Skip to main content
SpringerLink
Log in

A 5-Year Exercise Program in Pre- and Peripubertal Children Improves Bone Mass and Bone Size Without Affecting Fracture Risk

  • Original Research
  • Published:
Calcified Tissue International Aims and scope Submit manuscript

Abstract

We studied the effect in children of an exercise intervention program on fracture rates and skeletal traits. Fractures were registered for 5 years in a population-based prospective controlled exercise intervention study that included children aged 6–9 years at study start, 446 boys and 362 girls in the intervention group and 807 boys and 780 girls in the control group. Intervention subjects received 40 min/school day of physical education and controls, 60 min/week. In 73 boys and 48 girls in the intervention group and 52 boys and 48 girls in the control group, bone mineral density (BMD, g/cm2) and bone area (mm2) were followed annually by dual-energy X-ray absorptiometry, after which annual changes were calculated. At follow-up we also assessed trabecular and cortical volumetric BMD (g/cm3) and bone structure by peripheral computed tomography in the tibia and radius. There were 20.0 fractures/1,000 person-years in the intervention group and 18.5 fractures/1,000 person-years in the control group, resulting in a rate ratio of 1.08 (0.79–1.47) (mean and 95 % CI). The gain in spine BMD was higher in both girls (difference 0.01 g/cm2, 0.005–0.019) and boys (difference 0.01 g/cm2, 0.001–0.008) in the intervention group. Intervention girls also had higher gain in femoral neck area (difference 0.04 mm2, 0.005–0.083) and at follow-up larger tibial bone mineral content (difference 0.18 g, 0.015–0.35), larger tibial cortical area (difference 17 mm2, 2.4–31.3), and larger radial cross-sectional area (difference 11.0 mm2, 0.63–21.40). As increased exercise improves bone mass and in girls bone size without affecting fracture risk, society ought to encourage exercise during growth.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hind K, Burrows M (2007) Weight-bearing exercise and bone mineral accrual in children and adolescents: a review of controlled trials. Bone 40(1):14–27

    Article  PubMed  CAS  Google Scholar 

  2. Bradney M, Pearce G, Naughton G, Sullivan C, Bass S, Beck T, Carlson J, Seeman E (1998) Moderate exercise during growth in prepubertal boys: changes in bone mass, size, volumetric density, and bone strength: a controlled prospective study. J Bone Miner Res 13(12):1814–1821

    Article  PubMed  CAS  Google Scholar 

  3. McKay HA, Petit MA, Schutz RW, Prior JC, Barr SI, Khan KM (2000) Augmented trochanteric bone mineral density after modified physical education classes: a randomized school-based exercise intervention study in prepubescent and early pubescent children. J Pediatr 136(2):156–162

    Article  PubMed  CAS  Google Scholar 

  4. Petit MA, McKay HA, MacKelvie KJ, Heinonen A, Khan KM, Beck TJ (2002) A randomized school-based jumping intervention confers site and maturity-specific benefits on bone structural properties in girls: a hip structural analysis study. J Bone Miner Res 17(3):363–372

    Article  PubMed  CAS  Google Scholar 

  5. MacKelvie KJ, Khan KM, Petit MA, Janssen PA, McKay HA (2003) A school-based exercise intervention elicits substantial bone health benefits: a 2-year randomized controlled trial in girls. Pediatrics 112(6 Pt 1):e447

    Article  PubMed  Google Scholar 

  6. MacKelvie KJ, Petit MA, Khan KM, Beck TJ, McKay HA (2004) Bone mass and structure are enhanced following a 2-year randomized controlled trial of exercise in prepubertal boys. Bone 34(4):755–764

    Article  PubMed  Google Scholar 

  7. Linden C, Alwis G, Ahlborg H, Gardsell P, Valdimarsson O, Stenevi-Lundgren S, Besjakov J, Karlsson MK (2007) Exercise, bone mass and bone size in prepubertal boys: one-year data from the pediatric osteoporosis prevention study. Scand J Med Sci Sports 17(4):340–347

