Resistance Training and Rapamycin to Enhance Bone Formation in Postmenopausal Women

Inclusion criteria

• Women aged 60-75 years old, any ethnicity.
• Participants with T- score between < 1.0 and > -2.5 measured by DXA scan within 6 months of the first day of the study.
• Adequate cognitive function to be able to give informed consent.

Exclusion criteria

• Osteoporosis and fracture history

• Participants with osteoporosis (defined by DXA scan < 6 months old: low bone mass, T-score < -2.5 or hip fracture or clinical compression fracture of the spine).
• History of low energy fractures within last 6 months. Health conditions limiting exercise
• Health conditions that could limit walking and weightbearing exercise (for instance recent surgery, mobility limitation)
• Participants with impaired wound healing or history of a chronic open wound Bone metabolism disorders
• Primary hyperparathyroidism.
• Known vitamin D deficiency (<25 nM) (re-test after substitution acceptable).
• Known disorders affecting bone metabolism, e.g., uncontrolled thyrotoxicosis, severe renal impairment (eGFR < 30) or impaired liver function (baseline phosphatase higher than twice upper limit (105 U/L)), active rheumatic diseases, celiac disease, severe chronic obstructive lung disease (COPD), hypopituitarism, or Cushing's disease.
• Previous use of bone antiresorptive or bone anabolic drugs within the last 5 years.

Medication use and health conditions

• Use of anabolic steroids in the previous year.
• Use of antiresorptive therapy in the previous year.
• Known medication/supplements affecting bone in the previous year.
• Diabetes type 1 and 2.
• Heart failure similar to NYHA Class IV.
• Treatment with drugs known to affect cytochrome P450 3A due to its role in everolimus metabolism, excluding strong CYP3A4 inhibitors or inducers, while allowing weak and intermediate inhibitors or inducers. Patients on the following drugs will be excluded from the trial: Ketoconazole, Itraconazole, Posaconazole, Voriconazole, Telithromycin, Clarithromycin, Nedazodone, Ritonavir, Atazanavir, Saquinavir, Darunavir, Indinavir, Nelfinavir, Rifampicin, Dexamethasone, Carbamazepine, phenobarbital, Phenytoin, Efavirenz and Nivirapine.
• History of coagulopathy or medical condition requiring long-term anticoagulation.

Blood disorders and other health concerns

• Anemia - Hg < 5,59 mmol/L, Leukopenia - white blood cells (WBC) < 3,5 x 10⁹/L, Neutropenia absolute neutrophil count < 2,0 x 10⁹/L, or Platelet count - platelet count < 125 x 10⁹/L.
• Insufficiently treated dyslipidemia with LDL-c > 4,9 mmol/L and family history of dyslipidemia, Total cholesterol > 9,1 mmol/L, or triglycerides > 9,9 mmol/L.

Immunosuppressive and current cancer Treatment

• Scheduled for immunosuppressant therapy for transplant or scheduled to undergo chemotherapy or any other treatment for malignancy
• Any form of clinically relevant primary or secondary immune dysfunction or deficiency Cardiovascular and heart conditions
• Unstable ischemic heart disease.

Allergies

• Known allergy to rapamycin or rapalogs. Language limitations
• The study will exclude participants with inability to speak and understand Danish and with inability to cooperate.