Journal of Bone and Mineral Metabolism

, Volume 23, Supplement 1, pp 23–29

Loading and bone fragility

Invited paper


Data from retrospective and prospective observational and case-control studies suggest that activity is associated with reduced fracture risk, but consistently replicated bias may be responsible for this desired endpoint. Exercise during growth is likely to build a larger and stronger skeleton. However, cessation of exercise may erode the benefits. Modeling changes produced by exercise during growth may be permanent; remodeling changes may not be. Exercise during adulthood produces small increments in BMD or may prevent bone loss. Absence of evidence is not evidence of absence of effect, but the null hypothesis that exercise has no effect on fracture rates in old age cannot be rejected by any published data. Proof requires demonstration of a reduction in spine and hip fractures in well-designed and well-executed prospective randomized studies; none exists. Blinded studies cannot be done, but open trials can and should be done.

Key words

Exercise Osteoporosis Fracture prevention 


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  1. 1.
    Cooper C, Campion G, Melton LJD (1992) Hip fractures in the elderly: a world-wide projection. Osteoporosis Int 2:285- 289Google Scholar
  2. 2.
    Gregg EW, Cauley JA, Seeley DG, Ensrud KE, Bauer DC (1998) Physical activity and osteoporotic fracture risk in older women. Study of Osteoporotic Fractures Research Group [see comments]. Ann Intern Med 129: 81–88PubMedGoogle Scholar
  3. 3.
    Wickham CA, Walsh K, Cooper C, Barker DJ, Margetts BM, Morris J, et al (1989) Dietary calcium, physical activity, and risk of hip fracture: a prospective study [see comments]. BMJ 299 (6704): 889–892PubMedGoogle Scholar
  4. 4.
    Cooper C, Barker DJ, Wickham C (1988) Physical activity, muscle strength, and calcium intake in fracture of the proximal femur in Britain. BMJ 297(6661): 1443–1446PubMedGoogle Scholar
  5. 5.
    Coupland C, Wood D, Cooper C (1993) Physical inactivity is an independent risk factor for hip fracture in the elderly. J Epidemiol Community Health 47: 441–443PubMedGoogle Scholar
  6. 6.
    Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, et al (1995) Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group [see comments]. N Engl J Med 332: 767–773PubMedGoogle Scholar
  7. 7.
    Paganini-Hill A, Chao A, Ross RK, Henderson BE (1991) Exercise and other factors in the prevention of hip fracture: the Leisure World study. Epidemiology 2: 16–25PubMedGoogle Scholar
  8. 8.
    Farmer ME, Harris T, Madans JH, Wallace RB, Cornoni-Huntley J, White LR (1989) Anthropometric indicators and hip fracture. The NHANES I epidemiologic follow-up study. J Am Geriatr Soc 37: 9–16PubMedGoogle Scholar
  9. 9.
    Joakimsen RM, Fonnebo V, Magnus JH, Stormer J, Tollan A, Sogaard AJ (1998) The Tromso Study: physical activity and the incidence of fractures in a middle-aged population. J Bone Miner Res 13: 1149–1157PubMedGoogle Scholar
  10. 10.
    Meyer HE, Tverdal A, Falch JA (1993) Risk factors for hip fracture in middle-aged Norwegian women and men. Am J Epidemiol 137: 1203–1211PubMedGoogle Scholar
  11. 11.
    Johnell O, Gullberg B, Kanis JA, Allander E, Elffors L, Dequeker J, et al (1995) Risk factors for hip fracture in European women: the MEDOS Study. Mediterranean Osteoporosis Study. J Bone Miner Res 10: 1802–1815PubMedGoogle Scholar
  12. 12.
    Silman AJ, O’Neill TW, Cooper C, Kanis J, Felsenberg D (1997) Influence of physical activity on vertebral deformity in men and women: results from the European Vertebral Osteoporosis Study. J Bone Miner Res 12: 813–819PubMedGoogle Scholar
  13. 13.
    O’Neill TW, Marsden D, Adams JE, Silman AJ (1996) Risk factors, falls, and fracture of the distal forearm in Manchester, UK. J Epidemiol Community Health 50: 288–292Google Scholar
  14. 14.
