Skip to main content

The effect of physical exercise on bone density in middle-aged and older men: A systematic review

Osteoporosis International volume 24, pages 2749–2762 (2013)Cite this article

Abstract

Although trials have shown that exercise has positive effects on bone mineral density (BMD), the majority of exercise trials have been conducted in older women. The aim of this study was to systematically review trials examining the effect of weight-bearing and resistance-based exercise modalities on the BMD of hip and lumbar spine of middle-aged and older men. Eight electronic databases were searched in August 2012. Randomised controlled or controlled trials that assessed the effect of weight-bearing and resistance-based exercise interventions on BMD measured by dual-energy x-ray absorptiometry, and reported effects in middle-aged and older men were included. Eight trials detailed in nine papers were included. The interventions included walking (n = 2), resistance training (n = 3), walking + resistance training (n = 1), resistance training + impact-loading activities (n = 1) and resistance training + Tai Chi (n = 1). Five of the eight trials achieved a score of less than 50 % on the modified Delphi quality rating scale. Further, there was heterogeneity in the type, intensity, frequency and duration of the exercise regimens. Effects of exercise varied greatly among studies, with six interventions having a positive effect on BMD and two interventions having no significant effect. It appears that resistance training alone or in combination with impact-loading activities are most osteogenic for this population, whereas the walking trials had limited effect on BMD. Therefore, regular resistance training and impact-loading activities should be considered as a strategy to prevent osteoporosis in middle-aged and older men. High quality randomised controlled trials are needed to establish the optimal exercise prescription.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

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

Fig. 1

References

  1. Khosla S (2012) Pathogenesis of age-related bone loss in humans. J Gerontol Ser A Biol Sci Med Sci

  2. Amin S, Khosla S (2012) Sex- and age-related differences in bone microarchitecture in men relative to women assessed by high-resolution peripheral quantitative computed tomography. J Osteoporos 2012:129760

    PubMed  Google Scholar 

  3. Warming L, Hassager C, Christiansen C (2002) Changes in bone mineral density with age in men and women: a longitudinal study. Osteoporos Int 13:105–112

    Article  CAS  PubMed  Google Scholar 

  4. Khosla S, Riggs BL (2005) Pathophysiology of age-related bone loss and osteoporosis. Endocrinol Metab Clin N Am 34:1015–1030, xi

    Article  CAS  Google Scholar 

  5. Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359:1929–1936

    Article  PubMed  Google Scholar 

  6. Marcus R (2002) Post-menopausal osteoporosis. Best Pract Res Clin Obstet Gynaecol 16:309–327

    Article  PubMed  Google Scholar 

  7. Ryan CS, Petkov VI, Adler RA (2011) Osteoporosis in men: the value of laboratory testing. Osteoporos Int 22:1845–1853

    Article  CAS  PubMed  Google Scholar 

  8. Frost HM (1987) Bone “mass” and the “mechanostat”: a proposal. Anat Rec 219:1–9

    Article  CAS  PubMed  Google Scholar 

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

    CAS  Google Scholar 

  10. Kelley GA (1998) Exercise and regional bone mineral density in postmenopausal women: a meta-analytic review of randomized trials. Am J Phys Med Rehabil 77:76–87

    Article  CAS  PubMed  Google Scholar 

  11. Nikander R, Sievanen H, Heinonen A, Daly RM, Uusi-Rasi K, Kannus P (2010) Targeted exercise against osteoporosis: a systematic review and meta-analysis for optimising bone strength throughout life. BMC medicine 8:47

    Article  PubMed  Google Scholar 

  12. Wolff I, van Croonenborg JJ, Kemper HC, Kostense PJ, Twisk JW (1999) The effect of exercise training programmes on bone mass: a meta-analysis of published controlled trials in pre- and postmenopausal women. Osteoporos Int 9:1–12

    Article  CAS  PubMed  Google Scholar 

  13. Berard A, Bravo G, Gauthier P (1997) Meta-analysis of the effectiveness of physical activity for the prevention of bone loss in postmenopausal women. Osteoporos Int 7:331–337

    Article  CAS  PubMed  Google Scholar 

  14. Kelley GA, Kelley KS (2006) Exercise and bone mineral density at the femoral neck in postmenopausal women: a meta-analysis of controlled clinical trials with individual patient data. Am J Obstet Gynecol 194:760–767

    Article  PubMed  Google Scholar 

  15. Kelley GA, Kelley KS, Tran ZV (2002) Exercise and lumbar spine bone mineral density in postmenopausal women: a meta-analysis of individual patient data. In The journals of gerontology Series A, Biological sciences and medical sciences M599–604

  16. Borer KT (2005) Physical activity in the prevention and amelioration of osteoporosis in women: interaction of mechanical, hormonal and dietary factors. Sports Med 35:779–830

