Menopause Strength Training and the Bone Density Myth | Ep 495
Heavy lifting does build bone density. That part is true. But the rule going around that women must strength training with 5 sets of 5 at 85% of your max (1RM) plus box jumps or you lose your bone density, is a much bigger claim than the evidence supports.
We dismantle this claim and explain what the best studies can and cannot prove. We also share a simpler approach that still allows you to train hard, lower fracture risk, and keeps you consistent through perimenopause and postmenopause.
If you want to protect your bones without training in a way that makes you hate strength training or quit altogether, hit play!
Get the FREE Strength Training for Hormone Health guide, a free breakdown of how to lift in a way that supports your hormones through the menopause transition and beyond:
https://witsandweights.com/free
You'll learn:
How the LIFTMOR trial was designed and what it found on spine and hip bone density, as well as heavy vs. moderate strength training over 40
3 problems with drawing conclusions from the LIFTMOR trial
Why heavy lifting is not inherently unsafe for older women with low bone mass
How social media “telephone” turns nuanced evidence into rigid rules
DEXA body fat and lean mass scan precision error and why small changes may not be detectable
Heavy vs. moderate loading for bone mineral density
What we know so far from perimenopause data
Menopause transition bone loss rates and the hidden "big win" with strength training for women over 40
4 practical tips to do instead
A 30-second test to estimate whether your sets are heavy enough
Wits & Weights is the evidence-based podcast for strength training over 40, menopause and perimenopause fitness, body recomposition, metabolism recovery, and healthy aging. Hosted by Philip Pape, creator of Eat More Lift Heavy and Fitness Lab.
Timestamps:
0:00 - The bone density rule keeping too many women out of the gym
3:48 - Inside the LIFTMOR trial (strength training and bone density)
7:45 - Where bone and hormones are connected
9:05 - 3 gaps between the LIFTMORE trial and its interpretation
14:46 - Research on perimenopausal women over 40
16:29 - How the menopause transition affects bone loss
18:38 - 4 steps to maintain or build bone density
21:45 - Where jumping fits into your strength training protocol
25:16 - Finding your load range without attempting a 1 rep max attempt
26:20 - Bonus: 30-second test for whether you're lifting heavy enough
Episode Resources:
FREE 1RM and Strength Calculator (with Strength Standards):
https://www.witsandweights.com/strength-calculatorRelated episode: Are the Barbell Squat, Deadlift, and Row Actually Unsafe After 40?
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The bone density rule keeping too many women out of the gym
Philip Pape 0:00
If you've been told that you have to lift very heavy, you have to jump off of boxes, or you're just gonna lose your bone density. And that message has been scaring you out of the gym. This episode is for you. Today you'll hear what heavy lifting actually does to bone density, how that compares to what happens during the menopause transition, independent of that, and why the aspect related to jumping is probably the weakest link in the argument we have from the evidence. Also, I'm going to share one thing that protects you from a fracture far more than just bone density. Welcome to Wits and Weights, the show that puts a popular piece of fitness advice under the microscope, finds the hidden reason it doesn't work, and gives you the deceptively simple fix that does. I'm your host, certified nutrition coach Philip Pape, and this is one of those episodes where I have to be very careful because the fitness advice I'm about to question is mostly coming from people I respect. And it's even some things that I've stated or claimed that I'm gonna walk back a little bit on, which is really part of the process of skepticism and curiosity. The science underneath it is genuinely good science. I'm not gonna tell you that lifting doesn't do anything for your bones. Absolutely not. It totally does. What I want to do is show you the gap between what some of the evidence says and some of the evidence that's used often in the fitness industry on podcasts, social media, et cetera, and then how it evolved on social media versus what the reality is so that we can ground ourselves in reality. And I care about this because some of what is circulating out there is scaring women. I hear it constantly. Someone in perimenopause, maybe early post-menopause, hears she needs to be squatting 85% of her one rep max. And then she needs to be doing box jumps twice a week, or she's gonna lose her bone density. And it creates this all or nothing thinking. Well, I can't do that, so I guess I'm out. And then maybe she doesn't do anything. Maybe you're just thinking, well, it doesn't matter. I, you know, let me go walk, let me do cardio, let me just lift lightly, whatever, and don't worry about it. And I myself have talked about the value to bone density of lifting at a high percentage of your 1RM. Now, usually when I do that, it's in a nuanced approach of it's just part of your lifting, right? It's not like you have to do just that. I also don't