    Mallmin H, Ljunghall S, Persson I, Bergstrom R (1994) Risk factors for fractures of the distal forearm: a population-based case-control study. Osteoporosis Int 4: 298–304Google Scholar
  15. 15.
    Kelsey JL, Browner WS, Seeley DG, Nevitt MC, Cummings SR (1992) Risk factors for fractures of the distal forearm and proximal humerus. The Study of Osteoporotic Fractures Research Group [published erratum appears in Am J Epidemiol 1992; 135(10): 1183]. Am J Epidemiol 135: 477–489PubMedGoogle Scholar
  16. 16.
    Kujala UM, Kaprio J, Kannus P, Sarna S, Koskenvuo M (2000) Physical activity and osteoporotic hip fracture risk in men. Arch Intern Med 160: 705–708PubMedGoogle Scholar
  17. 17.
    Gregg EW, Pereira MA, Caspersen CJ (2000) Physical activity, falls, and fractures among older adults: a review of the epidemiologic evidence. J Am Geriatr Soc 48: 883–893PubMedGoogle Scholar
  18. 18.
    Grisso JA, Kelsey JL, O’Brien LA, Miles CG, Sidney S, Maislin G, et al (1997) Risk factors for hip fracture in men. Hip Fracture Study Group. Am J Epidemiol 145: 786–793PubMedGoogle Scholar
  19. 19.
    Chan HH, Lau EM, Woo J, Lin F, Sham A, Leung PC (1996) Dietary calcium intake, physical activity and the risk of vertebral fracture in Chinese. Osteoporosis Int 6: 228–232Google Scholar
  20. 20.
    Greendale GA, Barrett-Connor E, Edelstein S, Ingles S, Haile R (1995) Lifetime leisure exercise and osteoporosis. The Rancho Bernardo study. Am J Epidemiol 141: 951–959PubMedGoogle Scholar
  21. 21.
    Nguyen TV, Eisman JA, Kelly PJ, Sambrook PN (1996) Risk factors for osteoporotic fractures in elderly men. Am J Epidemiol 144: 255–263PubMedGoogle Scholar
  22. 22.
    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 [letter]. Lancet 355(9202): 469–470PubMedGoogle Scholar
  23. 23.
    Wyshak G, Frisch RE, Albright TE, Albright NL, Schifi I (1987) Bone fractures among former college athletes compared with nonathletes in the menopausal and postmenopausal years. Obstet Gynecol 69: 121–126PubMedGoogle Scholar
  24. 24.
    Jones HH, Priest JD, Hayes WC, Tichenor CC, Nagel DA (1977) Humeral hypertrophy in response to exercise. J Bone Joint Surg [Am] 59: 204–208Google Scholar
  25. 25.
    Huddleston AL, Rockwell D, Kulund DN, Harrison RB (1980) Bone mass in lifetime tennis athletes. JAMA 244: 1107–1109PubMedGoogle Scholar
  26. 26.
    Kannus P, Haapasalo H, Sievanen H, Oja P, Vuori I (1994) The site-specific effects of long-term unilateral activity on bone mineral density and content. Bone 15: 279–284PubMedGoogle Scholar
  27. 27.
    Haapasalo H, Sievanen H, Kannus P, Heinonen A, Oja P, Vuori I (1996) Dimensions and estimated mechanical characteristics of the humerus after long-term tennis loading. J Bone Miner Res 11: 864–872PubMedGoogle Scholar
  28. 28.
    Kannus P, Haapasalo H, Sankelo M, Sievanen H, Pasanen M, Heinonen A, et al (1995) Effect of starting age of physical activity on bone mass in the dominant arm of tennis and squash players. Ann Intern Med 123: 27–31PubMedGoogle Scholar
  29. 29.
    Dyson K, Blimkie CJ, Davison KS, Webber CE, Adachi JD (1997) Gymnastic training and bone density in pre-adolescent females. Med Sci Sports Exerc 29: 443–450PubMedGoogle Scholar
  30. 30.