    Article  PubMed  Google Scholar 

  17. Schmitt NM, Schmitt J, Doren M (2009) The role of physical activity in the prevention of osteoporosis in postmenopausal women-An update. Maturitas 63:34–38

    Article  PubMed  Google Scholar 

  18. Gómez-Cabello A, Ara I, González-Agüero A, Casajüs JA, Vicente-Rodríguez G (2012) Effects of training on bone mass in older adults: a systematic review. Sports Med 42:301–325

    Article  PubMed  Google Scholar 

  19. Lanyon LE (1996) Using functional loading to influence bone mass and architecture: objectives, mechanisms, and relationship with oestrogen of the mechanically adaptive process in bone. Bone 18:37S–43S

    Article  CAS  PubMed  Google Scholar 

  20. Lee KC, Lanyon LE (2004) Mechanical loading influences bone mass through oestrogen receptor alpha. Exerc Sport Sci Rev 32:64–68

    Article  PubMed  Google Scholar 

  21. Bassey EJ, Rothwell MC, Littlewood JJ, Pye DW (1998) Pre- and postmenopausal women have different bone mineral density responses to the same high-impact exercise. J Bone Miner Res 13(12):1805–1813

    Article  CAS  PubMed  Google Scholar 

  22. Watts NB, Adler RA, Bilezikian JP, Drake MT, Eastell R, Orwoll ES, Finkelstein JS (2012) Osteoporosis in men: an endocrine society clinical practise guideline. J Clin Endocrinol Metab 97:1802–1822

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  24. Kelley GA, Kelley KS, Tran ZV (2000) Exercise and bone mineral density in men: a meta-analysis. J Appl Physiol 88:1730–1736

    CAS  PubMed  Google Scholar 

  25. Kohrt WM, Bloomfield SA, Little KD, Nelson ME, Yingling VR (2004) American college of sports medicine position stand: physical activity and bone health. Med Sci Sports Exerc 36:1985–1996

    Article  PubMed  Google Scholar 

  26. Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM, Knipschild PG (1998) The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol 51:1235–1241

    Article  CAS  PubMed  Google Scholar 

  27. Verhagen AP, de Vet HC, de Bie RA, Boers M, van den Brandt PA (2001) The art of quality assessment of RCTs included in systematic reviews. J Clin Epidemiol 54:651–654

    Article  CAS  PubMed  Google Scholar 

  28. Woo J, Hong A, Lau E, Lynn H (2007) A randomised controlled trial of Tai Chi and resistance exercise on bone health, muscle strength and balance in community-living elderly people. Age Ageing 262–268

  29. Whiteford J, Ackland TR, Dhaliwal SS, James AP, Woodhouse JJ, Price R, Prince RL, Kerr DA (2010) Effects of a 1-year randomized controlled trial of resistance training on lower limb bone and muscle structure and function in older men. Osteoporos Int 21(9):1529–1536

    Article  CAS  PubMed  Google Scholar 

  30. Kukuljan S, Nowson CA, Bass SL, Sanders K, Nicholson GC, Seibel MJ, Salmon J, Daly RM (2009) Effects of a multi-component exercise programme and calcium-vitamin-D3-fortified milk on bone mineral density in older men: a randomised controlled trial. Osteoporos Int 20(7):1241–1251

    Article  CAS  PubMed  Google Scholar 

  31. Kukuljan S, Nowson CA, Sanders KM, Nicholson GC, Seibel MJ, Salmon J, Daly RM (2011) Independent and combined effects of calcium-vitamin d3 and exercise on bone structure and strength in older men: an 18-month factorial design randomized controlled trial. J Clin Endocrinol Metab 96(4):955–963

    Article  CAS  PubMed  Google Scholar 

  32. Ryan AS, Treuth MS, Rubin MA, Miller JP, Nicklas BJ, Landis DM, Pratley RE, Libanati CR, Gundberg CM, Hurley BF (1994) Effects of strength training on bone mineral density: hormonal and bone turnover relationships. J Appl Physiol 1678–1684

  33. Paillard T, Lafont C, Costes-Salon MC, Rivière D, Dupui P (2004) Effects of brisk walking on static and dynamic balance, locomotion, body composition and aerobic capacity in ageing healthy active men. Int J Sports Med 25(7):539–546

    Article  CAS  PubMed  Google Scholar 

  34. Huuskonen J, Vaisanen SB, Kroger H, Jurvelin JS, Alhava E, Rauramaa R (2001) Regular physical exercise and bone mineral density: a four-year controlled randomized trial in middle-aged men. The DNASCO study. Osteoporos Int 12(5):349–355

    Article  CAS  PubMed  Google Scholar 

  35. Menkes A, Mazel S, Redmond RA, Koffler K, Libanati CR, Gundberg CM, Zizic TM, Hagberg JM, Pratley RE, Hurley BF (1993) Strength training increases regional bone mineral density and bone remodeling in middle-aged and older men. J Appl Physiol 74:2478–2484

