Have you ever taken an empty piece of honeycomb and broke it apart with your bare hands? It was not too difficult, was it? The thinner the honeycomb, the easier it is to break. The shape of the honeycomb is similar to a microscopic cross-section of our bones. Healthy bones have a dense honeycomb shape, with thick calcified structures supporting each other, creating a solid support for our muscles and organs.
People may think of their bones as solid as steel, like an unshakable foundation. However, our skeletal system is not solid at all, but composed of living, growing cells. Our bones depend on a dynamic balance of available minerals (such as calcium) and the hormones that control mineral absorption, to stay strong and healthy well into old age.
Osteoporosis, the condition that turns so many older women, and some older men, into smaller, shrunken, weakened versions of their former selves, is not inevitable. It is possible to grow older and still stand tall, walk confidently, retain strong bones, and enjoy a great deal of physical strength.
Osteoporosis can often be prevented, or at least minimized, by simple improvements in nutrition and exercise before bone loss begins, generally around age 35. For those already affected by loss, medication therapy and other preventive measures can curb or even reverse bone loss, and minimize the risk of disabilities.
Although 28 million Americans, mostly women, are affected by thinning bones or outright osteoporosis, surveys show that most (3 out of 4) women from ages 45 to 75 have never spoken to their doctor about the disease. This is a missed opportunity, because there is now a great deal medical science can do to help halt the progression of this disease.
Today, there are several forms of drug and hormonal therapy that people use to prevent, treat or reverse osteoporosis. It is well known that resistance training causes the bones to adapt to the stress of the loads placed upon it. However, the scope of this article is to look at the benefits of a lesser known form of resistance training, Olympic weightlifting, in particular on preventing osteoporosis in both the young and old.
Bones and Osteoporosis: A Brief Summary
Before we dive into the benefits of Olympic Weightlifting on the musculoskeletal system, a brief review of general bone physiology is needed.
Bone cells, which store 99 percent of the calcium in our bodies, are continuously breaking down and building up, in a process called remodeling. The cells, which are interlaced with nerves and blood vessels, both collect calcium molecules from the bloodstream and release calcium back into circulation. The retained calcium adds to bone mass and keeps the skeleton strong.
Our body balances the two processes of building new bone and removing old bone through the actions of a variety of hormones, including estrogen. The steep decline of estrogen in women after menopause seems to be an important reason why osteoporosis is much more common in women than in men.
Estrogen plays a dual role in bone metabolism: It facilitates the absorption of calcium from the blood into the bone and inhibits the loss of calcium from the bone. Bone density peaks in women anywhere from their late 20’s – mid-30’s. After this time, and especially when estrogen levels drop after menopause, bone loss exceeds new bone formation.
Normal estrogen levels help to ensure an adequate level of calcium in the blood, which in turn influences muscle and nervous system functions. As estrogen levels decline, calcium blood levels can drop excessively, stimulating the production of another hormone called parathyroid hormone. This hormone, which is secreted by the parathyroid gland, then triggers the leaching of calcium from the reservoir in the bones. This corrects the deficit in the blood, but does it by decreasing bone health.
Bone loss accelerates after menopause, but varies considerably among individuals, for there is a wide variation in blood hormone levels among postmenopausal women. A woman can lose from one-half to 6 percent of her bone mass per year. This percentage may be even higher for women who experience surgical or chemically induced menopause, in which the estrogen supply is abruptly cut down. By the time a woman is 80, she can easily have lost 40 percent of her bone mass. Losing a certain amount of bone mass is therefore a natural result of the aging process, called osteopenia.
In osteoporosis, the bones become progressively more porous, making them more likely to break. Because of the thin honeycomb or Swiss cheese shape of osteoporotic bone, the slightest trauma can cause debilitating bone fractures—typically occurring in the hip, spine, and wrist.
Since the loss of crucial bone mass usually occurs without symptoms or pain, osteoporosis can go undetected for years, thus this is why osteoporosis is sometimes referred to as the Silent Thief—until a fracture occurs. The healing process of a broken bone is slower as we age – from healing in a couple of months to maybe not healing at all. A woman’s lifetime risk of developing a hip fracture is equal to her combined risk of developing breast, uterine, and ovarian cancer. Hip fractures leave many women permanently disabled; and within 6 months following the injury, between 15 and 20 percent of patients will die because of a hip fracture and its complications, usually pneumonia from the constant bed rest. One in 3 women over 50 suffers vertebral fractures, which can lead to height loss and a stooped posture.
