Bone-afied path to ageing well: Never too old, or young, to start building bone density and muscle mass

Q: My mother suffered a hip fracture in her 60s, and things went downhill from there. As I approach menopause, what can I do to prevent this from happening to me?

A: Start resistance training. Start now in any amount. You’re never too old, too young or too weak to start.

You don’t have to weight train at a gym if you don’t want to. Resistance training is any exercise where you work against an external force.

There are many moves that achieve this — with or without weights: squats, planks, push-ups, deadlifts, glute bridges and more.

Resistance training can help address two critical issues of ageing that disproportionately affect women: loss of muscle mass and bone density.

These two are often linked, with increases in muscle strength helping prevent bone mineral density loss.

But most adults aren’t meeting the Centres for Disease Control and Prevention’s guideline of doing muscle-strengthening activities at least twice a week.

About 27 per cent of adult women meet the mark, and that number plummets to around 17 per cent among women aged 65 or above.

Low-impact activities such as walking or non-weight-bearing activities, such as water aerobics or cycling, are wonderful for reducing the risk of cardiovascular disease as well as providing other health benefits.

But they might not be enough to help women age well.

Remember, any resistance training is better than none, so start slowly and find the exercises you most enjoy. I started out with three-pound weights at home that I’m very proud of.

It’s never too late to build muscle

Muscle mass loss starts well before menopause, usually in our late 20s and 30s.

But you can make improvements at any age.

In a study published in the New England Journal of Medicine in 1994, researchers conducted a randomised controlled trial of nursing home residents — where the average age was 87 years old — and found that resistance training was not only feasible but highly effective in building muscle and counteracting frailty.

And a large analysis of more than 100 studies found that whether you’re lifting heavy or light weights, a man or a woman, young or old, or doing it just once a week versus several times a week, you’ll experience substantial gains in strength and muscle mass.

Many studies on the benefits of resistance training tended to looked at “high-intensity” exercise, such as in the nursing home study, but don’t let that intimidate you: It means participants aimed for 80 per cent of their maximum possible effort while maintaining proper form.

Keeping bones healthy as you age

During the first five years after menopause, bone density loss is devastating and swift — as much as 20 per cent of women’s baseline disappears.

Consider this: 1 in 2 postmenopausal women will have a bone fracture from osteoporosis, or loss of bone mineral density, during their remaining lifetimes.

The United States Preventive Services Task Force recommends screening for osteoporosis in women 65 years or older.

But osteoporosis is one of those diseases that lurks under the surface: You may not know you have it until you get that scan — or worse, break a bone.

This means if you wait to act, you’ve lost critical time to prevent a bad outcome.

A 2021 study analysing over 66,000 female participants in the Women’s Health Initiative, a landmark reproductive health study funded by the National Institutes of Health, found that about 44 per cent of traumatic fractures — meaning after an obvious fall or injury — occurred between ages 55 to 65.

That same age group experiences about 34 per cent of non-traumatic fractures — that is, a bone fracture that occurs spontaneously, simply because the bone is weak.

Many types of exercise have been shown to help older women maintain healthier bones, but greater physical stress, like the kind experienced during resistance training, causes a strengthening of the bone’s internal architecture.

Randomised controlled trials have found that regular resistance training among sedentary postmenopausal women significantly improves bone mineral density in the hip and spine.

Those who did no resistance training kept on losing bone.

How to start resistance training

Talk to your doctor about the best form of resistance training for you.

If you already have osteoporosis or joint problems, lighter impact training, such as with resistance bands, may be a better choice.

You may also benefit from exercises to improve balance.

At the gym: For people with a new 2025 gym membership, try this 15-minute weight-training routine. Heavy weights aren’t actually necessary: Studies have confirmed that lighter loads used until your muscles feel tired are also effective.

Aim for as many repetitions as you can until your muscles are too tired to continue — something called volitional failure — then stop and move on.

Experts say once you can comfortably repeat a move 25 times, it’s time to try moving up to a higher weight.

Also, it’s worth noting that many gyms have trainers who specialise in working with older people.

With weights, at home: You don’t really need much equipment, but if you want, get an exercise mat, resistance bands and possibly a kettleball or a set of weights — light or heavy.

Without weights, from just about anywhere: Start with simple moves such as lunges, squats, crunches, holding a plank, and triceps dips.

These exercises are all part of the science-backed 7-minute workout — and can be done in a tiny space, no fancy equipment required.

What I want my patients to know

When I was in medical school, many of my patients who were hospitalised for months on end — with complications ranging from stroke to sepsis — often had a similar start to their saga.

They were doing perfectly fine until one day, they broke a bone.

Then they became chronically weaker, and other bones broke soon thereafter.

Medical complications started to snowball, keeping them bouncing in and out of hospitals and rehabs for months on end.

My own observations fit with the data: Studies have found that 25 per cent of people over the age of 65 who suffer from a hip fracture die within a year. We need badly to get ahead of that curve.

Trisha Pasricha is an instructor of medicine at Harvard Medical School.

(c) 2025 , The Washington Post