A Word from Joleen Zivnuska

Building Strong Bones: It's Never Too Late

If you have ever been in my exam room, you know I grew up on a cattle ranch in the Flint Hills, where my days were filled with carrying five-gallon buckets of grain, hefting hay bales, lugging heavy saddles, and teaching colts and 4-H club calves to lead. Back then, I had no awareness of how all those childhood activities were building the foundation for the bone health I'm still benefiting from today in menopause.

The Foundation Starts in Childhood

Belinda Beck, PhD, an exercise physiologist and bone researcher, states "Osteoporosis is a childhood disease." The seeds of bone health are planted in our youth through proper nutrition, including adequate calcium and vitamin D, but nutrition alone isn't enough. Dr. Beck emphasizes diverse sports and movements that create mechanical stress on bones: activities involving impact, jumping, and resistance rather than just swimming, walking, or cycling. She advocates for variety over specialization, as repetitive movements don't provide the diverse loading that builds comprehensive bone strength. Our maximum bone potential is largely determined by the time growth plates fuse, around age 18 for females and 25 for males, making these early years critical.

Maintaining Bone Strength Throughout Life

Building strong bones in childhood is important, but maintaining them throughout life is just as critical. Bones are constantly remodeling through the work of osteoblasts, which build bone, and osteoclasts, which break it down. Estrogen plays a key role in this process by slowing osteoclast activity and keeping the breakdown of bone in check. Adults in their 30s and 40s can benefit from many of the same strategies as children, particularly regular mechanical loading through physical activity. Bones get stronger when they are challenged and weaken without demand, making continued movement an essential part of lifelong bone health.

Gender-Specific Considerations

Men typically maintain protective testosterone levels throughout life, though they too lose bone strength when muscle mass declines. For women, the relationship between hormones and bone health is particularly profound. Both estrogen and progesterone stimulate bone formation and prevent excessive breakdown. In fact, hormone replacement therapy (HRT) has proven to be the most effective intervention for preventing osteoporosis and fractures in postmenopausal women, with studies demonstrating a 35 to 50 percent reduction in fracture risk among women taking estrogen. Testosterone also plays an important role in women's bone health by stimulating bone-building cells and helping maintain lean muscle mass. However, the benefits of HRT are only maintained with continued use. When hormone therapy is discontinued, osteoclast activity accelerates and fracture risk rapidly returns to baseline within six years. This is particularly significant given that 25 to 30 percent of women who suffer a hip fracture die within one year, and survivors rarely regain previous mobility, often requiring assisted living. For these reasons, beginning hormone replacement during perimenopause and continuing lifelong is strongly encouraged.

Risk Factors for Osteoporosis

• Family history of osteoporosis or hip fracture
• Early menopause or low estrogen/testosterone
• Low body weight or eating disorders
• Long-term corticosteroid use (prednisone, etc.)
• Smoking or heavy alcohol consumption
• Insufficient weight-bearing exercise

It's Never Too Late to Improve

Dr. Beck's LIFTMOR study provides compelling evidence that it is never too late to support your bone health. Postmenopausal women with significant bone loss showed remarkable improvements after just eight months of twice-weekly 30-minute sessions of supervised heavy lifting and jumping, significantly better than low-intensity exercise. This proves that we can meaningfully improve skeletal health even with existing bone loss after menopause.

Progression of bone loss can be slowed and existing damage reversed through:

• Hormone Replacement Therapy (HRT): The gold standard for postmenopausal women.
• Exercise: Resistance training (weights, bands, body weight), weight-bearing activities (weighted vest walking, stair climbing), and balance work (yoga, tai chi).
• Nutrition: Adequate calcium, vitamin D3, and protein.

Strong bones do not happen by accident. With the right nutrition, movement, and hormonal support, protecting your bone health is absolutely within reach, and the Prairie Health and Wellness team is here to support you every step of the way. We offer a variety of tools and resources designed to create meaningful change. Transform Training is a great option for those interested in resistance training. Please see the link below to learn more. As always, talk with your provider about whether supplementation, hormone therapy, or a weight training program is right for you.

Recommended Resource

For a deeper dive into bone health, we recommend this podcast episode:
Bone Health for Life on "The Drive" by Peter Attia

Check out our Bone Health Cookbook!

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