Bone Health

You're unique, so your approach to bone health should be unique, too!

We are all different, from the shapes and sizes of our bones to our medical history. This makes all the difference in creating the right approach to your bone health. To reduce the chance of injury and to gain the most optimal results, make sure to approach your bone health in a way that respects your uniqueness.

Bone quality vs. bone density

The DXA (dual-energy x-ray absorptiometry) scan, which measure bone mineral density, indicates the presence of osteopenia or osteoporosis. But while the DXA scan has been the gold standard for testing bone health for the last several decades, some experts believe that bone quality may be a more important indicator of bone health than bone density. In addition, the traditional DXA scan can give inaccurate readings for some individuals, such as those with arthritis. Unfortunately, at the time that this was written (2024), there aren't any perfect measurements of bone quality. Hopefully, science will catch up with the need to accurately assess bone quality and fragility.

Bone turnover markers indicate bone formation (osteoblastic activity) and bone resorption (osteoclastic activity) and are tested via blood or urine samples. If bone turnover marker results indicate an issue, they can be re-tested every 3 - 12 months. Tracking your Trabecular Bone Score (TBS), which is done while getting a DXA scan, provides clues to changes in your bone quality over time. And a new but promising technology is REMS (radiofrequency echographic multi-spectrometry), which measures bone structure and may provide a more accurate bone fragility score (1).

Factors that contribute to bone health

Many factors affect bone health, including:

hormones
nutrition
gut health (if you're gut health isn't optimal, you won't be able to properly absorb bone-building nutrients from even the best diet)
sleep quality and quantity
stress levels
postural alignment
flexibility and mobility
strength
some medications
some diseases & health conditions

Due to these multiple factors, it's important to incorporate a multi-faceted approach to bone health. It's also important to note that the largest single risk factor for fractures is not osteoporosis but falling. In fact, over 90% of hip fractures are the result of a fall (2). That's why fall prevention and balance training are critical components in any bone health program.

Improving bone health and reducing the risk of injury

As a health coach, I recommend a multi-faceted approach to maximizing your bone health. In no particular order, your bone health team might include:

general physician
integrative/functional practitioners (doctor of osteopathy, naturopath, TCM practitioner, women's health specialist, etc.)
hormone specialist (endocrinologist, women's health specialist)
sleep specialist
functional nutritionist
health coach
personal trainer or strength coach
physical therapist
postural alignment specialist
massage therapist, structural integration therapist, chiropractor, MAT practitioner, body worker
acupuncturist
yoga teacher, meditation teacher
therapist
life coach

While a life coach or health coach can help you identify a plan of action to assemble your dream team, always follow your intuition and find practitioners that resonate with you.

Things you can implement now

If you've received a recent diagnosis of osteopenia or osteporosis, it can feel overwhelming (I know this from personal experience!). As you begin the lengthier process of assembling your team, here are some things that you can implement right away:

strength training (make sure your form is perfect and include a recovery day between sessions or body parts, don't forget toe and ankle strength!)
core training (note that some core exercises might put you at an increased fracture risk so train smartly)
balance and agility training
postural alignment training (find resources online or work with a specialist)
flexibility & mobility training (targeted/adapted stretching, myofascial release, and therapeutic yoga can be great)
good office ergonomics (set up your computer & workspace for optimal alignment and movement mechanics)
mindful breathing and meditation (start with 2 minutes of sitting meditation or try a gentle 5-minute walk while breathing only through your nostrils)

Check out the free resources on breathing, fitness, alignment, yoga, nutrition and lifestyle on this website. And remember, stress contributes to bone loss so take a DEEP BREATH and give yourself some love. You've got this!

Bone health resources

You may find one or more of these modalities helpful. Please remember that proper alignment is critical and adapt each approach to your unique needs.

Therapeutic Yoga, including Mukunda Stiles' Joint-Freeing Series
Gokhale Method
The Meeks Method
The Egoscue Method
Foundation Training
12 Yoga Poses for Osteoporosis (This is a set of poses studied by Dr. Loren Fishman et al. and shows that, contrary to previous studies, yoga can be safe for individuals with osteoporosis.)
Onero Online (Please note: This program is NOT the same as the LIFTMOR exercises performed at Onero™ Clinics (see below). The LIFTMOR/Onero™ exercises must be performed under direct supervision by an accredited practitioner to reduce the risk of injury and fractures.)

The LIFTMOR Trial and Onero™ Bone Clinics
Onero™ is an evidence–based exercise program supervised by Professor Belinda Beck, one of the authors of the LIFTMOR study, conducted at Griffith University, and published in the Journal of Bone Mineral Research (3). The LIFTMOR trial proved that high intensity strength training is highly effective at increasing bone mass, improving posture and decreasing falls. Like the LIFTMOR findings, ongoing data collection at The Bone Clinic sites indicates that Onero™ increases bone mass, improves posture and decreases falls in clinic patients. Results show that 86% of patients increased bone mass at the lumbar spine and 69% of patients increased bone mass at the hip. However, it's important to note that participants are ALWAYS supervised and slowly work up to performing the exercises in proper form with heavier weights, with the ultimate goal of lifting 80-85% of their 1-rep max. If these exercises (or any exercise or movement!) is done in bad form, the risks of injury and bone fracture greatly increase, so in-person supervision is critical. To learn more and find an accredited Onero™ practitioner, go to Onero Academy.

While resistance training under a heavy load is optimal to build bone density, if you have secondary bone or spinal issues (like severe disc, facet joint, or vertebral damage), high intensity strength training is likely contraindicated. However, light to moderate resistance training may be appropriate.

Strength, mobility, proper posture and movement are critical for bone heath but, if you have bone or spinal issues, always consult with a qualified doctor or physical therapist to find the most appropriate exercise prescription for you.

Radiofrequency echographic multi-spectrometry for the in-vivo assessment of bone strength. Aging Clinical and Experimental Research, 2019 Oct;31(10):1375-1389. https://pubmed.ncbi.nlm.nih.gov/31422565/
Risk Factors for Falls as a Cause of Hip Fracture in Women. The New England Journal of Medicine, 1991 May 9;324(19):1326-31. https://www.nejm.org/doi/full/10.1056/NEJM199105093241905
High-intensiy Resistance and Impact Training improve Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. The Journal of Bone Mineral Research, 2018 Feb;33(2):211-220. https://pubmed.ncbi.nlm.nih.gov/28975661/