really talk about jumping too much, even though I have mentioned how some experts I've talked to, some of the science suggests that jumping is helpful to, you know, restore, especially if you have osteoporosis to reverse it or to add new bone density. And there's some evidence that says, oh, maybe you can't create new bone density from lifting alone, et cetera. So we're gonna cover that today based on a rereading of the science. And then stick around to the end because I'm going to give you a 30-second test that you can use where you could gauge whether the weight you've been putting on the bar, the dumbbells or machines or whatever is anywhere near the range that the research talks about. Okay. So that's gonna help you ground in reality for yourself. Am I lifting the way I want to lift for my goals? Along the way, you're gonna hear about the lift more trial that I've mentioned a few times before and that we're revisiting, sort of what it concludes versus what it doesn't, even though people misinterpret it. And there's three specific places where I think the findings get stretched on social media. We're gonna talk about the menopause transition, how that affects bone density, and we can compare it to this other stuff. And then what I would suggest that you do about it from a practical standpoint, which is simpler and a lot less intimidating than you might think. So here we go.
Inside the LIFTMOR trial (strength training and bone density)
Philip Pape 3:48
Let's start with the Liftmore trial. That's kind of the foundation of a lot of the claims. Some of it, some of them good, some of them not so much. It's called Liftmore, L-I-F-T-M-O-R. Watson and colleagues out of Belinda Beck's group in Australia. They published this in 2018. Dr. Beck is the real deal. I think she has spent her, you know, entire career on studying bone and exercise. And it's a very well-designed trial. They took 101 postmenopausal women with low bone mass, the average age around 65, and they looked at them for eight months. The training group did two supervised sessions a week: deadlift, overhead press, back squat, above 80% of their one rep max for five sets of five. Okay. Plus, they did jumping chin-ups with a drop landing. And so the results of that group are their lumbar spine bone density went up 2.9% in the training group, but it dropped 1.2% in the control group. So the femoral neck, that's the top of your thigh bone where the hip fractures occur, it went up 0.3% in the training group and down 2% in the control group. And then we have safety data that they measured, which is pretty cool. Across more than 2,600 training sessions with women who had osteopenia and osteoporosis, there was only one adverse event. It was a minor back spasm. There weren't any fractures. The leg extensor strength went up 37%, back extensor strength 36%, they got taller. Okay, isn't that wild? These women are in their 60s with thinning bones, they're deadlifting heavy, and they got taller and they didn't get injured. Okay, so that's good to know. When someone tells you, hey, lifting is heavy is dangerous for older women with low bone density, that's BS. So that's really good information to know. Now, what happened next? Well, the the protocol from this research got turned into a licensed trademarked program that is sold to clinics. And Dr. Beck is a director and shareholder in the company that runs it, and they disclose that in the paper. I don't have a problem with that. It's the translational science, the methodology is sound. I don't think there's anything shady with that. Just because people are involved or there's funding from certain sources in and of itself isn't a reason to discount things. But a lot of the you must train this exact way messaging is coming from people who sell, sell it that way. And you have to know it. You have to be able to question it. All right. So does it make sense? Well, it doesn't make the science wrong, but it makes the certainty of it suspicious, right? You just have to have to, if somebody's saying it has to be this way, I always question it. And then that same information was used for other kind of nonsense or silly stuff, like the weighted vests, right? Hey, you need to carry a specific percentage of body weight. It's gonna help your bones. The popular version that goes back to some trial from 2000, I think, is the foundation for a lot of the weighted vest stuff, right? But it's not a mountain of evidence that it gets presented at. There's currently no good evidence that walking around in a weighted vest raises your bone density, period. So that's the origin of this information. A really, really good trial. There's the commercial program built from that trial. And then a lot of, you know, the game of telephone on social media and people believing that, okay, on the other extreme here, anything short of five by five at 85% isn't effective in some way. So hopefully I've never made that claim, right? We always put it in the context of your lifestyle, a varied program, progressive overload, strength versus hypertrophy, all of that stuff. Now, before I get into where the translation of the data went off that we need to kind of pull back on, I want to mention something that connects to this conversation.