    Google Scholar 

  36. Braith RW, Mills RM, Welsch MA, Keller JW, Pollock ML (1996) Resistance exercise training restores bone mineral density in heart transplant recipients. J Am Coll Cardiol 28(6):1471–1477

    Article  CAS  PubMed  Google Scholar 

  37. Turner CH, Robling AG (2005) Mechanisms by which exercise improves bone strength. J Bone Miner Metab 23(Suppl):16–22

    Article  CAS  PubMed  Google Scholar 

  38. Turner CH (1998) Three rules for bone adaptation to mechanical stimuli. Bone 23:399–407

    Article  CAS  PubMed  Google Scholar 

  39. Bailey CA, Brooke-Wavell K (2010) Optimum frequency of exercise for bone health: randomised controlled trial of a high- impact unilateral intervention. Bone 46(4):1043–1049

    Article  PubMed  Google Scholar 

  40. Martyn-St. James M, Carroll S (2006) High-intensity resistance training and postmenopausal bone loss: a meta-analysis. Osteoporos Int 17:1225–1240

    Article  CAS  PubMed  Google Scholar 

  41. Martyn-St James M, Carroll S (2010) Effects of different impact exercise modalities on bone mineral density in premenopausal women: a meta-analysis. J Bone Miner Metab 28:251–267

    Article  PubMed  Google Scholar 

  42. Specker B, Vukovich M (2007) Evidence for an interaction between exercise and nutrition for improved bone health during growth. Med Sport Sci 51:50–63

    Article  PubMed  Google Scholar 

  43. 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 of systematic reviews (Online) CD000333 doi:10.1002/14651858.CD000333.pub2

  44. Martyn-St JM, Carroll S (2008) Meta-analysis of walking for preservation of bone mineral density in postmenopausal women. Bone 43:521–531

    Article  Google Scholar 

  45. Martyn-St JM, Carroll S (2009) A meta-analysis of impact exercise on postmenopausal bone loss: the case for mixed loading exercise programmes. Br J Sports Med 43:898–908

    Article  Google Scholar 

  46. Hunter GR, McCarthy JP, Bamman MM (2004) Effects of resistance training on older adults. Sports Med 34:329–348

    Article  PubMed  Google Scholar 

  47. Kannus P, Sievanen H, Palvanen M, Jarvinen T, Parkkari J (2005) Prevention of falls and consequent injuries in elderly people. Lancet 366(20):1885–1893

    Article  PubMed  Google Scholar 

  48. Galvao DA, Nosaka K, Taaffe DR, Spry N, Kristjanson LJ, McGuigan MR, Suzuki K, Yamaya K, Newton RU (2006) Resistance training and reduction of treatment side effects in prostate cancer patients. Med Sci Sports Exerc 38:2045–2052

    Article  PubMed  Google Scholar 

  49. Winters-Stone KM, Dobek J, Nail LM, Bennett JA, Leo MC, Torgrimson-Ojerio B, Luoh SW, Schwartz A (2012) Impact + resistance training improves bone health and body composition in prematurely menopausal breast cancer survivors: a randomized controlled trial. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA

  50. Saarto T, Sievanen H, Kellokumpu-Lehtinen P et al (2012) Effect of supervised and home exercise training on bone mineral density among breast cancer patients. A 12-month randomised controlled trial. Osteoporos Int 23(5):1601–1612

    Article  CAS  PubMed  Google Scholar 

  51. Bolotin HH, Sievanen H (2001) Inaccuracies inherent in dual-energy X-ray absorptiometry in vivo bone mineral density can seriously mislead diagnostic/prognostic interpretations of patient-specific bone fragility. J Bone Miner Res: Off J Am Soc Bone Miner Res 16:799–805

    Article  CAS  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. School of Human Movement Studies, The University of Queensland, Brisbane, QLD, Australia

    K. A. Bolam, J. G. Z. van Uffelen & D. R. Taaffe

  2. Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, VIC, Australia

    J. G. Z. van Uffelen

  3. School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, NSW, Australia

    D. R. Taaffe

  4. Edith Cowan University Health and Wellness Institute, Edith Cowan University, Joondalup, WA, Australia

    D. R. Taaffe

Authors
  1. K. A. Bolam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. G. Z. van Uffelen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. R. Taaffe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. A. Bolam.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bolam, K.A., van Uffelen, J.G.Z. & Taaffe, D.R. The effect of physical exercise on bone density in middle-aged and older men: A systematic review. Osteoporos Int 24, 2749–2762 (2013). https://doi.org/10.1007/s00198-013-2346-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-013-2346-1

Keywords

  • Ageing
  • Bone
  • Exercise
  • Men
  • Osteoporosis
  • Systematic review