Exercise in the Prevention of Osteoporosis-Related Fractures (original) (raw)
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Physical Exercise for Prevention of Falls and Fractures
intechopen.com
Human beings reach their bone mass peak around age 30 years being strongly affected by genetic, representing 60-80% of the bone mass peak showed by an individual (Ramalho & Castro, 1999). In the adult, 90% of bone mass is resting, while 10% is in constant activity to revitalize the bone tissue. Neoformation occurs only after the resorption of a damaged bone. In a year, 25% of the trabecular bone and 1% of cortical bone are remodeled by a still unknown mechanism. During growth, the balance of this renewal is positive. In the adulthood, it is even and after age 40 it starts being negative. During the age where this balance is negative, the portion destroyed is not completely remodeled and around 1% of the bone mass is lost annually (Carvalho, 2006). The decrease in bone mineral density (BMD) with age is considered as a physiological osteopeny, being a universal phenomenon that affects all races and cultures; nonpathological by itself in most of the individuals, but it is the background to development of osteoporosis and consequently, a higher risk of fractures (Ramalho & Castro, 1999). The sequence of this negative renewal throughout the years is responsible for the primary osteoporosis (Carvalho, 2006). During the age-related bone loss, there is an unbalance in bone remodeling, with an increase of bone resorption compared to formation. In the stage of accelerated postmenopausal bone loss, there is a high rate of bone remodeling, with an increase in the number of osteoclasts that forms a very deep resorption cavity leading to a trabecular perforation. In the slow process of bone loss, osteoclasts build a bone resorption cavity with a normal depth, however the osteoclasts fail in replacing the new bone in a proper way (Yoshinari & Bonfá, 2000). The incidence of osteoporotic fractures (Figure 1) is strictly related to the individual bone mass that depends on the speed of loss throughout life as well as the amount of bone tissue in the end of puberty and beginning of adulthood. The great variation in bone mass peak is explained not only by hereditary factors but also by gender, race, eating habits, several hormone influence, body composition of lean mass and body fat, intercurrent diseases, chronic use of medications and physical activity (Brandão & Vieira, 1999). Like any other chronic disease, the ethiology of osteoporosis is multifactorial. Genetic factors contribute approximately with 46% to 62% of bone mineral density (BMD) whereas other causes include lifestyle, diet and physical exercise (Neto et al., 2002). Osteoporosis is considered a "silent disease" until a fracture occurs. Approximately 1.5 million fractures per year are attributable to this disease. Only in the USA, these fractures result in 500.000 hospitalizations, 800.000 emergency room visits, 2.6 million physician visits. The treatment cost is high. In 2002, 12 billion dollars to 18 billion dollars were spent (Gass & Huges, 2006). In 1998, cost management of osteoporosis fractures in the UK recorded 942 million pounds per year (Szejnfeld et al., 2007). Because it is considered a "silent" disease, it may progress for decades before being diagnosed. Osteoporosis has become one of the major public health problems. Nowadays, the impact of osteoporosis is compared to the impact caused by most important health problems, such as cardiovascular diseases and cancer (Froes et al., 2002). It exposes the fallers to a high risk of fractures (Johnell et al., 2005; Siris et al., 2006). The first hip fracture is associated to 2.5-fold increased risk of subsequent fracture (Cólon-Emeric et al., 2003) with a high level of morbidity and mortality (Cathleen et al., 2006).
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
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.
Preventing osteoporosis with exercise: A review with emphasis on methodology
Medical Hypotheses, 1989
Exercise is thought to have considerable potential as a preventive for osteoporosis. We critically examined 27 studies that address the prophylactic role of exercise in osteoporosis. The results from both cross-sectional and longitudinal studies showed that differences in bone mass were more pronounced in the axial skeleton as opposed to the peripheral compact skeleton. The 17 cross-sectional studies demonstrated greater bone mass among highly trained athletes compared with sedentary subjects, while results among recreational athletes were inconsistent. The 10 prospective investigations examining the effect of exercise on bone mass yielded conflicting results; only one study of six found an overall positive response in compact bone mass at the radial site, and only one study examining the spine showed a significant gain among the exercisers. Additionally, all the prospective investigations included serious methodologic flaws; most failed to employ a randomized design, appropriate estimates of sample size were lacking, none provided information on blind outcome assessment, and most studies were of short duration. Current evidence suggests that exercise may have only limited value in affecting bone mass in the short term and widespread recommendations for the prophylactic use of exercise should await further validation using better methodological rigor.
Prescribing exercise for osteoporosis
Osteoporosis is a major public health problem because of the morbidity and mortality associated with fracture. Minimizing the risk of fracture is the primary objective of osteoporosis management. The role of exercise in osteoporosis management is to increase and maintain peak bone density and reduce the rate of bone loss and the risk of falling. This article provides recommendations focusing on a lifespan approach to minimizing the risk of fracture associated with osteoporosis. Osteoporosis prevention begins in childhood, when exercise can increase peak bone strength. In young adults, it can maintain peak bone mineral density. In elderly individuals, physical activity can slow bone loss and improve fitness and muscle strength, helping prevent falls and lower the risk of fracture. Exercise goals for individuals with osteoporosis should include reducing pain, increasing mobility, and improving muscle endurance, balance, and stability in order to improve the quality of life and reduce the risk of falling. Thus, exercise plays a significant part in reducing fractures in later life.
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...
Too Fit To Fracture: a consensus on future research priorities in osteoporosis and exercise
Osteoporosis International, 2014
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