Loading Your Bones: Site-Specific Exercises and Safe Power Lifting Protocols for Osteoporosis and Spinal Arthritis

Bone Mineral Density (BMD) naturally peaks in our 20s (late teens for females, early 20s for males). After this peak, the goal becomes prevention of decline, especially for women who can lose about one-third of their bone mass at the onset of menopause. Bone is an active piece of tissue that responds to deformation; you must put strain into the bone for it to respond and strengthen. This response is not primarily driven by general cardio like running or swimming but by targeted mechanical stress.

The relationship between muscle and bone is critical: muscle attaches to bone, and as muscle pulls on bone, it creates a load and stimulation required for bone building. Therefore, resistance training is considered vital for preventing osteopenia and the loss of bone.

The audience understands the severity of low bone density (osteoporosis) but struggles with the practical implementation of "heavy loading" protocols, particularly if they have existing joint issues like spinal arthritis or are elderly and fearful of injury. Traditional advice often focuses on calcium and Vitamin D, but they want specific, high-efficacy exercise protocols. They are confused about whether:

1. Mild activity is enough.
2. Heavy resistance training is safe given the risk of injury.
3. General lifting (squats, deadlifts) is enough, or if specific fragile areas (like the wrist) need direct loading.

The most effective, non-pharmaceutical interventions for improving bone density are heavy resistance training and jump training. Heavy loading must be administered safely and progressively. For those with joint constraints, prioritize High Ground movements (supported machine exercises) to target hypertrophy and strength. Ensure optimal protein intake and Vitamin D/Calcium levels to support the bone-building process.

Dr. Peter Attia
Dr. Attia provided the scientific rationale for bone loading and referenced the key study on lifting protocols for osteoporosis.

• Clarity, Depth, Practicality: He stated that the most important behavioral thing a person can do with low bone density is applying heavy load to the bone. Anything that puts the long bones (femurs, hips) under deformation will force them to undergo a strengthening response.
• Unique Perspectives/Actionable Advice: He cited the LYFTMORE study (Belinda Beck) which demonstrated that heavy resistance training significantly improved bone density in women with osteoporosis, contrasting starkly with the decline seen in those doing usual activities like yoga. He emphasized that the risk of injury while participating in sports is "not trivial" if one has low bone density. He listed exercises that apply deformation: Farmer's Carry, step-up, box squat, grappling, and Jiu-Jitsu.
• Testing Nuance: He noted that BMD (Bone Mineral Density) testing alone may not be sufficient; CT scans in the LYFTMORE study showed an increase in cortical thickening of bone, suggesting bones were getting stronger even if density didn't change drastically on DEXA. DEXA measures density, but Trabecular Bone Score (TBS) assesses bone microarchitecture (quality), providing a fuller picture of bone health.

Dr. Stacy Sims
Dr. Sims focused on the urgency of intervention for women undergoing menopause and provided specific jump protocols.

• Clarity, Depth, Practicality: She stated that women lose about one-third of their bone mass at the onset of menopause. She recommended jump training, heavy resistance training, and Sprint Interval Training (SIT) as the three key interventions.
• Unique Perspectives/Actionable Advice: She detailed that jump training should be done for 10 minutes, three times a week, focusing on impact in the skeletal system, not landing softly. She mentioned a specific study by Dr. Tracy Beck where participants went from being osteopenic to normal bone density after four months of this training. This impact creates an external stress to invoke change without pharmaceuticals. She also stressed that resistance training for older women should focus on strength and power, achieved by training heavy and leaving two to three reps in reserve.

Dr. Gabrielle Lyon
Dr. Lyon emphasized the foundational importance of muscle to bone health and provided a safety framework for training.

• Clarity, Depth, Practicality: She explained that muscle health is essential because bone attaches to muscle, and muscle pulls bone, creating the necessary load. She noted that low muscle mass can be an early indication of osteoporosis.
• Unique Perspectives/Actionable Advice: For individuals who are unskilled or frail, she recommends utilizing High Ground movements (supported machines like leg presses, hack squats, supported rows). These movements allow the individual to focus on fully contracting the muscle and achieving the necessary intensity for adaptation (where the last 2–3 reps are challenging) without the stability risk associated with free weights, which can lead to tendon injury—a major concern in the 40s and beyond.

If medically cleared, incorporate impact loading into your routine: jump up and down on a sturdy surface or step (if you are fit enough to jump safely) for 10 minutes. Alternatively, focus on controlled eccentric resistance training using machine supports.

• Mistake: Avoiding all resistance training because of fear of injury from osteoporosis or arthritis.
  Fix: Train heavy, but safely. Use High Ground machine-based movements to gain the benefit of intensity (last few reps near failure) while the machine controls the stability and risk.
• Mistake: Relying on standard BMD DEXA scans alone to determine bone strength.
  Fix: If possible, ask your doctor about the Trabecular Bone Score (TBS). TBS measures the quality and microarchitecture of the bone, giving a more complete picture of fracture risk than density alone.
• Mistake: Assuming general full-body lifting will fix a specific low-density area (like the wrist).
  Fix: While general lifting helps overall density, specific areas (e.g., the wrist) should be targeted with direct loading exercises, as bone responds to the deformation applied to it.
• Mistake: Thinking that supplements like Vitamin D or Calcium are the intervention.
  Fix: Supplements (Vitamin D, Calcium) correct deficiencies, but mechanical loading (heavy lifting and jumping) is the necessary external stress that stimulates the bone cells to build new tissue.

• “My main concern, however, was my bone density indicated I had osteoporosis. At that point, I started resistance training. I haven't made sufficient gains in muscle (as far as I can tell) though my bone density has increased. I believe the issue is that I haven't consumed enough protein. I eat solely plant-based food.”
• “What about vitamin D and k2 or calcium for old people with osteoporosis?”
• “What confuses me a little about this, in regards to the elderly exercising, is where is the middle line? She states that mild exercises like just sitting from standing aren't enough for the muscles but also warns that overdoing it and getting an injury is a very serious concern in the elderly?”
• “Strength Training Improves Bone Density In studies like the LYFTMORE study, heavy resistance training significantly improved bone density in women with osteoporosis.”
• “Quick question: If someone has low bone density in a specific area (like the wrist), do they need to load that area directly to improve it, or can general exercises like squats or deadlifts help overall bone density, even in areas not directly loaded?”
• “I’m 57 and have always been fairly active. Recently I was diagnosed with high parathyroid and had a bone scan showing I also had osteoporosis. Not unusual for a woman my age. I joined a gym and go 3x a week. After two months I’m already noticing an improvement in my strength. I’m going to add cardio now. Fear of breaking bones is definitely a motivator!”

For individuals concerned with osteoporosis or maintaining bone health, heavy, safe resistance training is the cornerstone of the longevity protocol. Bone mass can be preserved, and potentially improved, through intentional mechanical stress. Implement High Ground machine exercises to focus on muscle hypertrophy (growth) and strength safely. Complement lifting with jump training (10 minutes, 3x/week) to apply direct impact to the skeletal system, and ensure adequate protein and micronutrient intake to support the active bone turnover process.