Preventing osteoporosis with exercise: A review with emphasis on methodology (original) (raw)
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Role of exercise in osteoporosis prevention--current concepts
JOURNAL OF PAKISTAN MEDICAL ASSOCIATION, 2008
Osteoporosis is a metabolic disorder of the bones due to loss of both bone mineral and bone matrix in equal proportions resulting in a bone that is weak and unable to support the body. This becomes a problem in the elderly who are then at risk of frequent fractures increasing the morbidity and mortality. Measures taken early in life in the form of calcium and exercise go far in preventing the development of this disorder. The primary purpose of this narrative review is to evaluate the current literature and to provide insight into the role of exercise relating to osteoporosis. Emphasis is given to the importance of the specific types of exercises needed to increase bone strength and muscle power, keeping in view the age and general physical condition of the person.
The Effect of Physical Activity on Bone Accrual, Osteoporosis and Fracture Prevention
The Open Bone Journal, 2011
Background: Physical activity has been recommended for the prevention and even treatment of osteoporosis because it potentially can increase bone mass and strength during childhood and adolescence and reduce the risk of falling in older populations. However, few reports have systematically investigated the effect of physical activity on bone in men and women of different ages. Purpose: The goal of this study was to review the literature relating to the effect of physical activity on bone mineral density in men and women of various ages. Method: This review systematically evaluates the evidence for the effect of physical activity on bone mineral density. Cochrane and Medline databases were searched for relevant articles, and the selected articles were evaluated. Results: The review found evidence to support the effectiveness of weight bearing physical activity on bone accrual during childhood and adolescence. The effect of weight bearing physical activity was site-specific. In contrast, the role of physical activity in adulthood is primarily geared toward maintaining bone mineral density. The evidence for a protective effect of physical activity on bone is not as solid as that for younger individuals. Conclusions: The effect of weight bearing physical activity is seen in sites that are exposed to loading. There also seems to be a continuous adaptive response in bone to loading. Additional randomized, controlled studies are needed to evaluate the effect of physical activity in the elderly.
The Roles of Exercise and Fall Risk Reduction in the Prevention of Osteoporosis
Endocrinology and Metabolism Clinics of North America, 1998
Osteoporosis is an increasingly common condition in which bone is fragile and the incidence of minimal trauma fractures increases. The major contributors to the risk of osteoporotic fractures in the elderly are low bone strength and exposure to trauma, principally as falls. Bone mineral density (BMD), which is easily measured precisely in vivo, accounts for more than 70% of the variance in bone ~t r e n g t h .~~, "~ Therefore, it has been widely used as an independent variable and as an outcome measure for studies in osteoporosis. Other factors contributing to overall bone strength include the size and shape of the bones and their trabecular architecture.'*, 73 Another important component of fracture risk relates to falls, the risk of which rises rapidly with increasing age. About 30% of individuals older than 65 years fall at least once each year.8,134 It has been estimated that 10% of falls result in significant injury and 5% in a fracture.85, 134 Factors such as BMD, muscle strength, and postural stability interact to predispose to fractures.88
BMC Medicine, 2010
Background: Exercise is widely recommended to reduce osteoporosis, falls and related fragility fractures, but its effect on whole bone strength has remained inconclusive. The primary purpose of this systematic review and meta-analysis was to evaluate the effects of long-term supervised exercise (≥6 months) on estimates of lowerextremity bone strength from childhood to older age. Methods: We searched four databases (PubMed, Sport Discus, Physical Education Index, and Embase) up to October 2009 and included 10 randomised controlled trials (RCTs) that assessed the effects of exercise training on whole bone strength. We analysed the results by age groups (childhood, adolescence, and young and older adulthood) and compared the changes to habitually active or sedentary controls. To calculate standardized mean differences (SMD; effect size), we used the follow-up values of bone strength measures adjusted for baseline bone values. An inverse variance-weighted random-effects model was used to pool the results across studies. Results: Our quality analysis revealed that exercise regimens were heterogeneous; some trials were short in duration and small in sample size, and the weekly training doses varied considerably between trials. We found a small and significant exercise effect among pre-and early pubertal boys [SMD, effect size, 0.17 (95% CI, 0.02-0.32)], but not among pubertal girls [-0.01 (-0.18 to 0.17)], adolescent boys [0.10 (-0.75 to 0.95)], adolescent girls [0.21 (-0.53 to 0.97)], premenopausal women [0.00 (-0.43 to 0.44)] or postmenopausal women [0.00 (-0.15 to 0.15)].
