Barbells and Bone Health Version 2.0

People lift weights for varying reasons. Some want a big bench press, some want big biceps, and some just want to “look good naked” for that special someone. But I’ll bet ya that nobody in the gym thinks about how lifting weights affects their bones.   

Osteoporosis is a common condition that occurs when we break down more bone than we build up. This causes our bones to become thinner, weaker, and more fragile. Osteoporosis is often called "the silent thief" as many people don't know they have it until they fracture. While a fracture may not seem like much to you or I, for an elderly individual, the consequences of a fracture are dire and can include anxiety, depression, pain (1), and death (2).

But thankfully, lifting weights can help to prevent these from happening. When we load our bones we provide a strain that causes bone cells to be stimulated. This leads to osteoclasts (bone absorbing cells) reabsorbing bones just like how PacMan eats pacdots.

Afterwards osteoblasts (bone building cells) differentiate and lay down new, stronger bone which is like new, softer cement which hardens over time (3).

Disclaimer: This article is tailored more towards younger adults. I will write a similar article in the future that is directed more towards working with middle-aged and elderly individuals.

What kind of training program do I need to do to strengthen my bones?

Linear and undulating periodization are the two programming styles that have been studied and shown to increase bone formation and bone mineral density (BMD) (4-6).

*Side note: Before I get any hate messages in the comments - this isn’t to say that the other great training methods out there (e.g. 10/20/Life, Juggernaut, 5/3/1, Westside, Cube etc.) can’t strengthen your bones, it’s just that they’ve never been studied in this regard.

Linear periodization is a method of training where you gradually increase the weight and decrease the repetitions over a period of weeks and "peak" for an athletic event. Note that it only applies to your main or “opening” exercise in a workout such as a squat or deadlift variation for the lower body or a bench or military press variation for the upper body. There are many ways to cycle and train assistance work, but that’s beyond the scope of this article. Below is an example of a 17 week linear periodization model.

Phase	Weeks	Sets	Repetitions	Percentage of One Rep Max	Rest between sets
Hypertrophy/ Endurance	1-5	3-5	8-10	62-70%	3 minutes
Strength	7-10	3-5	4-6	75-85%	3 minutes
Power	10-14	3	3-4	87-93%	3-5 minutes
Peaking	14-17	2-3	1-3	95-99%	5-7 minutes

For more about linear periodization check out this link: https://www.elitefts.com/education/training/powerlifting/efs-classic-the-periodization-bible/

In contrast to linear periodization, undulating periodization uses a repetition scheme that is varied from workout to workout. Here's an example of an undulating periodization model which can be applied to almost all exercises in a workout:  

Week	Monday	Wednesday	Friday
1	3 x 12	3 x 8	3 x 4
2	3 x 8	3 x 4	3 x 12
3	3 x 4	3 x 12	3 x 8

For more about undulating periodization check out this link

Both periodization styles have similar effects on BMD in women (7) and have approximately the same effectiveness in improving maximal strength in beginner to novice trainees (8-12).

Progressive overload in a training program is critical for improving bone growth. Low intensity training doesn’t have the same effect on improving BMD (6, 11, 13). A 5 or 10 lb dumbbell is appropriate for someone new to the gym, but past that it’s only appropriate for prehab, as a doorstop, or as a paper weight. It’s not gonna improve your bone health.

Do men’s and women’s bones respond the same way to lifting?

College, adult, and middle aged men have all shown increases in their lumbar spine and hip BMD through lifting weights (5, 11, 14).

By contrast, premenopausal women respond more variably to lifting. Some studies show no effect of weight training on BMD (7, 15-17) while others (including a review) show a positive effect of lifting on hip BMD and bone formation (6, 18). Weight training (4), even explosive weight training (19), has been consistently shown to maintain or increase BMD in postmenopausal women (13) – a population at high risk of osteoporosis.

In my biased opinion, when you look at the effect of lifting on overall health, women can’t go wrong with lifting some weights. Your body will thank you for it in the long run.

Strength sports and bone health

Several studies have shown that Olympic weightlifters and powerlifters have a much higher BMD than people who are untrained or train at a lower intensity (11, 20-23). Competing as a high level strength athlete comes with its own health risks (24) but focusing on getting stronger can help your bones, your muscle mass, your athleticism, and your performance (wink).

In the strength and conditioning world you'll be hard pressed to find a strength coach that doesn't recommend a squat variation. But how do squats relate with bone health?

Some research hypothesizes that ground reaction force and rate of force development are linked with bone development (25). When you push into the ground, the ground sends an equal and opposite force into you, that's what a ground reaction force is. Rate of force development refers to the speed at which you can apply force.

A 2012 study in the Journal of Strength and Conditioning Research showed that in comparison to traditional squats and powerlifting squats, box squats have slightly lower ground reaction force but conversely have three to four times the rate of force development (26). This suggests that box squats may be a better choice of squat variations for bone development assuming you’re not a competitive strength athlete who has to do back squats in your sport.

What about plyometrics and bone health?

The relationship between jumping and BMD hasn’t been thoroughly researched in young adults. Several recent studies have shown a positive relationship between hip BMD, maximal vertical jump height (27), and maximal broad jump length (28). Low-repetition jump training has been shown to increase BMD in female college athletes (29) and higher-repetition jump training has been shown to increase lumbar spine and hip BMD in pre-menopausal women (30,31). Elite jumpers have been shown to have a higher BMD than matched controls (32).

Assuming you have no injury history and can land properly, adding in a few sets of jumps (e.g. 2-5 sets of 1-3 reps) once a week before a full body or a lower body workout can be a great way to improve your athleticism & explosiveness. As an added bonus jumps help to improve muscle power, something we lose with age.

Osteoporosis is a common condition that will change the face of the health care system as we age. But doing some periodized weight training & jumps can improve your physique, improve your athleticism, and keep your bones healthy for the long haul.

Practical takeaways

·         Both linear and undulating periodization programs have been shown to improve bone mineral density in young adults

·         To maximize your bone development in a training program, progressive overload must occur while maintaining good form

·         Assuming you can do them correctly and pain free, adding in a few sets of box squats and jumps into your training program may help to increase your BMD and keep your bones healthy for the long term

REFERENCES

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