Use It or Lose It

Hey {{first_name | reader}},

It's Tuesday, which means your weekly fitness check-in. Welcome to Week #41.

On a drive from the Black Range Lodge to Albuquerque with a fellow musician, the conversation turned, as conversations at a certain age do, to bone health.

I've always had a use-it-or-lose-it approach to fitness. When I was running marathons and people asked me why, I said that one day I wouldn't be able to run marathons, so I might as well run them while I could.¹

It was a flip answer about running. For bones, it turns out to be pretty good science.

When she was in her early 80s, my grandmother broke her hip. She lived alone in New York City and had an active social life. One night, on her way to the bathroom, she tripped over her own feet.

She had a total hip replacement and spent weeks in acute rehab. She never got her mobility back. She used a walker, lived with chronic pain, and could no longer live independently.

My great aunt broke her hip at 94. The change in her was even starker.

I watched two independent women I loved and admired get sidelined by a single fall.

If I'm honest, a lot of my training is organized around fear of the broken hip.

The fear is reasonable. According to the CDC, nearly one in five American women over 50 has osteoporosis, compared with about one in twenty men. More than half of women over 50 have low bone mass, including those with osteoporosis. And menopause doesn't help. Declining estrogen accelerates bone loss, making the years around menopause particularly important for bone health.²

Bone is not a fixed structure. It's living tissue that is constantly being broken down and rebuilt, and it responds to what you ask of it.

The bad news is that you have to ask.

Bone responds particularly well to loads that are sufficiently challenging, including heavy resistance and impact. Walking is good for almost everything, but a skeleton that's been walking for sixty years stopped taking notes a long time ago.

So I give mine something to notice.

Heavy compound lifts load my spine and hips: squats, deadlifts, overhead presses, single-leg RDLs. I keep running because impact provides a stimulus that ordinary walking generally doesn't. Before the ankle sprain, I'd added plyometrics and lateral movements to challenge my bones and muscles in different directions.³

But bone density is only half the equation.

Strong muscles help me recover when I trip. Balance and coordination help me avoid falling in the first place. And the ability to generate force quickly may be what keeps an ordinary stumble from becoming an ambulance ride.

None of this guarantees I won't break a hip.

It shifts the odds.

Use it or lose it was a joke about marathons. It's also a pretty accurate description of a skeleton.

Question: I'm past menopause. Is it too late to build bone?

Answer: No. It's harder, but bone keeps responding to load long after menopause.

For years, the standard advice for women with low bone density was gentle exercise, because heavy lifting seemed too risky.

Then an Australian trial called LIFTMOR tested the opposite. Postmenopausal women with osteopenia and osteoporosis did supervised deadlifts, squats, and overhead presses, five sets of five at more than 85% of their max, plus jumping. They trained twice a week for thirty minutes a session. After eight months, their bone density and fitness had improved compared with a low-intensity home program. Over the whole trial, the only adverse event in the lifting group was one minor back spasm.

The important word there is supervised. If you have bone loss, heavy lifting is not something to teach yourself from YouTube. Get a DEXA scan so you know your numbers. Find a coach or physical therapist who has worked with osteoporosis. Then build up.

You don't need to start where I am.

You do need to start.

Myth: I drink milk and take calcium supplements, so I don't have to worry about my bones.

Reality: Calcium is essential for bone health. So is vitamin D, which helps your body absorb it.

But calcium isn't a substitute for exercise.

Think of calcium as the building material and mechanical loading as one of the signals telling your body where to invest it.

You need both.

And while we're at it, more calcium isn't necessarily better. If you're getting enough through your diet, piling on supplements doesn't automatically give you stronger bones.

For women over 50, the recommended daily calcium intake is 1,200 milligrams from food and supplements combined. Vitamin D requirements vary with age and individual circumstances.

A supplement can help fill a nutritional gap.

It cannot do your squats for you.

The most bone-friendly meal I eat comes in a can and requires nothing more complicated than a can opener.

Sardines. Bones in.

The bones are soft enough that you barely notice them, and they're the reason this meal made the list. A typical 3.75-ounce can of sardines with bones provides roughly 350 milligrams of calcium, along with protein, vitamin D, and omega-3 fatty acids.

Not bad for something that lives in the pantry.

Ingredients

Assembly

Spread mustard on the crisp bread. Add the sardines, breaking them up slightly with a fork. Top with cornichons and onion. Finish with pepper and lemon.

Dinner in three minutes. No cooking. Almost no dishes.⁴

Bone Talk: Strong Bones for Midlife Women: Building Strength, Preventing Fractures, and Aging Well

Bone Talk is produced by the Bone Health & Osteoporosis Foundation, and its back catalog is worth exploring.

Start with this episode featuring physical therapist Lisa Hamilton. It covers what happens to women's bones in midlife, why strength training matters, and what we can do to preserve the mobility and independence we tend to take for granted.

It's the kind of conversation I wish someone had had with my grandmother forty years before she broke her hip.

My grandmother didn't break her hip lifting something heavy. She broke it tripping over her own feet on the way to the bathroom.

So this week's assignment isn't about building bone. It's about staying upright.

Stand next to a kitchen counter or sturdy chair. Lift one foot slightly off the floor and see how long you can balance on the other.

Aim for 30 seconds. Switch legs. Repeat twice.

If that's easy, try turning your head slowly from side to side while you balance. If it's hard, keep a fingertip on the counter for support. The goal is to challenge your balance, not test your ability to survive a fall.

Do this every day this week.

Balance is a skill, and like most skills, it gets better with practice. It won't increase your bone density, but it may help you avoid the fall that puts your bones to the test.

As for me, I'll be practicing on my good leg. My injured ankle has already demonstrated that my balance could use some work.⁵

Stay strong, {{first_name | reader}}

P.S. Eat the sardine bones. Load your own.