    Bass S, Pearce G, Bradney M, Hendrich E, Delmas PD, Harding A, et al (1998) Exercise before puberty may confer residual benefits in bone density in adulthood: studies in active prepubertal and retired female gymnasts. J Bone Miner Res 13: 500–507PubMedGoogle Scholar
  31. 31.
    Slemenda CW, Reister TK, Hui SL, Miller JZ, Christian JC, Johnston CC Jr (1994) Influences on skeletal mineralization in children and adolescents: evidence for varying effects of sexual maturation and physical activity. J Pediatr 125: 201–207PubMedGoogle Scholar
  32. 32.
    Cooper C, Cawley M, Bhalla A, Egger P, Ring F, Morton L, et al(1995) Childhood growth, physical activity, and peak bone mass in women. J Bone Miner Res 10: 940–947PubMedGoogle Scholar
  33. 33.
    Bailey DA, McKay HA, Mirwald RL, Crocker PR, Faulkner RA (1999) A six-year longitudinal study of the relationship of physical activity to bone mineral accrual in growing children: the University of Saskatchewan bone mineral accrual study. J Bone Miner Res 14: 1672–1679PubMedGoogle Scholar
  34. 34.
    Morris FL, Naughton GA, Gibbs JL, Carlson JS, Wark JD (1997) Prospective ten-month exercise intervention in premenarcheal girls: positive effects on bone and lean mass. J Bone Miner Res 12: 1453–1462PubMedGoogle Scholar
  35. 35.
    Bradney M, Pearce G, Naughton G, Sullivan C, Bass S, Beck T, et al (1998) Moderate exercise during growth in prepubertal boys: changes in bone mass, size, volumetric density, and bone strength: a controlled prospective study [see comments]. J Bone Miner Res 13: 1814–1821PubMedGoogle Scholar
  36. 36.
    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: 156–162PubMedGoogle Scholar
  37. 37.
    Heinonen A, Kannus P, Sievanen H, Pasanen M, Oja P, Vuori I (1999) Good maintenance of high-impact activity-induced bone gain by voluntary, unsupervised exercises: an 8-month followup of a randomized controlled trial. J Bone Miner Res 14: 125–128PubMedGoogle Scholar
  38. 38.
    Bradney M, Karlsson MK, Duan Y, Stuckey S, Bass S, Seeman E (2000) Heterogeneity in the growth of the axial and appendicular skeleton in boys: implications for the pathogenesis of bone fragility in men. J Bone Miner Res 15: 1871–1878PubMedGoogle Scholar
  39. 39.
    Bass S, Saxon L, Daly R (1999) Heterogeneity in the osteotrophic response to physical loading during different stages of puberty. J Bone Miner Res 15(S1): 558Google Scholar
  40. 40.
    Turner RT, Hannon KS, Demers LM, Buchanan J, Bell NH (1989) Differential effects of gonadal function on bone histomorphometry in male and female rats. J Bone Miner Res 4: 557–563PubMedGoogle Scholar
  41. 41.
    Garn S (1970) The earlier gain and later loss of cortical bone. Nutritional perspectives. Thomas, Springfield, pp 3–120Google Scholar
  42. 42.
    Woo SL, Kuei SC, Amiel D, Gomez MA, Hayes WC, White FC, et al (1981) The effect of prolonged physical training on the properties of long bone: a study of Wolff’s law. J Bone Joint Surg [Am] 63: 780–787Google Scholar
  43. 43.
    Ruff CB, Walker A, Trinkaus E (1994) Postcranial robusticity inHomo. III: Ontogeny. Am J Phys Anthropol 93: 35–54PubMedGoogle Scholar
  44. 44.
    Wronski TJ, Smith JM, Jee WAS (1981) Variations in mineral apposition rate of trabecular bone within the beagle skeleton. Calcif Tissue Int 33: 583–586PubMedGoogle Scholar
  45. 45.
    Ashizawa N, Nonaka K, Michikami S, Mizuki T, Amagai H, Tokuyama K, et al (1999) Tomographical description of tennisloaded radius: reciprocal relation between bone size and volumetric BMD. J Appl Physiol 86: 1347–1351PubMedGoogle Scholar
  46. 46.
