It’s an often-forgotten fact that being strong on the outside requires us to have a healthy, solid frame on the inside. Many gymgoers spend a great deal of time focusing on their aesthetics without paying proper attention to the all-important foundation, but it is essential to realize that big and beautiful muscles require support from solid, healthy bones. Skeletal density is essential for mobility, injury protection and mineral storage but as we age, our bones often need more attention, leading many to question whether it’s still ok to still lift weights as we hurtle through our 40s.

Maturity also brings the increased risk of a lack of bone density, leading to more fragile or brittle bones (osteoporosis). Linda A. Russell, MD,  member of the Hospital for Special Surgery, and a New York City-based expert in rheumatology, perioperative medicine, and metabolic bone, explains how we can keep our bones strong, and whether it’s still OK to lift weights as we get older.

What happens to our bones as we age?

“There are two major bone cell types,” Russell says. “The osteoclast, and the osteoblast. From the day that we are born, until around age 25 to 30, we make more bone than we lose. So, the bone strength gets better and better. And then somewhere around 25 and 30, we all sadly reach our peak bone density, and that’s the strongest that our bones will ever be. Then, as we start the normal aging process, we start to lose more bone than we make and slowly the bone density begins to decline.”

Can men just be given testosterone replacement therapy to reverse this process?

Men don’t go through a menopause,” Russell says. “But they do have a slow lowering of their testosterone levels. We don’t like to give elderly men TRT because it increases the risk of prostate cancer. I saw a young gentleman in his 30s, who had low testosterone levels and osteoporosis. We would probably supplement him (with testosterone), but with more elderly men we generally don’t.”

Is weightlifting a good way to maintain healthy bones naturally, even as we age?

“You know, it really depends on the individual and how much of their time they devote to fitness,” says Dr. Russell. “The interesting thing is that weight-bearing exercises are wonderful for bones. So, if you participate in a regular weight-bearing exercise program, your bone health will be absolutely better. And we know that, for instance, if you go into space, astronauts lose lots of bone because there is no gravity. If you take someone who is

sick, and you put them in a hospital bed, within about two weeks they’ll start losing bone. The more that you can have activities where you are against gravity, the better your bone health is going to be.”

How important is the relationship between muscle mass and strong healthy bones?

“Muscle is attached to bone. Muscle pulls on bone. The stronger the muscle, the greater the pull on the bone, and the better it is for the bone,” says Russell. “So, if you have somebody that is really well defined, they have a nice cardio program, and a nice weight-strengthening program, then that’s going to be beneficial. If you take a 40-year-old, who is a couch potato, and has some adiposity (fat) around their middle, they are not going to be as healthy as someone who’s hitting the gym five days a week. Strong muscle helps bone, age is important, but for me, being a rheumatologist and seeing people of all ages, it’s really their fitness that speaks more than their age.”

Russell points out that a good workout program becomes even more essential as we reach our 40s, because muscle mass is already beginning to decline naturally. “You lose about a third of a pound of muscle mass per year,” she says. “You can work hard so that this doesn’t happen. You can exercise and do your weight training, but if you’re just a guy that doesn’t really exercise you will start losing muscle and if you looked at an MRI of the that muscle, it has more fat interspersed with the muscle. For someone that is very fit, there is very little fat in the muscle shown on an MRI.”

What should men avoid to maintain healthy bones?

“A risk factor for osteoporosis is having more than three alcoholic beverages per day,” says Russell. “There are probably a good number of people that drink at least that much alcohol per day. It’s not ideal for bone.”

In addition, Russell adds that it is important to get checked out by a doctor because problems with bones can often be caused by other medical issues. “Rheumatoid arthritis is associated with bone loss,” she says. “A lot of liver diseases are also associated with bone loss. If you have rheumatoid arthritis and you are treated with medication, you reduce the chances of bone loss. But some medications are associated with bone loss, like prednisone, or medications used to treat prostate cancer because they are trying to lower the testosterone level. Tobacco is also very bad for bone health. Tobacco is directly toxic to the osteoblast, the cell that makes bone.”

So, it’s good to keep lifting in my 40s and beyond?

At any age, studying proper lifting form and not trying to move a force that is too heavy for you is a good idea to prevent injury, bone and joint problems. And in terms of minerals, Dr. Russell points out that vitamin D and calcium are essential for bone health, and these can

often be consumed through a normal diet, so make sure you include proper nutrition within your training resume. But when it comes to lifting weights, you still have plenty of life in those old bones!

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