Exercise, Osteoporosis, and Bone Geometry
Sports
Exercise is commonly recommended in the prevention and management of osteoporosis. The most common method to monitor bone mass and its response to interventions is bone densitometry. While closely associated with risk of fracture, densitometry-derived areal bone mineral density (aBMD) does not provide a reliable indication of bone geometry or morphological adaptation to stimuli. In fact, the effects of exercise interventions on aBMD are frequently modest, and may not fully represent the benefit of exercise to bone. Animal models suggest that mechanical loading indeed influences bone geometry and thus strength. Such an effect in humans has the potential to reduce osteoporotic fracture. The aim of the current narrative review is to provide an overview of what is known about the effects of exercise on bone geometry, with a focus on relevance to osteoporosis.
Exercise in the Prevention of Osteoporosis-Related Fractures
Osteoporosis, 2002
The prevention of osteoporotic fracture by exercise intervention requires a two-pronged approach; that is, the maximization of bone strength and the minimization of falls. The former is most effectively addressed before peak bone mass has been attained, so that the latter is the primary option for the older, osteoporotic individual. Intense animal and human research activity over the last twenty years has generated a wealth of data that has led to recommendations for exercise prescription to both enhance bone strength, and minimize risk of falling. Whether those exercise protocols will be shown to effectively reduce actual fracture incidence requires the analysis of longer term data than is currently available.
Exercise Training and Bone Mineral Density
Quest, 1995
The effect of exercise training on total and regional bone mineral density (BMD) in postmenopausal women is reviewed. Several studies on the non-estrogenreplete postmenopausal population show 1-2% changes in regional BMD with one year of weight-bearing exercises. Studies of exercise training in the estrogenreplete postmenopausal population suggest large BMD changes. The long-term effect of exercise on the rate of loss in BMD after menopause and its effects on osteoporotic fractures is a critical area for future investigations. The focus of this article is on the effects of exercise training on regional and total bone mineral density (BMD) in postmenopausal women. Excellent review articles on physical activity and bone mineral density have been completed (Drinkwater, 1994a, 1994b; Forwood & Burr, 1993; Marcus et al., 1992; Snow-Harter & Marcus, 1991). Much less is known on the relationship of physical activity to bone fracture risk. Studies on premenopausal female adults have shown that participation in exercise programs for up to one year can increase the regional BMD from 1 to 3% (Gleeson, Protos, LeBlanc, Schneider, & Evans, 1990; Lohman et al., in press; Snow-Harter, Bouxsein, Lewis, Carter, & Marcus, 1992). While this effect is statistically significant, it is not likely to have major health benefits on the incidence of osteoporosis in the elderly. Studies are needed on how exercise programs affect the older populations, where the rate of bone mineral loss may be decreased by exercise, as well as in the adolescent population, where bone mineral development may be enhanced by exercise. Drinkwater (1994b) summarizes the status of the literature in this area as follows: "There are no prospective studies to document the effect of increased physical activity with a resultant increase in bone mass on the incidence of osteoporotic fractures" (p. 724).
Journal of science and medicine in sport, 2016
Osteoporotic fractures are associated with substantial morbidity and mortality. Although exercise has long been recommended for the prevention and management of osteoporosis, existing guidelines are often non-specific and do not account for individual differences in bone health, fracture risk and functional capacity. The aim of the current position statement is to provide health practitioners with specific, evidence-based guidelines for safe and effective exercise prescription for the prevention or management of osteoporosis, accommodating a range of potential comorbidities. Position statement. Interpretation and application of research reports describing the effects of exercise interventions for the prevention and management of low bone mass, osteoporosis and osteoporotic fracture. Evidence from animal and human trials indicates that bone responds positively to impact activities and high intensity progressive resistance training. Furthermore, the optimisation of muscle strength, ba...