    Margulies JY, Simkin A, Leichter I, Bivas A, Steinberg R, Giladi M, et al (1986) Effect of intense physical activity on the bonemineral content in the lower limbs of young adults. J Bone Joint Surg [Am] 68: 1090–1093Google Scholar
  47. 47.
    Haapasalo H, Kontulainen S, Sievanen H, Kannus P, Jarvinen M, Vuori I (2000) Exercise-induced bone gain is due to enlargement in bone size without a change in volumetric bone density: a peripheral quantitative computed tomography study of the upper arms of male tennis players. Bone 27: 351–357PubMedGoogle Scholar
  48. 48.
    Damien E, Price JS, Lanyon LE (2000) Mechanical strain stimulates osteoblast proliferation through the estrogen receptor in males as well as females. J Bone Miner Res 15: 2169–2177PubMedGoogle Scholar
  49. 49.
    Jessop HL, Suswillo RFL, Rawlinson SCF, Zaman G, Lee K, Das-Gupta V, Pitsillides AA, Lanyon LE (2004) Osteoblastlike cells from estrogen receptor alpha knockout mice have deficient responses to mechanical strain. J Bone Miner Res 19: 938–946PubMedGoogle Scholar
  50. 50.
    Bouxsein ML, Marcus R (1994) Overview of exercise and bone mass. Rheum Dis Clin N Am 20: 787–802Google Scholar
  51. 51.
    Drinkwater BL (1993) Exercise in the prevention of osteoporosis. Osteoporosis Int 3(suppl 1): 169–171Google Scholar
  52. 52.
    Forwood MR, Burr DB (1993) Physical activity and bone mass: exercises in futility? Bone Miner 21: 89–112PubMedGoogle Scholar
  53. 53.
    Friedlander AL, Genant HK, Sadowsky S, Byl NN, Gluer CC (1995) A two-year program of aerobics and weight training enhances bone mineral density of young women. J Bone Miner Res 10: 574–585PubMedGoogle Scholar
  54. 54.
    Gleeson PB, Protas EJ, Leblanc AD, Schneider VS, Evans HJ (1990) Effects of weight lifting on bone mineral density in premenopausal women. J Bone Miner Res 5: 153–158PubMedGoogle Scholar
  55. 55.
    Lohman T, Going S, Pamenter R, Hall M, Boyden T, Houtkooper L, et al (1995) Effects of resistance training on regional and total bone mineral density in premenopausal women: a randomized prospective study. J Bone Miner Res 10: 1015–1024PubMedGoogle Scholar
  56. 56.
    Rockwell JC, Sorensen AM, Baker S, Leahey D, Stock JL, Michaels J, et al (1990) Weight training decreases vertebral bone density in premenopausal women: a prospective study. J Clin Endocrinol Metab 71: 988–993PubMedGoogle Scholar
  57. 57.
    Snow-Harter C, Bouxsein ML, Lewis BT, Carter DR, Marcus R (1992) Effects of resistance and endurance exercise on bone mineral status of young women: a randomized exercise intervention trial. J Bone Miner Res 7: 761–769PubMedGoogle Scholar
  58. 58.
    Kerr D, Morton A, Dick I, Prince R (1996) Exercise effects on bone mass in postmenopausal women are site-specific and loaddependent. J Bone Miner Res 11: 218–225PubMedGoogle Scholar
  59. 59.
    Bassey EJ, Ramsdale SJ (1995) Weight-bearing exercise and ground reaction forces: a 12-month randomized controlled trial of effects on bone mineral density in healthy postmenopausal women. Bone 16: 469–476PubMedGoogle Scholar
  60. 60.
    Heinonen A, Sievanen H, Kannus P, Oja P, Vuori I (1996) Effects of unilateral strength training and detraining on bone mineral mass and estimated mechanical characteristics of the upper limb bones in young women. J Bone Miner Res 11: 490–501PubMedGoogle Scholar
  61. 61.
