Thickening the trabeculae versus increasing the trabecular number

@gently Thanks for your comment.
I agree: "Both impact exercise and resistance lifting can be destructive to remaining bone." Yesterday, I spoke to a physiotherapist and he said more or less the same. I showed him the pictures of my Dexa and VFA scan and he said that because of my several vertebral compression fractures we would have to be careful when designing a program to improve my bone health and there's always a risk of a next fracture.

I asked him about specific exercises for the thickening of trabecular bones versus increasing the trabecular number, but he avoided my question and said that in next session, we would explore my possibilities for safely exercising.

My exercise of the last few months has been walking twice a day for 30-45 minutes with Nordic walking poles with a for me more or less natural speed of 2 miles an hour. I got the impression the physio thought that heavier shocks to my hips and vertebrae were needed to actually help build stronger bones.

In the mean time, I found this article: Bone Health and Physical Activity - The Complex Mechanism at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12539549/

It says e.g. "This article discusses matters concerning the mechanism of physical activity affecting bone tissue and factors modifying its response to mechanical loads, the knowledge of which may be of importance in the prevention of bone fractures associated with heavy training loads or osteoporotic changes."

I read somewhere (but forgot to document...) that women with osteoporosis tend to lose trabeculae while men would tend to lose thickness of the trabeculae.

It fascinates me, because I think this may have consequences for the kind of exercises that would fit me best as a woman. With weight lifting one improves the thickness of the trabeculae. But what if I'd better start with focusing on improving the amount of trabeculae? I think I need to start doing some further research on that.

This is what Google AI just generated:
Bone Loss Patterns in Women
* Loss of connectivity: Driven by postmenopausal estrogen deficiency, rapid remodeling causes complete perforation and disappearance of individual trabecular structures.
* Decreased number: Women experience a significant decline in trabecular number (Tb.N) rather than just uniform reduction in width.

Bone Loss Patterns in Men
* Trabecular thinning: Aging and gradual testosterone reductions lead to a generalized attenuation and narrowing of the trabeculae (Tb.Th).
* Preserved network: The overall structural connectivity of the network remains relatively better maintained compared to postmenopausal patterns in women.

In addition I asked Google: which exercises would be most suitable for women to increase the amount of trabeculae?

It answered:
To increase trabecular density or slow down its loss, women must engage in high-intensity resistance training (HIRT) and progressive high-impact loading exercises. [1, 2]

However, a critical biological distinction must be made first: adults cannot grow completely new, individual trabeculae once they have disappeared. Instead, targeted exercise applies mechanical stress that forces osteoblasts (bone-building cells) to thicken and reinforce the surviving trabeculae. This strengthens the remaining spongy network and prevents further connectivity failure. [1, 3]
The most effective, evidence-based exercises to stimulate trabecular bone remodeling include: [2]
## 1. High-Intensity Resistance Training (HIRT)
Heavy structural loading creates strong muscle contractions that pull on the bone, forcing the internal trabecular architecture of the spine and hips to reinforce itself. [1, 4, 5]

* Barbell or Dumbbell Deadlifts: Strongly loads the lumbar spine vertebrae and the hip joints.
* Weighted Back Squats: Compresses the femoral neck and hip, stimulating trabecular density where fractures most often occur.
* Overhead Shoulder Presses: Targets upper-body skeletal structure and thoracic vertebrae. [1, 4, 6, 7, 8]

## 2. Progressive High-Impact Exercises
Brief, sudden impacts generate ground reaction forces that travel up the skeleton, triggering rapid bone remodeling in the lower limbs and hips. [1, 9, 10]

* Stomping or Box Step-Downs: Deliberately driving the heel into the ground simulating heavy impacts.
* Countermovement Jumps or Leaps: Dropping into a partial squat and jumping upward, which clinical trials show improves hip bone mineral density.
* Bounding or Skipping: Creates multidirectional mechanical stress to protect the hips from varied angles. [11, 12, 13, 14]

## 3. Axial Weight-Bearing Cardio
Dynamic activities that force the body to continuously fight gravity help maintain the structural integrity of the lower skeleton. [3]

