many people. About 10 million Americans (male and female) are living with osteoporosis and about 43 million are living with osteopenia.⁴ Over half of these individuals are age 50 and older.

The rate at which bone density decreases depends a lot on the individual. Things like activity level, family history, menopause, certain medications, lifestyle habits (like smoking), chronic disease, and calcium intake can all factor into risk for osteoporosis.⁴

Usually osteoporosis affects females after menopause, however, males can also have osteoporosis.

Can Osteoporosis Be Reversed?

According to experts, not exactly.

While we can’t reverse the bone loss that has already occurred, you can help slow bone loss and “reverse the consequences of osteoporosis.”⁵

Basically, focusing on increasing BMD can help decrease risk of fracture, which is vital to maintaining function and independence.

What Can Be Done to Increase Bone Density?

Since we are trying to stimulate osteocytes and osteoblasts, we want to focus on weight bearing activities.

Things like walking, jogging, weight lifting, jumping are all examples of weight bearing exercise.

For those who are already in the category of osteoporosis, activities like climbing stairs, walking, or using an elliptical machine may be more appropriate and still count as weight bearing activities.

Exercises like swimming and biking do not fall into this category. While they’re great forms of exercise to increase your heart rate, they are not helping with increasing bone density.

If I Have Osteoporosis, Should I Jump?

It depends.

As a general rule, I would say hold off on jumping if you have a diagnosis of osteoporosis. You need to speak with your own physical therapist and doctor before starting an exercise routine.

This isn’t to say you can’t do weight bearing exercise, but I would limit it so you’re not doing high impact exercise (like jumping and jogging) until cleared by your healthcare team.

The weight bearing exercises described above (stair climbing, elliptical, walking) and strengthening will likely be crucial to help reverse the consequences of osteoporosis, but just make sure you check in with your own PT first!

7 Exercises to Help Increase Bone Density

Check out this video of Dr. Katie doing all the exercises!

1. Standing Marches

1. Start with feet hip-distance apart.
2. Lift right knee towards chest, not allowing pelvis to drop.
3. Return right knee to starting position.
4. Lift left knee towards chest, not allowing pelvis to drop.
5. Return left knee to starting position.
6. This is one rep.
7. Repeat for 8-10 reps.
8. Rest for 1-3 minutes.
9. Perform 3 sets total.

2. Bridges

1. Lie on your back with knees bent, feet on the floor/stable surface.
2. Pressing into your feet, lift your hips off the floor/stable surface.
3. Slowly lower hips back down.
4. Repeat 8-10 times.
5. Rest for 1-3 minutes.
6. Complete 3 sets.

3. Lunges

1. Stand with feet hip-distance apart.
2. If you need balance support, stand next to a stable chair or counter.
3. Take a long step backward with your right leg.
4. Keeping your weight evenly distributed between your right and left leg, bend both knees about 6 inches. 
5. Make sure you’re not lunging forward or backward, but keeping centered as you lower.
6. Return to standing.
7. Repeat 8-10 times.
8. Repeat with left leg.

4. Triceps Pushups

If you’re unable to get down to the floor for this, you can do this same exercise with hands against a wall or a countertop.

1. Get down to all fours on a mat.
2. Place hands under shoulders, knees under hips.
3. Bend the elbows, keeping elbows narrow, pointed towards your thighs.
4. Imagine you are trying to touch your forehead between your hands (like a bow motion).**Elbows won’t touch the ground but you want to feel the work in the back of the arm**
5. Straighten elbows.
6. Repeat 5-10 times.
7. Rest for 1-3 minutes.
8. Complete 3 sets.

5. Squats

1. Stand with feet a little wider than shoulder-distance apart, with toes slightly turned out.
2. Imagine you’re trying to sit in a chair behind you as you bend your knees, pushing your bum backwards.
3. Straighten your knees to stand.
4. Repeat steps 3-4 10x.
5. Rest for 1-3 minutes.
6. Repeat for a total of 3 sets.

6. Shoulder Press

This exercise can be done with or without hand weights.

1. Sit or stand with feet hip-distance apart.
2. Lift elbows to shoulder height, bent at 90 degrees (like you’re making a goal post).
3. Reach your hands overhead, straightening your elbows.
4. Bend elbows, return them to shoulder height.
5. Repeat 8-10 times.
6. Rest for 1-3 minutes.
7. Complete 3 sets total.

7. Side Jumps

1. Start with feet together, arms down by sides.
2. Push off of right leg to hop/step to the left, landing on the left foot.
3. Return to starting position by pushing off with the left and landing on the right foot.
4. Repeat to the left.
5. Complete 8-10 on each side.
6. Rest for 1-3 minutes.
7. Complete 3 sets total.

Have the Strength to Live Life to the Fullest!

Sources:

1. Bone density test – Mayo Clinic. (2022). Retrieved 2 June 2022, from https://www.mayoclinic.org/tests-procedures/bone-density-test/about/pac-20385273#:~:text=The%20test%20usually%20takes%20about,often%20used%20at%20health%20fairs.
2. Bone Mass Measurement: What the Numbers Mean | NIH Osteoporosis and Related Bone Diseases National Resource Center. (2018). Retrieved 2 June 2022, from https://www.bones.nih.gov/health-info/bone/bone-health/bone-mass-measure
3. Florencio-Silva, R., Sasso, G. R., Sasso-Cerri, E., Simões, M. J., & Cerri, P. S. (2015). Biology of Bone Tissue: Structure, Function, and Factors That Influence Bone Cells. BioMed research international, 2015, 421746. https://doi.org/10.1155/2015/421746
4. Ratini, M. (2021). Causes of Osteoporosis. Retrieved 2 June 2022, from https://www.webmd.com/osteoporosis/guide/strong-bones
5. Doheny, K. (2010). Can You Reverse Osteoporosis?. Retrieved 2 June 2022, from https://www.webmd.com/osteoporosis/features/can-you-reverse-osteoporosis
6. All photos made on canva.com