    PubMed  CAS  Google Scholar 

  8. Linden C, Ahlborg HG, Besjakov J, Gardsell P, Karlsson MK (2006) A school curriculum-based exercise program increases bone mineral accrual and bone size in prepubertal girls: two-year data from the Pediatric Osteoporosis Prevention (POP) study. J Bone Miner Res 21(6):829–835

    Article  PubMed  Google Scholar 

  9. Valdimarsson O, Linden C, Johnell O, Gardsell P, Karlsson MK (2006) Daily physical education in the school curriculum in prepubertal girls during 1 year is followed by an increase in bone mineral accrual and bone width—data from the prospective controlled Malmo Pediatric Osteoporosis Prevention study. Calcif Tissue Int 78(2):65–71

    Article  PubMed  CAS  Google Scholar 

  10. Alwis G, Linden C, Ahlborg HG, Dencker M, Gardsell P, Karlsson MK (2008) A 2-year school-based exercise programme in pre-pubertal boys induces skeletal benefits in lumbar spine. Acta Paediatr 97(11):1564–1571

    Article  PubMed  Google Scholar 

  11. Lanyon LE (1992) Control of bone architecture by functional load bearing. J Bone Miner Res 7(Suppl 2):S369–S375

    Article  PubMed  Google Scholar 

  12. Rubin CT, Lanyon LE (1984) Regulation of bone formation by applied dynamic loads. J Bone Joint Surg Am 66(3):397–402

    PubMed  CAS  Google Scholar 

  13. Hui SL, Slemenda CW, Johnston CC Jr (1990) The contribution of bone loss to postmenopausal osteoporosis. Osteoporos Int 1(1):30–34

    Article  PubMed  CAS  Google Scholar 

  14. Melton LJ 3rd, Atkinson EJ, O’Fallon WM, Wahner HW, Riggs BL (1993) Long-term fracture prediction by bone mineral assessed at different skeletal sites. J Bone Miner Res 8(10):1227–1233

    Article  PubMed  Google Scholar 

  15. Kannus P, Haapasalo H, Sankelo M, Sievanen H, Pasanen M, Heinonen A, Oja P, Vuori I (1995) Effect of starting age of physical activity on bone mass in the dominant arm of tennis and squash players. Ann Intern Med 123(1):27–31

    PubMed  CAS  Google Scholar 

  16. Hasselstrom HA, Karlsson MK, Hansen SE, Gronfeldt V, Froberg K, Andersen LB (2008) A 3-year physical activity intervention program increases the gain in bone mineral and bone width in prepubertal girls but not boys: the prospective Copenhagen School Child Interventions Study (CoSCIS). Calcif Tissue Int 83(4):243–250

    Article  PubMed  CAS  Google Scholar 

  17. Johnell O, Gullberg B, Kanis JA, Allander E, Elffors L, Dequeker J, Dilsen G, Gennari C, LopesVaz A, Lyritis G et al (1995) Risk factors for hip fracture in European women: the MEDOS Study. Mediterranean Osteoporosis Study. J Bone Miner Res 10(11):1802–1815

    Article  PubMed  CAS  Google Scholar 

  18. Clark EM, Ness AR, Tobias JH (2008) Vigorous physical activity increases fracture risk in children irrespective of bone mass: a prospective study of the independent risk factors for fractures in healthy children. J Bone Miner Res 23(7):1012–1022

    Article  PubMed  Google Scholar 

  19. Jonsson B, Gardsell P, Johnell O, Redlund-Johnell I, Sernbo I (1994) Remembering fractures: fracture registration and proband recall in southern Sweden. J Epidemiol Community Health 48(5):489–490

    Article  PubMed  CAS  Google Scholar 

  20. Dencker M, Thorsson O, Karlsson MK, Linden C, Eiberg S, Wollmer P, Andersen LB (2006) Daily physical activity related to body fat in children aged 8–11 years. J Pediatr 149(1):38–42

    Article  PubMed  CAS  Google Scholar 

  21. Duke PM, Litt IF, Gross RT (1980) Adolescents’ self-assessment of sexual maturation. Pediatrics 66(6):918–920

    PubMed  CAS  Google Scholar 

  22. Ferretti JL, Capozza RF, Zanchetta JR (1996) Mechanical validation of a tomographic (pQCT) index for noninvasive estimation of rat femur bending strength. Bone 18(2):97–102