Where bone and hormones are connected
Philip Pape 7:45
When you think of bone and bone density, it's downstream of hormones. So there's a story here where what's happening to your skeleton and perimenopause is happening because estrogen is decreasing and estrogen is estrogen was kind of holding back the cells that break bone down, if you will, just to kind of layman's term the thing. Training is, of course, a huge lever you have relative to that system, your body. It's not the only lever, of course, but I don't think a lot of women get a clearer picture of how training and hormones fit together. So a few years ago, I actually put up put together a guide called Strength Training for Hormone Health. It still holds up. I still think it's really helpful for those looking to lift in a way that's supportive of hormones, what it does and doesn't do, how to think about training if you're on hormone therapy or considering it, how to structure things through the transition, et cetera. Very practical, very simple. Go to wits and weights.com slash free or click the link in the show notes to get the strength training for hormone health guide. I just wanted to mention that before we continue, in case you're looking for some more resources to do this. And it's not, you know, all about percentages of one rep max. Okay. So we have the trial, we have the messaging on social media.
3 gaps between the LIFTMORE trial and its interpretation
Philip Pape 9:05
Let's look at where the gaps are. Okay, there's three things I mentioned, I think, in the intro where I have a problem with it. And the first one is the comparison group. So in Liftmore, the control group, they were not doing moderate lifting. They were giving, given basically a home exercise program that was extremely light. It was hand weights that topped out at like three kilograms. So you could say, well, then what the what the study showed is that heavy supervised training beats what amounts to almost nothing. I mean, let's be honest, hand weights is almost nothing. It's just walking around with a little bit, a few pounds, kind of like a weighted vest, actually. But of course, it's going to beat that. Pretty much any half-ass lifting program is going to beat you know the hand weights or the nothing. So it can't tell you, oh, heavy training beats moderate training, because they didn't compare to that. So if that that probably makes sense, right? They didn't compare to moderate training or hypertrophy training or whatever. It was just compared to almost nothing. And you guys remember Dr. Lauren Calenzo Semple from Mass. She was on the show a while back. And the point that she makes, I love the way she put it, she doesn't attack the trials, she just talks about what they can and can't tell us. If you compare five by five against two-pound dumbbells, what are you gonna learn? You're gonna learn that the two-pound dumbbells don't work too well. I guess that's helpful, but should be no surprise to you, dear listener, who listens to wits and weights. So that's the first one. The second one is the measurement. So this is where my engineering brain comes in. They use DEXA. So DEXA has a precision error. I get that it's the gold standard for research. And they have an error measure called the least significant change. It's like the threshold below which your scan can't detect the real change from noise, so signal from noise. So in a typical clinical practice, that's like two to four percent at the spine, and apparently it's three to six percent at the hip. Now, if you look at the result from the femoral neck I mentioned earlier, of plus 0.3%, the authors themselves describe it as like a maintenance effect, which is actually a win in this case versus losing bone density. Now, if you personally trained for eight months and then you went and you got scanned, the report's not going to tell you the difference between that and like nothing happened because of this error, because of the resolution of the measurement. And that affects the conclusions we make out of this. Because we're arguing very loudly about differences that the bone density scan might not be accurate enough to measure. So, especially at the individual level, like across 100 women in a trial, sure. And we did see that the control group had the drop of, I think I'm saying it right, I think it was 2%, right? I just want you to know that the measurement should be questioned when you look at these trials and also when you do it for yourself. Like people reach out to me all the time about body fat and fat-free mass and all that. And I usually just say, hey, just use the Navy formula and look at the trend over time. Like don't overcomplicate it, don't rely on DEXs and in bodies and all that because of the error. The third gap I'll say is that the research on load, on the weight that you lift, I think isn't in full agreement. At least not to the extent where we can just make a confident conclusion. Like it's not settled. And and I and you see this when you look at the best of the best, like Eric Helms, when he reviews the state of the literature, he'll even say, Well, this one says this, this one says this. So where are we? So Kissler, Fischbacher, and colleagues, so that's the Beck group