* Weighted Vest Stair Climbing: Forcing the body to lift additional weight against gravity strongly benefits postmenopausal hip and spine density.
* Brisk, High-Step Hiking: Provides variable, uneven impact forces that challenge bone structure better than flat-surface walking. [13, 15, 16, 17]

## Important Safety and Modification Rules

* The Osteoporosis Caveat: High-impact jumping and heavy lifting are highly effective for prevention and treating mild osteopenia. However, if you have already been diagnosed with severe osteoporosis, high-impact movements can trigger fractures. [2, 11, 18, 19, 20]
* Get Supervised Guidance: Always seek a physical therapist or specialist to design a supervised, progressive program tailored to your bone density scores. [1, 2, 21]
===
So, I'm afraid I already got an answer to my question above...

Yet, at the top of this thread I already referred to: https://pubmed.ncbi.nlm.nih.gov/34905673/ (though somehow the link isn't visible there) and then wanted to explore further. That article made me think it was possible to improve the amount of trabeculae... Though, of course, I'm not a rat...

In addition I asked Google: which exercises would be most suitable for women to increase the amount of trabeculae?

It answered:
To increase trabecular density or slow down its loss, women must engage in high-intensity resistance training (HIRT) and progressive high-impact loading exercises. [1, 2]

However, a critical biological distinction must be made first: adults cannot grow completely new, individual trabeculae once they have disappeared. Instead, targeted exercise applies mechanical stress that forces osteoblasts (bone-building cells) to thicken and reinforce the surviving trabeculae. This strengthens the remaining spongy network and prevents further connectivity failure. [1, 3]
The most effective, evidence-based exercises to stimulate trabecular bone remodeling include: [2]
## 1. High-Intensity Resistance Training (HIRT)
Heavy structural loading creates strong muscle contractions that pull on the bone, forcing the internal trabecular architecture of the spine and hips to reinforce itself. [1, 4, 5]

* Barbell or Dumbbell Deadlifts: Strongly loads the lumbar spine vertebrae and the hip joints.
* Weighted Back Squats: Compresses the femoral neck and hip, stimulating trabecular density where fractures most often occur.
* Overhead Shoulder Presses: Targets upper-body skeletal structure and thoracic vertebrae. [1, 4, 6, 7, 8]

## 2. Progressive High-Impact Exercises
Brief, sudden impacts generate ground reaction forces that travel up the skeleton, triggering rapid bone remodeling in the lower limbs and hips. [1, 9, 10]

* Stomping or Box Step-Downs: Deliberately driving the heel into the ground simulating heavy impacts.
* Countermovement Jumps or Leaps: Dropping into a partial squat and jumping upward, which clinical trials show improves hip bone mineral density.
* Bounding or Skipping: Creates multidirectional mechanical stress to protect the hips from varied angles. [11, 12, 13, 14]

## 3. Axial Weight-Bearing Cardio
Dynamic activities that force the body to continuously fight gravity help maintain the structural integrity of the lower skeleton. [3]

* Weighted Vest Stair Climbing: Forcing the body to lift additional weight against gravity strongly benefits postmenopausal hip and spine density.
* Brisk, High-Step Hiking: Provides variable, uneven impact forces that challenge bone structure better than flat-surface walking. [13, 15, 16, 17]

## Important Safety and Modification Rules

* The Osteoporosis Caveat: High-impact jumping and heavy lifting are highly effective for prevention and treating mild osteopenia. However, if you have already been diagnosed with severe osteoporosis, high-impact movements can trigger fractures. [2, 11, 18, 19, 20]
* Get Supervised Guidance: Always seek a physical therapist or specialist to design a supervised, progressive program tailored to your bone density scores. [1, 2, 21]
===
So, I'm afraid I already got an answer to my question above...

Yet, at the top of this thread I already referred to: https://pubmed.ncbi.nlm.nih.gov/34905673/ (though somehow the link isn't visible there) and then wanted to explore further. That article made me think it was possible to improve the amount of trabeculae... Though, of course, I'm not a rat...

@wilweten I have severely degraded trebeculae and my endocrinologist basically told me there is no way to rebuild the structure once it is gone. Anabolics like Forteo or Tymolos can thicken the structure that remains, but improving my TBS is going to be especially difficult. Instead I was encouraged to focus on improving bone density because that would be an easier goal to achieve. Needless to say I felt very discouraged.