    Article  PubMed  CAS  Google Scholar 

  23. Duan Y, Parfitt A, Seeman E (1999) Vertebral bone mass, size, and volumetric density in women with spinal fractures. J Bone Miner Res 14(10):1796–1802

    Article  PubMed  CAS  Google Scholar 

  24. Duan Y, Seeman E, Turner CH (2001) The biomechanical basis of vertebral body fragility in men and women. J Bone Miner Res 16(12):2276–2283

    Article  PubMed  CAS  Google Scholar 

  25. Ahlborg HG, Johnell O, Turner CH, Rannevik G, Karlsson MK (2003) Bone loss and bone size after menopause. N Engl J Med 349(4):327–334

    Article  PubMed  Google Scholar 

  26. Clark EM, Ness AR, Tobias JH (2008) Bone fragility contributes to the risk of fracture in children, even after moderate and severe trauma. J Bone Miner Res 23(2):173–179

    Article  PubMed  Google Scholar 

  27. Karlsson MK, Linden C, Karlsson C, Johnell O, Obrant K, Seeman E (2000) Exercise during growth and bone mineral density and fractures in old age. Lancet 355(9202):469–470

    Article  PubMed  CAS  Google Scholar 

  28. Nordstrom A, Karlsson C, Nyquist F, Olsson T, Nordstrom P, Karlsson M (2005) Bone loss and fracture risk after reduced physical activity. J Bone Miner Res 20(2):202–207

    Article  PubMed  Google Scholar 

  29. Manias K, McCabe D, Bishop N (2006) Fractures and recurrent fractures in children; varying effects of environmental factors as well as bone size and mass. Bone 39(3):652–657

    Article  PubMed  Google Scholar 

  30. Guadalupe-Grau A, Fuentes T, Guerra B, Calbet JA (2009) Exercise and bone mass in adults. Sports Med 39(6):439–468

    Article  PubMed  Google Scholar 

  31. Heinonen A, Oja P, Kannus P, Sievanen H, Haapasalo H, Manttari A, Vuori I (1995) Bone mineral density in female athletes representing sports with different loading characteristics of the skeleton. Bone 17(3):197–203

    Article  PubMed  CAS  Google Scholar 

  32. Nikander R, Sievanen H, Heinonen A, Kannus P (2005) Femoral neck structure in adult female athletes subjected to different loading modalities. J Bone Miner Res 20(3):520–528

    Article  PubMed  Google Scholar 

  33. Stenevi-Lundgren S, Daly RM, Linden C, Gardsell P, Karlsson MK (2009) Effects of a daily school based physical activity intervention program on muscle development in prepubertal girls. Eur J Appl Physiol 105(4):533–541

    Article  PubMed  Google Scholar 

  34. Treuth MS, Hunter GR, Figueroa-Colon R, Goran MI (1998) Effects of strength training on intra-abdominal adipose tissue in obese prepubertal girls. Med Sci Sports Exerc 30(12):1738–1743

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgement

We thank the teachers and students for participating in the study. Financial support for this study was received from ALF, the Centre for Athletic Research, the Osterlund Foundation, the Kock Foundation, and the Region Skåne Foundation.

Author information

Authors and Affiliations

  1. Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Skåne University Hospital, Lund University, SE-205 02, Malmö, Sweden

    Fredrik T. L. Detter, Björn E. Rosengren, J.-Å. Nilsson & Magnus K. Karlsson

  2. Department of Clinical Physiology, Skåne University Hospital, SE-205 02, Malmö, Sweden

    Magnus Dencker

Authors
  1. Fredrik T. L. Detter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Björn E. Rosengren
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Magnus Dencker
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J.-Å. Nilsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Magnus K. Karlsson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fredrik T. L. Detter.

Additional information

The authors have stated that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Detter, F.T.L., Rosengren, B.E., Dencker, M. et al. A 5-Year Exercise Program in Pre- and Peripubertal Children Improves Bone Mass and Bone Size Without Affecting Fracture Risk. Calcif Tissue Int 92, 385–393 (2013). https://doi.org/10.1007/s00223-012-9691-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00223-012-9691-5

Keywords

Search

Navigation