    Vuori I, Heinonen A, Sievanen H, Kannus P, Pasanen M, Oja P (1994) Effects of unilateral strength training and detraining on bone mineral density and content in young women: a study of mechanical loading and deloading on human bones. Calcif Tissue Int 55: 59–67PubMedGoogle Scholar
  62. 62.
    Cann CE, Martin MC, Genant HK, Jaffe RB (1984) Decreased spinal mineral content in amenorrheic women. JAMA 251: 626–629PubMedGoogle Scholar
  63. 63.
    Drinkwater BL, Nilson K, Chesnut CH, Bremner WJ, Shainholtz S, Southworth MB (1984) Bone mineral content of amenorrheic and eumenorrheic athletes. N Engl J Med 311: 277–281PubMedGoogle Scholar
  64. 64.
    Pearce G, Bass S, Young N, Formica C, Seeman E (1996) Does weight-bearing exercise protect against the effects of exerciseinduced oligomenorrhea on bone density? Osteoporos Int 6: 448–452PubMedGoogle Scholar
  65. 65.
    Drinkwater BL, Nilson K, Ott S, Chesnut CH (1986) Bone mineral density after resumption of menses in amenorrheic athletes. JAMA 256: 380–382PubMedGoogle Scholar
  66. 66.
    Keen AD, Drinkwater BL (1997) Irreversible bone loss in former amenorrheic athletes [editorial]. Osteoporosis Int 7: 311–315Google Scholar
  67. 67.
    Micklesfield LK, Reyneke L, Fataar A, Myburgh KH (1998) Long-term restoration of deficits in bone mineral density is inadequate in premenopausal women with prior menstrual irregularity. Clin J Sport Med 8: 155–163PubMedGoogle Scholar
  68. 68.
    Otis CL (1992) Exercise-associated amenorrhea. Clin Sports Med 11: 351–362PubMedGoogle Scholar
  69. 69.
    Dalsky GP, Stocke KS, Ehsani AA, Slatopolsky E, Lee WC, Birge SJ Jr (1988) Weight-bearing exercise training and lumbar bone mineral content in postmenopausal women. Ann Intern Med 108: 824–828PubMedGoogle Scholar
  70. 70.
    Nelson ME, Fiatarone MA, Morganti CM, Trice I, Greenberg RA, Evans WJ (1994) Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. A randomized controlled trial. JAMA 272: 1909–1914PubMedGoogle Scholar
  71. 71.
    Ebrahim S, Thompson PW, Baskaran V, Evans K (1997) Randomized placebo-controlled trial of brisk walking in the prevention of postmenopausal osteoporosis. Age Ageing 26: 253–260PubMedGoogle Scholar
  72. 72.
    Lau EM, Woo J, Leung PC, Swaminathan R, Leung D (1992) The effects of calcium supplementation and exercise on bone density in elderly Chinese women. Osteoporosis Int 2: 168–173Google Scholar
  73. 73.
    McMurdo ME, Mole PA, Paterson CR (1997) Controlled trial of weight bearing exercise in older women in relation to bone density and falls [see comments]. BMJ 314(7080): 569PubMedGoogle Scholar
  74. 74.
    Prince R, Devine A, Dick I, Criddle A, Kerr D, Kent N, et al(1995) The effects of calcium supplementation (milk powder or tablets) and exercise on bone density in postmenopausal women. J Bone Miner Res 10: 1068–1075PubMedGoogle Scholar
  75. 75.
    Pruitt LA, Taaffe DR, Marcus R (1995) Effects of a one-year high-intensity versus low-intensity resistance training program on bone mineral density in older women. J Bone Miner Res 10: 1788–1795PubMedGoogle Scholar
  76. 76.
    Hartard M, Haber P, Ilieva D, Preisinger E, Seidl G, Huber J (1996) Systematic strength training as a model of therapeutic intervention. A controlled trial in postmenopausal women with osteopenia. Am J Phys Med Rehabil 75: 21–28PubMedGoogle Scholar
  77. 77.
    Kelley GA (1998) Aerobic exercise and bone density at the hip in postmenopausal women: a meta-analysis. Prev Med 27: 798–807PubMedGoogle Scholar
  78. 78.