that we already talked about with Lyftmore, they published a meta-analysis in 2021 and they found that high-intensity exercise was a better stimulus for the lumbar spine than low or moderate exercise. But there was no advantage at the femoral neck. And they said this. Then Wang and colleagues in 2023, this was a network meta-analysis that combined 19 trials with 919 women. They ranked moderate intensity, so that's like 65 to 80% of one rep max, as the highest performing for both the spine and the femoral neck. So they rated it as better than heavy lifting, believe it or not. And then a 2025 review said, no, no, no, wait, heavier lifting is actually more effective, but they use a different cutoff for what counts as heavy. So if we're not even using the same percent RM, that's gonna cause a problem because we're just bucketizing as like heavy and moderate, but the numbers we're doing it aren't normalized. That's a problem, right? There was just this year, 2026, meta-analysis of 18 trials, and it found that high intensity training. So again, we've talking intensity meaning weight, like load, was clearly better for leg strength. I mean, I don't I don't have any con I don't have any problems with that conclusion. It seems to make sense, but it found no significant difference between heavier and lighter training for bone density at the sites that they measured. So here we have four meta-analysis, which is pretty high quality in the hierarchy of evidence that don't necessarily agree with each other. What they do agree on is that resistance training is more beneficial than not. So I don't know how helpful that is. I guess what I'd have you take from that is that both moderate and heavy loading work. The claim that heavy loading is required or that moderate loading is a waste of your time, that's definitely not supported. And you have to be careful with that. Okay, so that's the nuance. Now, one last thing is what population was studied?
Research on perimenopausal women over 40
Philip Pape 14:46
Because this was done in women who are on average 65 years old, at least five years past menopause. Well, if you're 45 or 49, if you're in perimenopause, that's not you. But there is a trial on that population. It's called Stop EM, stop-EM. Whitman and colleagues, it was published this year out of Canada. 40 women ages 45 to 60, and half of them perimenopausal. So for nine months, twice a week, they trained five by five at 80 to 85% of their max. And they used progressive drop landings. And this was compared to people not doing this. And they had huge gains in strength, 12 to 30 percent across the lifts. And then they held on to their lean mass while the control group lost some lean mass. Not surprising, right, to all of us here who know the value of lifting weights. But then for bone density, the difference between the groups at the lumbar spine was two hundredths of a gram per square centimeter. And the range of uncertainty around that was almost zero. So, given that this was a feasibility trial, it was designed to test whether you could even just recruit and run the protocol. It wasn't actually designed to detect a bone difference, and there was no moderate load comparison group. So I think the honest conclusion is that we don't have enough data for perimenopausal women for the bone side of things. We do for muscle. I mean, we're starting to get more and more. And it again, it's not to say that lifting isn't tremendously beneficial. We know that. It's more about the heavy versus the light and also the jumping piece. However, we do have the swan
How the menopause transition affects bone loss
Philip Pape 16:29
study. Now, the swan study has followed women through the menopause transition for decades, and it gives us a pretty good picture of what's happening to your bone and when it happens. So bone loss starts roughly a year before your final period and then accelerates really quickly for about three years. During that window, the average woman is losing around 2.5% per year at the lumbar spine and just under 2% per year at the femoral neck. And then it starts to slow down. That loss starts to slow down. So over the full menopause transition, that's roughly 10% loss of bone density. So that's pretty decent. That's pretty big. The very best exercise trials we have are showing us one to three percent increase versus that 10%. So if you think about the ratio, the question is can exercise rebuild what is lost during menopause? This would seem to suggest not. Now, I'm not trying to depress you or scare you. We're trying to pick this apart, nuance and all. So if you're going in starting to exercise or lift, expecting you're going to rebuild like all your bone density, and you don't, you might be disappointed. But if you significantly attenuate that loss, that's actually a big win. And that's kind of what we see is like, are we maintaining our bone density or avoiding as much of a loss? And in some cases, we are restoring and building bone density. So it's very highly individual. And I'm not saying that it doesn't restore or build bone density. In fact, we do see that at the individual level quite a bit, but anecdotally, it's hard to say from the literature one way or the other at the moment. So I would rather you pretty much hold steady rather than lose 2% a year. Wouldn't you? Peak bone mass actually happens in your 20s. So while you're pretty young, so really for the rest of your life, you're just managing against the loss. Muscle is a bit different. Muscle you can keep adding at any age. So I think we're confusing the two a little bit. Bone plays by a little bit different rules. So what do you actually
