Exercise Plus Calcium Helps Keep Bones Strong 

Bone Density May Improve For Some 

Women who have stopped taking hormone replacement therapy (HRT) often worry about losing the protective effect that estrogen had on their bone density.

But a new study reported in the medical journal Osteoporosis International suggests that performing regular weight-bearing and resistance exercise, and consuming calcium in foods and supplementation, can help maintain bone density, especially in the hip.

Researchers looked at the effect of exercise and calcium in two groups of women, those already on HRT and those who were not, says study author Dr. Timothy Lohman, a researcher at the University of Arizona.

The effects on bone were better with HRT, especially in the spine area, Dr. Lohman concedes, but adds, "In the hip area, it looks good just with exercise and calcium."

The study reported by Dr. Lohman is known as The Bone, Estrogen and Strength Training (BEST) study, and is supported by the National Institutes of Health (NIH).

Women Look for Alternatives to HRT

When the Women's Health Initiative was halted last year after unacceptably increased risks of breast cancer and heart attack were found among women on HRT compared to those not on the regimen, many women decided to discontinue the daily treatment and many others opted not to start it.

But one potential downside was losing the known protective effect estrogen has on maintaining bone density and decreasing the risk of osteoporosis, the gradual loss of bone density that can lead to fractures of the hip, spine, and wrist.

In the most recent evaluation, researchers looked at 159 women who were on HRT and 161 who had not used it, dividing those two groups into an exercising group or a non-exercising group, for a total of four groups.

The exercise regimen, performed three days each week, included 20 to 25 minutes of resistance training (two sets of six to eight repetitions) and six exercises (back extension, leg press, squats, the lateral pulldown, dumbbell press, and seated row).

Women also performed seven to 10 minutes of cardiovascular weight-bearing activity, such as jumping rope, jogging, or skipping, during each session.

All women took a total of 800 milligrams of calcium citrate daily, with two pills spaced at least four hours apart.

Those who took HRT, calcium, and who exercised increased their bone density in more body sites, increasing it by 1 percent to 2 percent in the hip and spine, Dr. Lohman says.

In those women who exercised and took calcium but did not take HRT, bone density in the hip increased about 1 percent, the study reports.

"HRT was critical for improving spine bone density, but not hip density," says Linda Houtkooper, another member of the research team. And, she stresses, it was the combination of both types of exercise and getting calcium from both food and supplements that appeared critical.

As a woman ages, just maintaining the bone mass she has can be good news.

Maintaining Bone Density a Must

"If a woman in her 50s can just maintain her bone mass, she goes a long way toward warding off osteoporosis," Dr. Lohman says. "Exercise helps you whether you are on HRT or not."

The study "confirms what we have known," says Dr. Robert P. Heaney, an osteoporosis researcher at Creighton University in Omaha. "It shows that if you exercise and are given adequate calcium and are on hormones, you will preserve bone."

He views the preservation of bone as a "three-legged stool. One is hormones, one is nutrition, one is exercise," he says.

"I think hormones are still important," Dr. Heaney adds, although he recommends that estrogen be given by patch rather than orally to preserve bone after menopause.

Women who use weight-training must progress to heavier weights to achieve the benefit, Dr. Lohman says. And he advises them to check in first with their physician and with a physical therapist. The physical therapist can alert women to any physical limitations and instruct them on the proper way to do the exercises.

Dr. Lohman also recommends that all women get a baseline bone density test in their 40s or 50s, then repeat it annually.

Depending on age, a daily calcium intake of 1,000 mg to 1,300 mg is recommended, according to the National Osteoporosis Foundation. If women have trouble taking in that much from calcium-rich foods such as dairy products, supplements are recommended.

Always consult your physician for a diagnosis.

November 2003

Exercise Plus Calcium Keeps Bones Strong

Women Look for Alternatives to HRT

Maintaining Bone Density a Must

Bone Density Testing

Online Resources

Bone Density Testing

A bone density test, also known as bone mass measurement or bone mineral density test, measures the strength and density of your bones as you approach menopause.

Then when the test is repeated sometime later, it can help determine how quickly you are losing bone mass and density.

The tests are painless, noninvasive, and safe.

A comparison is made of your bone density with standards for what is expected in someone of your age, gender, and size and to the optimal peak bone density of a healthy young adult of the same gender.

Bone density testing can help to:

If you have one or more of the following risk factors for osteoporosis, you may want to consider having a bone density test:

Always consult your physician for more information.

Online Resources

(Our Organization is not responsible for the content of Internet sites.)    

Centers for Disease Control and Prevention (CDC)

HealthierUS.Gov

National Institute of Arthritis and Musculoskeletal and Skin Diseases

National Institutes of Health (NIH)

National Osteoporosis Foundation

National Women's Health Information Center

Osteoporosis and Related Bone Diseases - National Resource Center

Office of Research on Women's Health