Better Bone Health: New evidence suggests two proven interventions work best together
HRT and Resistance Training for Better Bone Health
For our patients, we encourage horizon planning. Osteoporosis risk jumps after menopause, when declining oestrogen accelerates bone mineral loss. The risk of neglecting skeletal health is high if you want to be skiing down mountains into your 80s!
A new systematic review suggests a smarter, combined approach to preserving bone strength could deliver real-world gains with relatively modest commitments.
What Does the Latest Evidence Actually Show?
A 2025 systematic review in Frontiers in Reproductive Health (DOI: 10.3389/frph.2025.1542746) analysed 20 trials in postmenopausal women. It found that combining low-dose hormone replacement therapy with resistance training two to three times per week significantly improved bone mineral density (BMD) compared to either strategy alone.
Effect sizes: Moderate for both lumbar spine and hip BMD improvements.
Adherence: Good overall safety profiles but varied training intensities and drop-out rates highlight the need for personalisation.
Synergy: The evidence suggests an additive benefit — not merely stacking two interventions, but amplifying their impact together.
The important take-away is not that everyone should be on HRT, some don’t need it or can’t take it, but for those who are on it, don’t neglect strength training. The combination may meaningfully slow or reverse bone loss. And for those who aren’t on HRT or can’t take it, don’t neglect strength training!
What Does the Other Evidence Say?
This isn’t the only evidence connecting muscle, hormones, and bone health. These recent systematic reviews support the benefits of strength training. Both in 2023, one published in Osteoporosis International and another in Frontiers in Physiology confirmed that progressive resistance training alone can improve bone density in postmenopausal women (DOI: 10.3389/fphys.2023.1105303 & 10.1007/s00198-023-06682-1). However, the effect sizes were smaller than those shown by the combined approach in the newer review, highlighting that synergy matters.
Together, these studies build a strong case for an integrated approach rather than substitution.
How Should this Change What You Do?
Execution requires consistency.
You need structure: Ad-hoc training won’t deliver these results. The trials used well-designed resistance programmes with progressive overload.
Tailored HRT: HRT isn’t for everyone and needs to be personalised. Your hormonal baseline, family history, and other risks must be reviewed carefully. There’s no one-size-fits-all dose.
Lifestyle context: Factors like protein intake, creatine, vitamin D sufficiency, and sleep quality are non-negotiable for bone remodelling.
Time investment: Two to three high-quality resistance sessions per week are the sweet spot. Sporadic effort does not yield the same gains.
Next Steps If You Don’t Already Do This:
So, what does this mean for you today? Five steps to make the evidence work:
Get your baseline: A DEXA scan shows your current bone density at key sites like the lumbar spine and hip.
Consult on HRT suitability: Work with a physician who understands life pressures and tailors dose, formulation, and delivery method.
Prioritise progressive resistance: Two to three sessions weekly, focusing on compound lifts and loading bones meaningfully.
Align nutrition and recovery: Assuming a robust nutritional pattern already, aim for 1.2–1.5 g of protein per kg body weight daily, plus adequate calcium and vitamin D.
Track and adapt: Reassess BMD periodically, tweak training loads, and adjust your hormone prescription based on life stage and goals.
FAQs
Q: What if I already lift weights? Should I still consider HRT?
A: Possibly. Evidence shows that even trained women may gain an extra edge by adding low-dose HRT but it must be carefully assessed.
Q: Is impact training better than weights?
A: Not necessarily. Resistance training is safer for many and delivers predictable, load-bearing stress to bones. Some impact work may complement it if your joints and technique allow.
Q: Are there known risks with this combined approach?
A: The review found no significant increase in adverse events with the combined strategy. But the hormonal aspect demands a personalised risk-benefit discussion.
If you’re perimenopausal and aiming for long-term resilience, think of your bone health as an asset. It compounds or decays over time. Invest now and reap the rewards with time to maintain your independence actively into your 60s, 70s, or beyond.