4 steps to maintain or build bone density
Philip Pape 18:38
do about this? I'm gonna give you four things to consider. The first one is, of course, to lift weights progressively at a load that is genuinely hard for you and just keep doing that for years. Somewhere in the range of 70 to 85% of your one rep max, two to three times a week on compound movements is a great foundation. All the other stuff you want to have in there for hypertrophy, because you love it, because you want the variation, because you want to do different rep ranges, that is great. I would just say if you have a squat pattern, hinge pattern, pressing, maybe some rowing in there, pulling, right? Not necessarily rowing, but some type of pull. So just having those different rep ranges, especially on the heavier side for a portion of your lifting is gonna be tremendous. And the real thing I want you to pay attention here, it's not the percentage so much, it's the doing it for years consistently part. I would rather you have a moderate program that you can run consistently and train hard with, even if it's not quote unquote heavy. That's gonna pay off tremendously versus something you wouldn't run. I'm not giving you permission to go easy, it's going to be hard. And in fact, many find that the higher rep ranges are pretty mentally challenging anyway, and actually find lower rep ranges kind of enjoyable despite being heavy. It's it's the difference between heavy but fewer reps and not as heavy but many more reps, and they're just different variables to play with. So progressive overload over a long time horizon is the way to go. Number two is to think about adding in balance and single leg work. And this one, I'm a little bit, I'll say I have a little bit less expertise in, and honestly, the evidence or the research is not, I'm not gonna say it's not as solid, but you're not gonna hear this as much in the strength community. I think it gets skipped a lot, but it could be very important. And there's folks like Megan Dahlman who are really into this and do a great job. I should have her on the show again, I think. But, you know, we care about bone density because of fractures, and fractures, at least outside the spine, come from falling down. Well, if you don't fall very often or at all, you overwhelmingly don't get fractures. So we know that exercise reduces the rate of falls significantly, I think by as much as a quarter from some studies. And, you know, balance training, functional training, if you want to call it, combined combining balance with resistance training. I don't like the term functional training because I think lifting weights is functional. Balance also comes from lifting weights. However, the unilateral or the single leg work can increase your balance even further. And so go ahead and do like the split squats or do the single arm whatever's deadlifts, RDL, et cetera. Incorporate them and see if it doesn't help even further with the balance. Okay, number three is impact. So I think the jury is still out on this. I think the jumping part of this, even though I mean I've had I've had folks on who are super smart talking about bone density and osteopenia osteoporosis, saying, you know, we probably need to have some jumping
Where jumping fits into your strength training protocol
Philip Pape 21:45
in there along with our lifting. But, you know, if you if you've died, if you have diagnosed osteoporosis, or if you've had a previous like fidd fragility fracture, they call it, especially in your spine, or if you have a balance problems or history of Falls, or you're dealing with pelvic floor symptoms and leaking, or you know, you've never ever done jumping, you're probably okay. And you always have to think of it as like, how do you ease into things? How do you progress? Think of it as progressive overload, think of it as a skill. You look at something like the UK, they have this Royal Osteoporosis Society and they have a guidance statement that recommends lower impact instead of moderate impact for most people as a general rule, with higher impact only after someone has assessed you individually. And so I'm not, as far as a coach goes, like I don't program jumping stuff. And, you know, I worry about like people doing stupid things and getting injured. I mean, I I used to do CrossFit. So trust me, I know more than anyone. And it's not about being cautious, it's more of just if you want to add impact, I want you to go to ladder it up, ladder it up. You know, start with heel drops, then do skipping, then do two-footed hops, and just kind of build from there. Like don't start on a box necessarily. That's my thought on that. And as a side tangent to that, there are some interest, there's some interesting research about vibration plate machines being helpful as providing the same kind of