    Karlsson MK, Johnell O, Obrant KJ (1993) Bone mineral density in professional ballet dancers. Bone Miner 21: 163–169PubMedGoogle Scholar
  79. 79.
    Karlsson MK, Johnell O, Obrant KJ (1995) Is bone mineral density advantage maintained long-term in previous weight lifters? Calcif Tissue Int 57: 325–328PubMedGoogle Scholar
  80. 80.
    Karlsson MK, Hasserius R, Obrant KJ (1996) Bone mineral density in athletes during and after career: a comparison between loaded and unloaded skeletal regions. Calcif Tissue Int 59: 245–248PubMedGoogle Scholar
  81. 81.
    Karlsson MK, Johnell O, Obrant KJ (1993) Bone mineral density in weight lifters. Calcif Tissue Int 52: 212–215PubMedGoogle Scholar
  82. 82.
    Khan KM, Green RM, Saul A, Bennell KL, Crichton KJ, Hopper JL, et al (1996) Retired elite female ballet dancers and nonathletic controls have similar bone mineral density at weightbearing sites. J Bone Miner Res 11: 1566–1574PubMedGoogle Scholar
  83. 83.
    Duppe H, Johnell O, Lundborg G, Karlsson M, Redlund-Johnell I (1994) Long-term results of fracture of the scaphoid. A followup study of more than thirty years. J Bone Joint Surg [Am] 76: 249–252Google Scholar
  84. 84.
    Etherington J, Harris PA, Nandra D, Hart DJ, Wolman RL, Doyle DV, et al (1996) The effect of weight-bearing exercise on bone mineral density: a study of female ex-elite athletes and the general population. J Bone Miner Res 11: 1333–1338PubMedGoogle Scholar
  85. 85.
    Kontulainen S, Kannus P, Haapasalo H, Heinonen A, Sievanen H, Oja P, et al (1999) Changes in bone mineral content with decreased training in competitive young adult tennis players and controls: a prospective 4-yr follow-up. Med Sci Sports Exerc 31: 646–652PubMedGoogle Scholar
  86. 86.
    Michel BA, Lane NE, Bjorkengren A, Bloch DA, Fries JF (1992) Impact of running on lumbar bone density: a 5-year longitudinal study. J Rheumatol 19: 1759–1763PubMedGoogle Scholar
  87. 87.
    Lipsitz LA, Nakajima I, Gagnon M, Hirayama T, Connelly CM, Izumo H (1994) Muscle strength and fall rates among residents of Japanese and American nursing homes: an International Cross- Cultural Study. J Am Geriatr Soc 42: 953–959PubMedGoogle Scholar
  88. 88.
    Lord SR, Ward JA (1999) Age-associated differences in sensorimotor function and balance in community dwelling women. Age Ageing 23: 452–460Google Scholar
  89. 89.
    Hakkinen K, Hakkinen A (1995) Neuromuscular adaptations during intensive strength training in middle-aged and elderly males and females. Electromyogr Clin Neurophysiol 35: 137–147PubMedGoogle Scholar
  90. 90.
    Tracy BL, Ivey FM, Hurlbut D, Martel GF, Lemmer JT, Siegel EL, et al (1999) Muscle quality. II. Effects of strength training in 65- to 75-yr-old men and women. J Appi Physiol 86: 195–201Google Scholar
  91. 91.
    Roman WJ, Fleckenstein J, Stray-Gundersen J, Alway SE, Peshock R, Gonyea WJ (1993) Adaptations in the elbow flexors of elderly males after heavy-resistance training. J Appl Physiol 74: 750–754PubMedGoogle Scholar
  92. 92.
    Hyakutake S, Goto S, Yamagata M, Moriya H (1994) Relationship between bone mineral density of the proximal femur and lumbar spine and quadriceps and hamstrings torque in healthy Japanese subjects. Calcif Tissue Int 55: 223–229PubMedGoogle Scholar
  93. 93.
    Snow-Harter C, Bouxsein M, Lewis B, Charette S, Weinstein P, Marcus R (1990) Muscle strength as a predictor of bone mineral density in young women. J Bone Miner Res 5: 589–595PubMedGoogle Scholar
  94. 94.
