Archives of Osteoporosis

, Volume 7, Issue 1–2, pp 301–306 | Cite as

Exercise effects on hip bone mineral density in older, post-menopausal breast cancer survivors are age dependent

  • Kerri M. Winters-StoneEmail author
  • Michael C. Leo
  • Anna Schwartz
Short Communication



We evaluated whether age moderated the effect of impact + resistance exercise on hip BMD in older post-menopausal breast cancer survivors (BCS). Exercise was more beneficial among younger than older women within our sample, suggesting that much older BCS may require different training programs to improve hip health.


Previously, we reported that a program of resistance + impact training stopped bone loss at the spine in older, post-menopausal BCS but had no effect on bone mineral density (BMD) at the hip. Aging may blunt the responsiveness of the hip to mechanical loading, so we conducted a secondary data analysis to evaluate whether age moderated the effect of exercise on hip BMD.


We analyzed data from our randomized, controlled trial in older (≥ 50 years of age at diagnosis), post-menopausal, post-adjuvant treatment BCS (n = 106) comparing women assigned to impact + resistance exercise (POWIR) or to a control program of low-intensity stretching (FLEX). We examined effect modification by age on BMD at three hip sites (greater trochanter, femoral neck, and total hip) using hierarchical linear modeling adjusting for time since diagnosis and use of adjuvant hormone therapy.


Age moderated the effect of exercise on total hip BMD such that younger women in POWIR were more likely to see a positive net benefit than FLEX compared to older women where there was little difference between groups (p = 0.02).


The skeletal response to loading at the hip within post-menopausal BCS diminishes with age. Whether more vigorous exercise programs and/or longer training periods are required to favorably change hip health in older BCS will require future study and careful thought about the risks and benefits of tougher training programs.


Osteoporosis Resistance exercise Neoplasms Aging Physical activity 



Supported by Susan G. Komen Race for the Cure and the National Cancer Institute (1R01 CA120123, to Dr. Winters-Stone) and with partial support from the Oregon Clinical and Translational Research Institute (OCTRI), grant number UL1 RR024140 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. We thank the Oregon State Cancer Registry for their assistance with recruitment efforts for the study. Thera-band provided elastic bands for home exercise programs. We thank Ms. Jessica Dobek for data management and manuscript preparation, Ms. Ann Reiner for helping to manage the study, and Mr. Nathan Brooks, Ms. Camella Potter, and Mr. Anton Stupnitskiy for their assistance with data collection. We also thank Ms. Janice Hoffman, Ms. Laurie Iverson, and Ms. Lisa Domenico for their assistance with exercise training.

