Measuring bone health can be done in various ways. The most common and accurate test is a dual-energy x-ray absorptiometry (DEXA) scan. This is a low dose x-ray that measures bone strength, thickness and calcium of the bones to determine bone density and mass. The results from this scan allow for diagnosis of osteopenia or osteoporosis, and can predict the risk of future fractures or monitor treatment for osteoporosis. 

The magnitude, rate and frequency of strain on the body during exercise all play a role in building bone density. Putting stress (load) on the muscles increases muscle mass, and puts mechanical stress on the bones stimulating osteoblast activity to produce more bone cells, thereby keeping bones stronger and increasing muscle strength. Therefore, exercise, specifically single leg exercises, improves balance and coordination, resulting in less risk of falls and in turn fractures from falling. 

Exercises that include impact such as running, jumping, walking, tennis, and other similar activities create forces that move through your bones and help with increasing the density of the bone. A study has shown that women who performed both high impact (e.g. jumping) and weight lifting exercises improved the density of their spines by 2 percent compared to a control group. 

The prevalence of osteoporosis is higher in the ageing population, and particularly in females, but engaging in strength training and high impact activities at an earlier age can significantly reduce the health risks associated with the bone condition.

In your 20s:

If you are in your 20s and engaging in strength training, you are already preventing the onset of low bone mineral density. If you aren’t, now is the time to start.

In your 30s:

In your mid 30s, you reach peak bone mass, meaning your bones are stronger at this point than they ever will be in your lifetime. Continue hitting your recommended daily intakes of calcium and vitamin D, and include strength training as part of your exercise routine. 

In your 40s:

Once you reach your 40s, bone begins to break down faster than new bone is built. Pay more attention to your daily intake of calcium and include weight bearing activities in your daily life. These might include stair climbing, single leg exercises, dancing, jogging, hiking and impact exercises. 

In your 50s and beyond:

It’s never too late to begin strength training, however, starting before the onset of menopause gives women the best chance at building the strength they will need for resilient ageing. Despite the many health benefits of low impact exercise such as swimming, cycling, rowing and yoga, these activities have not been shown to improve bone mineral density. 

Guidelines:

The exact amount of exercise required for people with osteoporosis is currently unknown. However, current research suggests partaking in 45 minutes to one hour of aerobic activity two or three times a week, balance exercises twice a week and stretching to promote mobility and flexibility.

The most beneficial exercise is resistance or strength training two to three times a week, including lower limb, trunk and upper body exercises with an 8-10 rep range. Strength training involves lifting weights (weighted squats, deadlifts and lunges), weight bearing activities (walking, stair walking, running), using the weight of your own body to press on the muscles and bones (planks, push ups) and impact exercises (jumping, hopping, bounding). 

Menopause is a huge transformation for the female body, but there are lots of things you can do as you transition through this period to make your experience more positive. Protecting your bones is key, and remember that it’s never too late to start exercising to strengthen them and reduce associated risks.

Georgia Cutt is an exercise physiologist and women’s health personal trainer at Joint Dynamics Evolve. 

Hayley Iwaszko is a senior sports therapist and women’s health personal trainer at Joint Dynamics Evolve.

Front & Female’s Women’s Health With Evolve series is a collaboration with Joint Dynamics Evolve, Hong Kong’s first multidisciplinary women’s health clinic with services spanning physiotherapy, osteopathy, rehabilitation, personal training, nutrition and psychology. The series addresses all aspects of female health to support women at various life stages and open up the conversation around women's health topics, from the awkward to the unknown.

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