    Pocock N, Eisman J, Gwinn T, Sambrook P, Kelly P, Freund J, et al (1989) Muscle strength, physical fitness, and weight but not age predict femoral neck bone mass. J Bone Miner Res 4: 441–448PubMedGoogle Scholar
  95. 95.
    Seeman E, Hopper JL, Young NR, Formica C, Goss P, Tsalamandris C (1996) Do genetic factors explain associations between muscle strength, lean mass, and bone density? A twin study. Am J Physiol 270(2 pt 1): E320-E327PubMedGoogle Scholar
  96. 96.
    Kritz-Silverstein D, Barrett-Connor E (1994) Grip strength and bone mineral density in older women. J Bone Miner Res 9: 45–51PubMedGoogle Scholar
  97. 97.
    Tinetti ME, Williams TF, Mayewski R (1986) Fall risk index for elderly patients based on number of chronic disabilities [see comments]. Am J Med 80: 429–434PubMedGoogle Scholar
  98. 98.
    Wolfson LI, Whipple R, Amerman P, Kleinberg A (1986) Stressing the postural response. A quantitative method for testing balance. J Am Geriatr Soc 34: 845–850PubMedGoogle Scholar
  99. 99.
    Overstall PW, Johnson AL, Exton-Smith AN (1978) Instability and falls in the elderly. Age Ageing Suppl:92-96Google Scholar
  100. 100.
    Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319: 1701–1707PubMedGoogle Scholar
  101. 101.
    Myers AH, Young Y, Langlois JA (1996) Prevention of falls in the elderly. Bone 18(suppl 1): 87S-101SGoogle Scholar
  102. 102.
    Fiatarone MA, O’Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME, et al (1994) Exercise training and nutritional supplementation for physical frailty in very elderly people [see comments]. N Engl J Med 330: 1769–1775PubMedGoogle Scholar
  103. 103.
    Daley MJ, Spinks WL (2000) Exercise, mobility and aging. Sports Med 29: 1–12PubMedGoogle Scholar
  104. 104.
    Nevitt MC, Cummings SR, Hudes ES (1991) Risk factors for injurious falls: a prospective study. J Gerontol 46: M164-M170PubMedGoogle Scholar
  105. 105.
    Hu MH, Woollacott MH (1994) Multisensory training of standing balance in older adults: II. Kinematic and electromyographic postural responses. J Gerontol 49: M62-M71PubMedGoogle Scholar
  106. 106.
    Nevitt MC, Cummings SR, Kidd S, Black D (1989) Risk factors for recurrent nonsyncopal falls. A prospective study. JAMA 261: 2663–2668PubMedGoogle Scholar
  107. 107.
    Province MA, Hadley EC, Hornbrook MC, Lipsitz LA, Miller JP, Mulrow CD, et al (1995) The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques [see comments]. JAMA 273: 1341–1347PubMedGoogle Scholar
  108. 108.
    Fiatarone MA, Marks EC, Ryan ND, Meredith CN, Lipsitz LA, Evans WJ (1990) High-intensity strength training in nonagenarians. Effects on skeletal muscle. JAMA 263: 3029–3034PubMedGoogle Scholar
  109. 109.
    Hakkinen K, Komi PV (1983) Alterations of mechanical characteristics of human skeletal muscle during strength training. Eur J Appl Physiol 50: 161–172Google Scholar
  110. 110.
    Narici MV, Roi GS, Landoni L, Minetti AE, Cerretelli P (1989) Changes in force, cross-sectional area and neural activation during strength training and detraining of the human quadriceps. Eur J Appl Physiol 59: 310–319Google Scholar
  111. 111.
    Pyka G, Lindenberger E, Charette S, Marcus R (1994) Muscle strength and fiber adaptations to a year-long resistance training program in elderly men and women. J Gerontol 49: M22-M27PubMedGoogle Scholar
  112. 112.
    Lord SR, Ward JA, Williams P, Strudwick M (1995) The effect of a 12-month exercise trial on balance, strength, and falls in older women: a randomized controlled trial. J Am Geriatr Soc 43: 1198–1206PubMedGoogle Scholar
  113. 113.
