A couple of years back, my uncle hit the ground butt-first. He didn’t slip on ice or crack in two like an oak hit by lightning. No, he went out gloriously – falling off of a ladder while performing a two-person job solo. Classic guy stuff. He fractured the head of his femur, which is quite the achievement. You usually need to get hit by a car for that.
On the left are the two most common types of hip breaks. On the right is what he did.
Images from the Mayo Clinic and Dr. Martin Rinio, Senior Orthopaedic Consultant and Trauma Surgeon
Osteoporosis and osteopenia (less severe – bone loss) are more common in women. That’s a bone size/thickness issue compounded by menopause, during which bone-protecting estrogen levels fall. However, at least one in five men will break a bone due to osteoporosis – and about a quarter of the hip fractures in Canada are suffered by guys. No data is available on how many of these are compounded “hold-my-beer” style moments.
Let’s talk about best practices for building bone mineral density.
EUSTRESS THOSE SUCKERS
I’m using the term eustress to denote stresses that – in the presence of adequate recovery – yield positive results. After all, you need a stimulus for adaptation. When you load your bones, it triggers a cascade of changes. Some changes are via mechanical pressure, like when you squish and deform the bone matrix under load, stimulating bone cells and signalling pathways involved in bone formation. Some are epigenetic, like how gene expression changes to down-regulate sclerostin, which inhibits bone formation.
Bone mineral density-building eustress comes in four flavours: load; speed; novelty; and consistency
Load asks how heavy you’re going and how hard you’re pushing. A standard-ish protocol is 2-3 sets at over 80% of your one-rep max (a rep that you can do ~8 reps with – but no more), 2-3 times per week. Squats, deadlifts, and other barbell work are regularly recommended (more on that in Section 3)
Speed asks about how quickly you’re loaded – and how quickly you generate force. Here, we’re talking about jumping, sprinting, hopping, and skipping. Jogging works but not as well. Walking has a great deal of value – including bone density maintenance – but doesn’t trigger increased bone density. Loaded walking, i.e. “rucking” can work but seems to be best paired with jumping or resistance training. Please note that rucking may promote bone mineral density in the same way that Froot Loops are part of a balanced breakfast. Evidence TBD.
Novelty has to do with variety in training, observed by changes in directional forces, technique, and distribution of load. Novelty is like spice. By that, I mean that you should take something you’re already good at and sprinkle a bit on. Eating a full bowl of spice (AKA exercise slop) is not recommended.
Consistency is more about what you can reliably do than what is theoretically perfect. It can take 6-12 months (at a minimum) of 2-3 sessions per week. So, you have to ask what you can reliably deliver. And what support you need support to do so.
EAT TO SUPPORT BONE HEALTH
Nutrition for bone health means adequate protein (shoot for at least 100g per day). Don’t forget that collagen, a protein, is part of what makes bones bones. You also need adequate vitamin D and calcium. Finally, you need at least maintenance calories. Running at a constant caloric deficit may be good for fat loss but it’s also good for bone mineral loss. So, finding a balance is key. Especially since it’s hard to exercise effectively with bird bones.
AVOID UNFORCED ERRORS
Don’t smoke, mmkay? Or drink too much. Or do only low-impact/low-load exercise. Or under-eat. Leave heroine chic in the 80s. And if you need help getting something heavy from a high shelf, call your nephew.
There are also some medications, like corticosteroids, that can negatively impact bone mineral density. Check in with your doctor here. The main thing is to keep moving and stay loaded and challenged – and to invest in the biological infrastructure that supports that process.
Circling back to heavy barbell lifts, there is a bit of a paradox that I want to address. A lot of the literature, like the LIFTMOR Trial recommends heavy barbell training. However, barbells are not always the most orthopedically-friendly tool. So, when in doubt, prioritize 1-arm or 1-leg strength exercises. As long as your approaching failure in your sets, you’ll probably be ok.
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