When it comes to bone loss, much of the discussion centers on women, but there isn’t as much focus on bone loss in men. In fact, a man may have bone loss and experience a bone fracture before anyone notices.
Research on bone loss shows that consistent exercise is an effective way to slow it, and in some cases, it can even help reverse it. Now, a new meta-analysis published in Frontiers in Physiology explains that different types of exercise, as well as how often and how long they are performed, can help build bone density in men aged 45 and older.
Bone density in both men and women peaks during their late 20s and early 30s. As men and women age, both bone density and bone mass decrease, leading to reduced bone strength and the development of osteoporosis.
Of the estimated 10 million Americans with osteoporosis, more than 80 percent are women. However, surveys show that osteoporosis affects about 12 percent of men worldwide and exceeds 20 percent in some regions.
Osteoporosis is also a common cause of fractures in older men. Because men gradually lose bone density without realizing it, osteoporosis is often diagnosed only after a fracture occurs.
One reason why men may not be getting as much attention, diagnoses, and treatment is that bone loss in men tends to show up differently than in women. For example, the inner structure of women’s bones deteriorates rapidly after menopause. In men, the inner structure thins more gradually while the outer shell of their bones actually widens slightly to compensate.
About the Study
Researchers from three universities in China analyzed 12 randomized controlled trials involving over 1,000 men aged 45 to 78. The investigators’ objective was to see if exercise could significantly improve bone mineral density (BMD) at three sites:
• The lumbar spine
• The total hip
• The femoral neck (the narrow section of bone connecting the femoral head to the shaft of the thigh bone)
The researchers saw that exercise resulted in significant improvements in lumbar spine and femoral neck BMD. However, the total hip did not show a significant response to exercise.
According to the study, the finding about the hip was related to bone anatomy rather than to exercise quality. For example, the total hip contains a higher proportion of dense cortical (compact) bone, which forms the outer shell and shaft of long bones. Regardless of training quality or exercise duration, cortical bone adapts more slowly than the spongy (trabecular) bone in the lumbar spine and femoral neck. Having more spongy bone makes the lumbar spine and femoral bone more sensitive to exercise signals and more likely to respond.
This difference is important for understanding how bone density scans are interpreted. For instance, a DEXA scan (an imaging test that measures BMD) that shows stable total hip BMD as well as improving lumbar spine or femoral neck BMD may seem like a mixed result, but it’s actually a good result. Improvements at other sites of the body mean that the person is making good progress.
The Frequency, Duration, and Type of Exercise
The researchers conducted a subgroup analysis based on type, frequency, and duration of exercise. Then they developed a “practical prescription” that involved specific factors that determined the difference between effective bone-building programs and ineffective ones.
The subgroup analysis found that exercise programs with three or more sessions each week led to noticeable improvements in lumbar spine and femoral neck BMD. This was primarily due to “mechanical loading,” the physical force that comes from lifting a weight, jumping, or walking briskly. When bone tissue is stressed by physical forces, bone cells called osteocytes send signals to begin breaking down old bone and building new bone. This process is called bone remodeling.
The more consistently the signals are sent, the more reliably the bone remodeling process stays active. This is why at least three exercise sessions per week are necessary to maintain consistent bone remodeling, according to the subgroup analysis. Programs with fewer than three sessions per week didn’t show any meaningful effects on bone health.
It’s recommended to space exercise sessions throughout the week rather than doing them day after day. Having three non-consecutive sessions gives bone tissue a chance to recover, while still maintaining the frequency needed to keep the remodeling process going. Bone remodeling takes longer to notice compared to muscle, which can show measurable changes within weeks of beginning a new program.
The meta-analysis found that exercise programs lasting longer than six months led to notable improvements in BMD, whereas programs of six months or less did not show a significant effect at the lumbar spine. On the other hand, it didn’t take long for the femoral neck to respond to exercise, suggesting it may be more sensitive to early mechanical loading.
However, to achieve reliable and statistically significant improvements on both sites, the evidence suggests that exercise needs to continue beyond six months. What’s more, the men who achieve results are the ones who make bone-building exercise a lifelong habit rather than a temporary fix.
The Practical Prescription
Based on the meta-analysis, the researchers created a “practical prescription” for men who want to protect and build bone density:
1. Exercise. Consider multiple types of training that combine resistance work with impact-based movements such as jumping, plyometrics, and weight-bearing aerobic activity.
2. Frequency. At least three sessions per week, spaced across the week for adequate recovery.
3. Duration. Be prepared to commit to more than six months, as your bones need time to adapt and strengthen through consistent, sustained loading.
4. Target sites. Focus on exercises that load the lumbar spine and femoral neck, where bone is most responsive.
This exercise regimen might consist of two days of full-body resistance training (squats, deadlifts, rows, overhead press) plus one day of impact-focused work (jump rope, box jumps, stair intervals). As your fitness level advances, you can add a fourth session to boost your weekly training stimulus.
Muscle and bone are closely linked, and the opportunity to develop both is more important than many men understand. It’s evident that exercise helps build bone in the areas most important for preventing fractures, but it only works when men do it at the right intensity and the program they use includes the type of work the bones actually need.
This site offers information designed for educational purposes only. You should not rely on any information on this site as a substitute for professional medical advice, diagnosis, treatment, or as a substitute for, professional counseling care, advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional.
