Public Release: 

Researchers show the 'BEST' way to reduce osteoporosis risk

Weight-bearing regimen and calcium citrate proven to increase bone mineral density

Manning Selvage & Lee

Osteoporosis International, the leading clinical publication on the disease, published data from the Bone Estrogen Strength Training (BEST) Study at The University of Arizona which confirmed that a specific regimen of weight-bearing and resistance exercises, combined with calcium citrate supplement over four years, provided significant improvement in bone mineral density (BMD) of postmenopausal women at key skeletal sites, whether or not they were on hormone therapy (HT).

The findings from this four-year study indicate that the protective measures of adequate calcium supplementation and resistance exercise improve bone mineral density. Women can lose 10 to 20 percent of their BMD as they age, (80% of those affected by osteoporosis are women), but the researchers found that on average women following the exercise and calcium regimen not only did not lose bone density, but increased it by 1 to 2 percent.

"The good news is these long-term data confirmed the potent combination of improved nutrition and increased physical activity to prevent bone loss. The extended use of calcium supplementation and exercise counteracted the typical loss of BMD in women at this age, in a regimen that women really can stick with," said Timothy Lohman, PhD, principal investigator for the study, director of the UA Center for Physical Activity and Nutrition (CPAN) and UA professor of physiology. "This is quite significant for younger women as well, as these exercises and calcium supplementation can help build peak BMD which may prevent health problems and osteoporosis in the future."

BEST Study Co-Investigator Lauve Metcalfe, MS, director of Program Development and Community Outreach for CPAN and an exercise interventionist with the UA Department of Physiology, added, "What sets this regimen apart is the six specific exercises that help build bone in the wrist, hip and spine--three key fracture sites. This type of weight-bearing exercise now is proven to be beneficial and represents a shift in prior bone health recommendations. It previously was thought that any type of exercise was helpful, but now we understand that resistance and weight-bearing exercise are essential."

BEST Study participants were coached in specific exercises aimed at building bone in key fracture points of the wrist, hip and spine. Mission Pharmacal Company supplied Citracal® calcium citrate for the study. Women were encouraged to take two Citracal® tablets twice a day, morning and evening, to ensure at least 800 mg of calcium. The balance of the remaining recommended dietary allowance (RDA) of 1,000 mg per day was to be supplied by their food intake. The women who regularly took the recommended level of 800 mg of calcium supplement daily and continued to consume calcium in their meals showed greater improvement than those who consumed less than the RDA, and women who kept up the with the exercises showed greater improvement than less frequent exercisers. In addition, the study reinforced evidence that long-term, consistent calcium intake and exercise are valuable, as they provided significant improvement in BMD. The UA investigators developed the BEST regimen, which they found effective in building bone in typically vulnerable areas. The regimen includes six core exercises:

  • Leg Press
  • One-arm Military Press
  • Seated Row
  • Wall Squat and Smith Squat
  • Back Extension
  • Lat Pull Down

Study participants did two sets of six-to-eight repetitions, three times a week. Seven-to-ten minutes of cardiovascular weight-bearing activity, such as stair climbing, treadmill walking with a weighted vest and postural stretches, round out the study regimen. Participants lifted increasingly heavier weights, with the amount of weight lifted in correct form emphasized over number of repetitions.

Building BMD is important in preventing osteoporosis, which often results in fractures of the hip, spine and wrist. Adequate calcium intake and exercise throughout life help prevent bone loss, and these measures also can help the millions of Americans already diagnosed. The best treatment is prevention, and women of all ages should be concerned about their bone health and take action to stay active and improve their nutrition and bone strength.


About Citracal®
Calcium Citrate Citracal® is the trademark name of a highly soluble calcium citrate supplement. Many physicians recommend Citracal® calcium citrate as one of the best absorbed, most easily digestible forms of supplemental calcium. Go to for more information on Citracal® and to see visuals of the BEST exercises.

About Mission Pharmacal Company
Mission Pharmacal Company, the makers of Citracal® brand of calcium citrate supplement, is a family-owned pharmaceutical company based in San Antonio, TX.

About the BEST Study
The most extensive study of its kind in the United States, the Bone Estrogen Strength Training (BEST) Study began in 1995 to examine how strength-training exercise affects changes in bone density in two groups of postmenopausal women: those on hormone therapy (HT) and those who were not. All participants took Citracal® calcium citrate supplements, provided by Mission Pharmacal Company, twice daily to provide 800 mg of calcium a day. The women were randomized to either a control group or an exercise group. Those in the exercise group performed supervised aerobic, weight-bearing and weightlifting exercises, three times per week in community-based exercise facilities.

The first results showed that weight-bearing and resistance exercises over a 12-month period, combined with Citracal® calcium supplementation, significantly improved bone mineral density at skeletal sites at risk for osteoporotic fractures in postmenopausal women (Osteoporosis International, September 2003). HT was most successful at maintaining or increasing bone mineral density, although exercise without HT also showed positive results.

During the first year, the study examined 266 Tucson-area women, ages 45-65, who were three to 10 years postmenopausal;167 remained in the study through the fourth year (Osteoporosis International, December 2005). Study investigators are continuing to track the participants to observe the long-term effects of exercise on fracture risk in post-menopausal women.

Funded by a grant from the National Institute for Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health, the BEST Study was a cooperative effort by The University of Arizona (UA) College of Medicine Department of Physiology, UA Department of Nutritional Sciences, UA College of Agriculture and Life Sciences, UA College of Medicine Department of Family and Community Medicine, UA Mel and Enid Zuckerman College of Public Health, University Medical Center Wellness Program, Fitness & Health Institute of Tucson (FIT), Naturally Women Fitness Centers, Metro Fitness and Mission Pharmacal Company of San Antonio, Texas.

The BEST Study findings led to the development of The BEST Exercise Program for Osteoporosis Prevention (The BEST Book), to provide guidelines for exercise that will make a difference in bone health. To order a copy of The BEST Book, contact the UA Center for Physical Activity and Nutrition (CPAN) at or email Michele Graves, UA Department of Physiology, at

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