What Can You Do?
There are a number of treatments for preventing and/or treating osteoporosis. Healthy lifestyle choices including a diet rich in dark green vegetables and almonds, removal of grains in your diet, safe home environments, regular sunlight, protein, and weight-bearing and resistance exercises are the best choices available.
It is now recognized that resistance exercise could have a positive effect on osteoporosis. Although there is some research that is controversial, the majority of it has repeatedly shown resistance training could not only prevent osteoporosis, but it may also reverse/improve bone mineral density (BMD) in individuals already diagnosed with it.
The American College of Sports Medicine (ACSM) published in 1998 in their Position Paper on Exercise and Physical Activity for Older Adults that “the effects of a heavy resistance strength training program on bone density in older adults can offset the typical age-associated declines in bone health by maintaining or increasing bone mineral density and total body mineral content. However, in addition to its effect on bone, strength training also increases muscle mass and strength, dynamic balance, and overall levels of physical activity. All of these outcomes may result in a reduction in the risk of osteoporotic fractures. In contrast, traditional pharmacological and nutritional approaches to the treatment or prevention of osteoporosis have the capacity to maintain or slow the loss of bone but not the ability to improve balance, strength, muscle mass, or physical activity.”
However, neither the ACSM position paper nor the National Strength and Conditioning Association (NSCA) have any recommendations regarding ballistic exercises such as Olympic weightlifting in terms of improving BMD in adults with osteoporosis. I doubt that the lack of recommendations are intentional, however, it certainly would have to do with the lack of evidence of the Olympic lifts being applied to the elderly population or people already diagnosed with osteoporosis.
When I speak of “resistance training,” I am referring to performing several sets of sub-maximal work for a certain body part, such as 3 sets of bench press for 10-12 reps each set. An individual cannot perform 12 reps of any exercise with heavy weight or greater than 80% of their 1 rep maximum. Olympic weightlifting (OWL) protocols involve performing 1-5 reps while lifting heavy weight (i.e. >80% 1 RM). Because of the lack of research investigating the benefits of OWL, I will use some of the research from utilizing resistance training protocols. Understand that these protocols are usually less intense, thus I realize I am extrapolating the research in one sense, yet OWL is still a form of resistance training in that it involves performing weight-bearing exercise. There is plenty of evidence to suggest why the Olympic lifts are the best choice for improving BMD, and should be applied early in an individual’s life – the sooner, the better.
Olympic Weightlifting and Bone Mineral Density
Physical activity is a determinant of peak BMD. There is evidence that activity during growth modulates the external structure of bone, potentially enhancing skeletal strength, while during the adult years daily activity may reduce age-related bone loss. There are several studies demonstrating that when resistance training has been removed from pre- and postmenopausal women, BMD subsequently decreases.
The magnitude of the effect of a 7% to 8% increase in peak BMD, if maintained through the adult years, could translate to a 1.5-fold reduction in fracture risk. Low BMD at the hip increases the risk of fracture, and it is estimated that each 1 standard deviation decrease in BMD increases fracture risk 10%. However, most reported broken hips are not caused by low BMD alone, but rather result from injury associated with a fall. Thus, the combination of low BMD and a propensity to fall significantly increases an individual’s risk of a broken hip. Poor lower extremity strength and power and instability are independently associated with increased fall risk. As individuals get older, osteopenia, decreased muscle mass, and decreased physical function occur. However, age-associated declines may be attributed partly to accompanying reductions in habitual physical activity, as inactivity, immobilization, and bed rest also lead to significant musculoskeletal and functional decrements. Research suggests that engaging in activities that apply high loads to the musculoskeletal system may reverse or slow these physiological and functional declines.
Unfortunately, in this country, the sport and benefits of Olympic weightlifting (OWL) have been overlooked for far too long, but finally they have been applied to developing power in athletes of various sports. OWL refers to the collection of exercises called the snatch, the clean and jerk. The most powerful athletes in the world are elite level Olympic weightlifters. The ground reaction forces these athletes develop have been measured to be as much as 150% greater than the body weight and barbell weight they are lifting. When compared to other powerlifting exercises (i.e. squats, deadlifts, or bench press), Olympic weightlifters create more human power outputs than powerlifters – almost 5 times more power during the jerk. The amount of force these athletes must produce in order to perform these ballistic movements must be at a very high intensity when performing maximal effort lifts. Without a doubt, OWL is the best way to develop power in an athlete or individual. This is why strength and conditioning coaches utilize these lifts for developing athletes involved in explosive sports.