Conflicts of interest



  1. 1.
    Saad F, Adachi JD, Brown JP, Canning LA, Gelmon KA, Josse RG, Pritchard KI (2008) Cancer treatment-induced bone loss in breast and prostate cancer. J Clin Oncol 26(33):5465–5476PubMedCrossRefGoogle Scholar
  2. 2.
    Chen ZMM, Aragaki AK, Mouton C, Arendell L, Lopez AM, Bassford T, Chlebowski RT (2009) Fracture risk increases after diagnosis of breast or other cancers in postmenopausal women: results from the Women’s Health Initiative. Osteoporos Int 20(4):527–536PubMedCrossRefGoogle Scholar
  3. 3.
    Neuner J, Yen T, Sparapani R, Laud P, Nattinger A (2011) Fracture risk and adjuvant hormonal therapy among a population-based cohort of older female breast cancer patients. Osteoporos Int 22(11):2847–2855PubMedCrossRefGoogle Scholar
  4. 4.
    Valachis A, Polyzos NP, Georgomicronulias V, Mavroudis D, Mauri D (2010) Lack of evidence for fracture prevention in early breast cancer bisphosphonate trials: a meta-analysis. Gynecol Oncol 117(1):139–145PubMedCrossRefGoogle Scholar
  5. 5.
    Winters-Stone KM, Schwartz A, Nail LM (2010) A review of exercise interventions to improve bone health in adult cancer survivors. J Cancer Surviv 4(3):187–201PubMedCrossRefGoogle Scholar
  6. 6.
    Saarto T, Sievanen H, Kellokumpu-Lehtinen P, Nikander R, Vehmanen L, Huovinen R, Kautiainen H, Jarvenpaa S, Penttinen HM, Utriainen M, Jaaskelainen AS, Elme A, Ruohola J, Palva T, Vertio H, Rautalahti M, Fogelholm M, Luoto R, Blomqvist C (2011) Effect of supervised and home exercise training on bone mineral density among breast cancer patients. A 12-month randomised controlled trial. Osteoporos Int, in pressGoogle Scholar
  7. 7.
    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 (7):CD000333Google Scholar
  8. 8.
    Kohrt WM (2001) Aging and the osteogenic response to mechanical loading. Int J Sport Nutr Exerc Metab 11(Suppl):S137–S142PubMedGoogle Scholar
  9. 9.
    Winters-Stone K, Dobek J, Nail L, Bennett JA, Naik A, Schwartz A (2011) Strength training stops bone loss and builds muscle in postmenopausal breast cancer survivors: a randomized controlled trial. Breast Cancer Res Treat 27(2):447–456CrossRefGoogle Scholar
  10. 10.
    Stewart AL, Mills KM, King AC, Haskell WL, Gillis D, Ritter PL (2001) CHAMPS physical activity questionnaire for older adults: outcomes for interventions. Med Sci Sports Exerc 33(7):1126–1141PubMedGoogle Scholar
  11. 11.
    Bassey E, Rothwell M, Littlewood J, Pye D (1998) Pre- and postmenopausal women have different bone mineral density responses to the same high-impact exercise. J Bone Miner Res 13(12):1805–1813PubMedCrossRefGoogle Scholar
  12. 12.
    Winters KM, Snow CM (2000) Detraining reverses positive effects of exercise on the musculoskeletal system in premenopausal women. J Bone Miner Res 15:2495–2503PubMedCrossRefGoogle Scholar
  13. 13.
    Shaw JM, Snow CM (1998) Weighted vest exercise improves indices of fall risk in older women. J Gerontol 53:M53–M58Google Scholar
  14. 14.
    Snow CM, Shaw JM, Winters KM, Witzke KA (2000) Long-term exercise using weighted vests prevents hip bone loss in postmenopausal women. J Gerontol A Biol Sci Med Sci 55(9):M489–M491PubMedCrossRefGoogle Scholar
  15. 15.
    Turner CH, Takano Y, Owan I (1995) Aging changes mechanical loading thresholds for bone formation in rats. J Bone Min Res 10(10):1544–1549CrossRefGoogle Scholar
  16. 16.
    Rubin CT, Bain SD, McLeod KJ (1992) Suppression of the osteogenic response in the aging skeleton. Calcif Tissue Int 50(4):306–313PubMedCrossRefGoogle Scholar
  17. 17.
    Maccormick RE (2006) Possible acceleration of aging by adjuvant chemotherapy: a cause of early onset frailty? Med Hypoth 67(2):212–215CrossRefGoogle Scholar
  18. 18.
    Winters-Stone KM, Dobek J, Bennett JA, Nail LM, Leo MC, Schwartz A (2011) The effect of resistance training on muscle strength and physical function in older, postmenopausal breast cancer survivors: a randomized controlled trial. J Cancer Surviv, in pressGoogle Scholar
  19. 19.
    Hamilton C, Swan V, Jamal S (2010) The effects of exercise and physical activity participation on bone mass and geometry in postmenopausal women: a systematic review of pQCT studies. Osteoporos Int 21(1):11–23PubMedCrossRefGoogle Scholar
  20. 20.
    Korpelainen R, Keinanen-Kiukaanniemi S, Nieminen P, Heikkinen J, Vaananen K, Korpelainen J (2010) Long-term outcomes of exercise: follow-up of a randomized trial in older women with osteopenia. Arch Intern Med 170(17):1548–1556PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • Kerri M. Winters-Stone
    • 1
    Email author
  • Michael C. Leo
    • 2
  • Anna Schwartz
    • 3
  1. 1.School of NursingOregon Health and Science UniversityPortlandUSA
  2. 2.Kaiser Permanente Center for Health ResearchPortlandUSA
  3. 3.School of NursingIdaho State UniversityPocatelloUSA

Personalised recommendations