stimulus as jumping and impact. So interesting. Maybe I should do an episode on that in the future. We'll see. Number four is I want you to get the boring things locked down. Okay. Get the boring things locked down. And that would be your food, you know, your protein, your micronutrients. Yeah, calcium, vitamin D, all of that is helpful for bone. The biggest lever is still going to be your movement and your lifting. But higher protein intake should help with your spine bone density. We don't know that it's overly beneficial for other aspects, but high protein is beneficial for many, many other things. Magic matters enormously for muscle, it matter, which itself helps your spine and bone and balance and not falling, et cetera. So it's all connected, right? It's I just like to separate what affects bone directly versus what affects it systematically, or by virtue of you being stronger or having more muscle. If you have actual osteoporosis, please be talking to this with your doctor anyway. I know there's all sorts of medications, there's biophosphates, there's like different types of exercise, different drugs now, all sorts of things happening, peptides, everything else. I have no idea. It's it's it's crazy. So that's in the medical world. I'm kind of staying out of that. I'm dealing more with the lifestyle piece. So, just in case you took the wrong message from this, I am not saying heavy lifting doesn't build bone. It does. I it also is essential, I would say. I think the strength and muscle benefits in many of these trials are probably a lot larger and more certain in our claims than the bone benefits. But you have tremendous bone benefits from lifting and possibly from jumping as well. Okay. I'm not saying bone density doesn't matter either, of course. It matters tremendously, but it may not be the only thing that determines things like fracture and break, you know, breaking your hip. Like I said, being strong, being balanced. Those are also tremendously important. So it's not just about the bone density, it's all the other stuff around it. And I'm also not saying you have to lift five by five, 85%, and use drop landings, and that's your program, right? Like you've got a lot of flexibility
Finding your load range without attempting a 1 rep max attempt
Philip Pape 25:16
here. All right, before we wrap up, I'm gonna give you a 30-second test that you can start this week. But before that, I did tell you about the 70 to 85% load of your one rep max. And I wanted to address that real quick because you're probably thinking, okay, I have no idea what that is. Like, I don't know what my one rep max is. How do I do this without getting crushed under a barbell or something? And that's totally fair. And you don't have to necessarily, you can start from a calculator to get in the range. And I actually have a calculator on my website. If you go to witsandweights.com slash calculators, I'll include the direct link in the show notes. There's a strength calculator. You put in the weight, a weight that you've actually lifted and how many reps you got, and it's going to estimate your one rep max based on the most useful formulas that are out there. But it also gives you load ranges off of that. It also gives you the strength standards. So you can see where like your squat, your deadlift, your press sit for your age and body weight, which can be helpful. I'm not saying it's be all end all. There's a huge variation, but it's nice to kind of get you in the ballpark. So go to wits and weights.com slash calculators, totally free to check that out. Okay. Here's a 30-second test that tells you, am
Bonus: 30-second test for whether you're lifting heavy enough
Philip Pape 26:20
I lifting heavy enough to matter for my bones? Assuming that we want to be in a high percentage of one rep max, which as I've stated, is somewhat supported by the evidence, but be careful not to overweight it. So pick your main lift. Take the weight that you normally use and do one set and stop about two reps shy of failure and count how many reps you did. If you did more than 12 reps, you are below 70% of your max. That's it. So if you're two reps shy of failure and you've done more than 12 reps, you're probably less than 70% of your max. If you're around eight to 12, you're like 70 to 80%, which is kind of the range we're going for. And five to eight reps puts you around 85%. So that's why I like the four to six range. And that's probably why the eight to 12 range is so common as well. Maybe. I don't know. There's a whole history with bodybuilding and everything regarding that. It's just an estimate and it varies person to person. But, you know, if you if you could do 15 reps, you're probably not training heavy. That's my point. So you can figure this out. You can use our calculator also to help you figure out and get after it. Until next time, keep using your wits, lifting those weights. And remember, your bones don't require you to go all out with the heaviest load every time in the gym. You just have to be consistent, train hard, have a good mix of rep ranges and loads, stay on your feet, move around, stay active, and you'll be good. I'm Philip Pape, and I'll talk to you next time here on the Wits and Weights podcast.
