Calcium, heavy lifting stave off osteoporosis

Janis Kelly

December 10, 2004

Dec 10, 2004

Seattle, WA - A simple program that combines strength training and calcium supplements can significantly increase bone-mineral density (BMD) in postmenopausal women, even those who do not take hormone replacement therapy (HRT) [ 1 ]. University of Arizona researchers reported these conclusions from 4-year follow-up data from the Bone Estrogen Strength Training (BEST) study at the 2004 American Society for Bone and Mineral Research (ASBMR) meeting.

Coauthor Ellen Cussler (University of Arizona, Tucson) tells rheuma wire that long-term follow-up confirmed initial findings that weight-bearing exercise plus calcium supplementation can effectively improve bone-mineral density, even in women who do not take hormone replacement therapy (HRT).

Exercisers gain, nonexercisers lose femur BMD

We found a difference of 3.9% at the femur trochanter, with a decline of 2.5% among controls and a gain of 1.4% among exercisers.

"We found a [BMD] difference of 3.9% at the femur trochanter, with a decline of 2.5% among controls and a gain of 1.4% among exercisers. Therefore, if a woman attended at least 50% of the program, she had, on average, approximately an annual 1% advantage over a control. A 1%-per-year difference in BMD has an unknown effect on fracture risk; however, we speculate that it would be enough to decrease the risk," Cussler says. A BMD difference of 1% per year relative to controls would be considered clinically important.

"The 8 core exercises include the seated leg press, lat pull down ( latissimus dorsi), weighted march, seated row, back extension, military press, squats (wall, hack, or Smith's), and rotary torso," Cussler says. The 6 exercises the researchers have decided to keep as part of the ongoing BEST program are:

  • Back extension.

  • Lat pull down.

  • Leg press.

  • One-arm military press.

  • Seated row.

  • Wall or Smith squats.

The exercise program included a 3- to 5-minute cardiovascular warm-up; 20 minutes of strength-training exercises; 15 minutes of "cardio-weight-bearing activity" such as weighted walking, stair climbing, or jogging; 5 minutes of small-muscle exercises; and 5 minutes of balance and stretching. Women in the study were asked to complete 2 sets of 6 to 8 repetitions of each core exercise. Total and regional BMD were measured at baseline and then annually using dual-energy x-ray absorptiometry (DXA) scans.

"By the fourth year, after excluding 10 women for cancer, Fosomax use, etc, 167 subjects had 4-year BMD data. Of these, 89 had been randomized to exercise at baseline. The population targeted was sedentary early postmenopausal women, ages 40 to 65," Cussler says. These 167 patients were the focus of the investigators' ASBMR presentation.

Over the 4 years, women lifted on average about 26 224 kg in the military press. Cussler reported that the tertile of those who lifted the least weight over 4 years had average BMD losses as great as 5.4% in the ulna, while those who lifted the most weight had BMD increases as high as 2.6% in the lumbar spine.

"Initially, the subjects participated in a 1-year trainer-supervised strength-training program. We followed them in years 2,3, and 4, as they continued to exercise on their own. With little trainer involvement, 55 of the 89 exercisers were still exercising in the fourth year, and a 33% attendance is very good," Cussler says.

The investigators emphasize that exercising 2 to 3 times per week and progressively increasing the weight lifted are essential parts of the program, as is taking 800 mg of calcium per day (calcium citrate [Citracal, Mission Pharmacal, San Antonio, TX]).



  1. Cussler E, Going S, Flint-Wagner H, et al. Weight lifted in strength training predicts 4-year bone changes in postmenopausal women. Presented at: American Society for Bone and Mineral Research 2004 meeting; October 1-5, 2004; Seattle, WA; presentation M455.


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