The NSCA paper entitled Health Aspects of Resistance Exercise and Training (2001) says that “animal and human studies suggest that muscular activity is effective in maintaining BMD if the forces developed reach a minimal effective strain, which is the level required to stimulate new bone formation. Because of the high forces that may be developed, resistance exercises appear to be specifically suited to prevent the loss of BMD and development of osteoporosis.”
One author has suggested that vigorous physical activity (including weight-bearing, resistance, and impact components) during childhood may maximize peak BMD. One study in particular did look at the benefits of OWL on BMD of the lower back and neck of the femur in elite junior Olympic weightlifters (average age was 17 years old). The weightlifters had a significantly greater BMD than their paired-age controls, and when compared with adult reference data of 20-39 yr old men, the BMD values were found to be significantly greater still. The authors concluded that the chronic high overloads of stress from OWL has a major influence on BMD.
Therefore, because muscle strain is necessary to maintain or improve BMD, and high-intensity OWL is the best for creating high power outputs and strength, I propose that the ideal choice of resistance training for treating and preventing osteoporosis would be OWL. According to the author’s statement above and the results of the above study, the sooner one would perform OWL, the better. This could overload the skeletal system during childhood in order to create optimal BMD, especially during puberty while estrogen is pumping high in the developing female body. If optimal BMD is created naturally early in life, and a child performing OWL will adapt by increasing BMD, then his/her developing body will create a stronger skeletal system; this may decrease the likelihood of developing osteoporosis later in life. I do not know of any long-term evidence that has specifically looked at junior weightlifters and their BMD when compared to it later in their life, thus this is only a hypothesis.
Safety of Olympic Weightlifting
There are a number of studies showing the safety of OWL in an assortment of populations. The literature has concluded that OWL is safe. Injuries among youth are one of the most infrequent among all sports in the world. When injuries do occur in a young population, it is usually because of incompetent supervision, improper technique or maximal lifting. Greater catastrophic events have been recorded with the bench press in youth than with any of the weightlifting movements. Rest assured, OWL is one of the safest sports on the planet.
One of the traditional arguments against resistance training in general for today’s youth is an injury to the growth plates. The NCSA paper on Basic Guidelines of Resistance Training in Athletes (2000) reports that there has not been an injury to the growth plates reported in a supervised environment with properly educated athletes. Although it is a concern, the risk is not greater than any other sport.
As for the elderly taking up OWL, this is a little more fuzzy. Because age-related declines in ability vary by individual, it is more of a question on whether or not the individual has the balance and/or flexibility to perform the Olympic lifts. One study discovered that in elite Master level Olympic weightlifters that investigated lower-limb strength, that the weightlifters and controls were such that an 85-yr-old weightlifter was as powerful as a 65-yr-old control subject. This would therefore represent an apparent age advantage of approximately 20 yr for the weightlifters! Unfortunately, this study did not investigate anything involving BMD. Once again, as I have previously mentioned, the research is scarce.
Research has shown the benefits of explosive movements (plyometrics) in post-menopausal women and the elderly population for BMD. Although plyometrics are not exactly the same as the Olympic lifts, they do still require explosive movements. These require less flexibility, thus, they are a great alternative to the Olympic lifts if they are not comfortable.
- Osteoporosis is a major public health threat for an estimated 44 million Americans, or 55 percent of the people 50 years of age and older. In the U.S. today, 10 million individuals are estimated to already have the disease and almost 34 million more are estimated to have low bone mass, placing them at increased risk for osteoporosis.
- Of the 10 million Americans estimated to have osteoporosis, eight million are women and 2 million are men.
- Thirty-four million Americans have low bone mass, which puts them at increased risk of developing osteoporosis and related fractures.
- One in two women and one in four men over age 50 will have an osteoporosis-related fracture in her/his remaining lifetime.
- Significant risk has been reported in people of all ethnic backgrounds.
- While osteoporosis is often thought of as an older person’s disease, it can strike at any age.
- Therefore, a healthy lifestyle and resistance exercise would be the best protection from the disease. Ideally, resistance training involving OWL would provide the best protection starting during childhood, however, it can be taken up at any time. Even if an individual has been diagnosed with osteoporosis, it is still not too late to try it and reap its benefits.