    Heislein DM, Harris BA, Jette AM (1994) A strength training program for postmenopausal women: a pilot study. Arch Phys Med Rehabil 75: 198–204PubMedGoogle Scholar
  114. 114.
    Ryan AS, Treuth MS, Rubin MA, Miller JP, Nicklas BJ, Landis DM, et al (1994) Effects of strength training on bone mineral density: hormonal and bone turnover relationships. J Appl Physiol 77: 1678–1684PubMedGoogle Scholar
  115. 115.
    Campbell AJ, Borrie MJ, Spears GF (1989) Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol 44: M112-M117PubMedGoogle Scholar
  116. 116.
    Grisso JA, Kelsey JL, Strom BL, Chiu GY, Maislin G, O’Brien LA, et al (1991) Risk factors for falls as a cause of hip fracture in women. The Northeast Hip Fracture Study Group. N Engl J Med 324: 1326–1331PubMedGoogle Scholar
  117. 117.
    Greenspan SL, Myers ER, Maitland LA, Resnick NM, Hayes WC (1991) Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly. JAMA 271: 128–133Google Scholar
  118. 118.
    Hayes WC, Myers ER, Morris JN, Gerhart TN, Yett HS, Lipsitz LA (1993) Impact near the hip dominates fracture risk in elderly nursing home residents who fall. Calcif Tissue Int 52: 192–198PubMedGoogle Scholar
  119. 119.
    Campbell AJ, Borrie MJ, Spears GF, Jackson SL, Brown JS, Fitzgerald JL (1990) Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study [published erratum appears in Age Ageing 1990;19(5):345-346] [see comments]. Age Ageing 19: 136–141PubMedGoogle Scholar
  120. 120.
    Tinetti ME, Inouye SK, Gill TM, Doucette JT (1995) Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. JAMA 273: 1348–1353PubMedGoogle Scholar
  121. 121.
    O’Loughlin JL, Robitaille Y, Boivin JF, Suissa S (1993) Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol 137: 342–354PubMedGoogle Scholar
  122. 122.
    Graafmans WC, Ooms ME, Hofstee HM, Bezemer PD, Bouter LM, Lips P (1996) Falls in the elderly: a prospective study of risk factors and risk profiles. Am J Epidemiol 143: 1129–1136PubMedGoogle Scholar
  123. 123.
    Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T (1996) Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques [see comments]. J Am Geriatr Soc 44: 489–497PubMedGoogle Scholar
  124. 124.
    Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Gottschalk M, et al (1994) A multifactorial intervention to reduce the risk of falling among elderly people living in the community [see comments]. N Engl J Med 331: 821–827PubMedGoogle Scholar
  125. 125.
    Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM (1999) Falls prevention over 2 years: a randomized controlled trial in women 80 years and older. Age Ageing 28: 513–518PubMedGoogle Scholar
  126. 126.
    Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG (1994) Preventing falls among community-dwelling older persons: results from a randomized trial. Gerontologist 34: 16–23PubMedGoogle Scholar
  127. 127.
    Mulrow CD, Gerety MB, Kanten D, Cornell JE, DeNino LA, Chiodo L, et al (1994) A randomized trial of physical rehabilitation for very frail nursing home residents. JAMA 271: 519–524PubMedGoogle Scholar
  128. 128.
    Gillespie LD, Gillespie WJ, Cumming R, Lamb SE, Rowe BH (2000) Interventions for preventing falls in the elderly. Cochrane Database Syst Rev 2:CD000340Google Scholar
  129. 129.
    Rubenstein LZ, Josephson KR, Robbins AS (1994) Falls in the nursing home. Ann Intern Med 121: 442–451PubMedGoogle Scholar
  130. 130.
    Wagner EH, Lacroix AZ, Grothaus L, Leveille SG, Hecht JA, Artz K, et al (1994) Preventing disability and falls in older adults: a population-based randomized trial. Am J Public Health 84: 1800–1806PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  1. 1.Endocrine Unit, Department of MedicineAustin Hospital, University of MelbourneMelbourneAustralia

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