Exercise and fractures in postmenopausal women. Final results of the controlled Erlangen Fitness and Osteoporosis Prevention Study (EFOPS)
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The EFOPS trial clearly established the positive effect of long-term exercise on clinical low-trauma fractures in postmenopausal women at risk. Bearing in mind that the complex anti-fracture exercise protocols also affect a large variety of diseases of increased age, we strongly encourage older adults to perform multipurpose exercise programs.
Physical exercise may be an efficient option for autonomous fracture prevention during increasing age. The aim of the study was to evaluate the effect of exercise on clinical overall fracture incidence and bone mineral density (BMD) in elderly subjects at risk.
In 1998 initially, 137 early-postmenopausal, osteopenic women living in Erlangen-Nuremberg, Germany, were included in the EFOPS trial. Subjects of the exercise group (EG; n = 86) conducted two supervised group and two home exercise sessions/week while the control group (CG; n = 51) was requested to maintain their physical activity. Primary study endpoints were clinical overall low-trauma fractures determined by questionnaires, structured interviews, and BMD at the lumbar spine and femoral neck assessed by dual-energy X-ray absorptiometry.
In 2014, 105 subjects (EG: n = 59 vs. CG: n = 46) representing 1680 participant-years were included in the 16-year follow-up analysis. Risk ratio in the EG for overall low-trauma fractures was 0.51 (95 % confidence interval (95 % CI) 0.23 to 0.97, p = .046), rate ratio was 0.42 (95 % CI 0.20 to 0.86, p = .018). Based on comparable baseline values, lumbar spine (MV −1.5 %, 95 % CI −0.1 to −2.8 vs. −5.8 %, −3.3 to −7.2 %) and femoral neck (−6.5 %, −5.2 to −7.7 vs. −9.6 %, −8.2 to 11.1 %) BMD decreased in both groups; however, the reduction was more pronounced in the CG (p ≤ .001).
This study clearly evidenced the high anti-fracture efficiency of multipurpose exercise programs. Considering furthermore the favorable effect of exercise on most other risk factors of increasing age, we strongly encourage older adults to perform multipurpose exercise programs.
KeywordsBone mineral density Clinical fractures Exercise Osteoporosis
We gratefully acknowledge the support of the nonprofit institutions “Behinderten und Rehabilitations Sportverband Bayern”, “Netzwerk Knochengesundheit,” and the Institute of Sport and Sport Science FAU Erlangen-Nuremberg. We also thank Sanofi-Synthelabo GmbH (Henning, Berlin, Germany) who supplied Ca and Vit D for the first five study years and the supply of elastic bands by TheraBand™ (Akron, Ohio, USA).
Conflicts of interest
- 3.Howe TE, Shea B, Dawson LJ, Downie F, Murray A, Ross C, Harbour RT, Caldwell LM, Creed G (2011) Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev CD000333Google Scholar
- 9.Body JJ, Bergmann P, Boonen S, Boutsen Y, Devogelaer JP, Goemaere S, Kaufman JM, Rozenberg S, Reginster JY (2010) Evidence-based guidelines for the pharmacological treatment of postmenopausal osteoporosis: a consensus document by the Belgian Bone Club. Osteoporos Int 21:1657–1680PubMedCentralCrossRefPubMedGoogle Scholar
- 13.Kemmler W, Lauber D, Weineck J, Hensen J, Kalender W, Engelke K (2004) Benefits of 2 years of intense exercise on bone density, physical fitness, and blood lipids in early postmenopausal osteopenic women: results of the Erlangen Fitness Osteoporosis Prevention Study (EFOPS). Arch Intern Med 164:1084–1091CrossRefPubMedGoogle Scholar
- 16.Kemmler W, Lauber D, Von Stengel S, Engelke K (2005) Developing maximum strength in older adults—a series of studies. In: Gießing J, Fröhlich M, Preuss P (eds) Current results of strength training research. Cuvillier Verlag, Göttingen, pp 114–133Google Scholar
- 18.DVO (2014) DVO-Leitlinien 2014 zur Prophylaxe, Diagnostik und Therapie der Osteoporose bei Männern ab dem 60. Lebensjahr und postmenopausalen Frauen, SchattauerGoogle Scholar
- 21.Cohen J (1988) Statistical power analysis for the behavioral sciences. Lawrence Earlbaum Associate, HillsdaleGoogle Scholar
- 25.Jansen JP, Bergman GJ, Huels J, Olson M (2011) The efficacy of bisphosphonates in the prevention of vertebral, hip, and nonvertebral-nonhip fractures in osteoporosis: a network meta-analysis. Semin Arthritis Rheum 40(275–284):e271–e272Google Scholar
- 27.McCloskey EV, Johansson H, Oden A, Austin M, Siris E, Wang A, Lewiecki EM, Lorenc R, Libanati C, Kanis JA (2012) Denosumab reduces the risk of osteoporotic fractures in postmenopausal women, particularly in those with moderate to high fracture risk as assessed with FRAX. J Bone Miner Res 27:1480–1486CrossRefPubMedGoogle Scholar
- 37.Rütten A, Abu-Omar K, Lampert T, Ziese T (2005) Körperliche Aktivität [Physical Activity]. Report. In: Robert-Koch-Institut (ed) Gesundheitsberichterstattung des Bundes. Statistisches Bundesamt, BerlinGoogle Scholar
- 40.Börjesson M, Hellenius ML, Jansson E, Karlson J, Leijon M, Staehle A, Sundberg CJ, Taube T (2010) Physical activity in the prevention and treatment of disease. Swedish Institute of Health, StockholmGoogle Scholar