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High-intensity exercise did not cause vertebral fractures and improves thoracic kyphosis in postmenopausal women with low to very low bone mass: the LIFTMOR trial



Our aim was to assess risk of vertebral fracture during high-intensity resistance and impact training (HiRIT) for postmenopausal women with low bone mass. HiRIT did not induce vertebral fracture, as evidenced by a reduction in kyphosis following 8 months of training and a lack of change in vertebral morphology.


The LIFTMOR trial demonstrated a novel, HiRIT program notably improved bone mass in postmenopausal women with osteopenia and osteoporosis. While no clinical signs or symptoms of vertebral crush fracture were evident during the trial, anecdotal feedback suggests that concerns about safety of HiRIT in the osteoporosis demographic remain. The aim of the current work was to assess vertebral body morphology, Cobb angle, and clinical measures of thoracic kyphosis in participants in the LIFTMOR trial for evidence of vertebral fracture following 8 months of supervised HiRIT.


Participants were randomized to either 8 months of 30-min, twice-weekly, supervised HiRIT or unsupervised, low-intensity, home-based exercise (CON). Lateral thoracolumbar DXA scans (Medix DR, Medilink, France) were performed at baseline and follow-up. Cobb angle was determined, and vertebral fracture identification was performed using the semiquantitative Genant method. Clinical kyphosis measurements were performed in relaxed standing (neutral posture) and standing tall using an inclinometer and a flexicurve.


The HiRIT group exhibited a reduction in inclinometer-determined standing tall thoracic kyphosis compared to CON (− 6.7 ± 8.2° vs − 1.6 ± 8.1°, p = 0.031). Both the HiRIT and CON groups exhibited within-group improvement in kyphosis in relaxed standing as measured by both inclinometer and flexicurve (p < 0.05). There were no changes in vertebral fracture classification in the HiRIT group post-intervention. A single, new, wedge deformity was observed for CON.


Supervised HiRIT was not associated with an increased risk of vertebral fracture in postmenopausal women with low bone mass. Indeed, a clinically relevant improvement in thoracic kyphosis was observed following 8 months of supervised HiRIT, further supporting its efficacy as an osteoporosis intervention for postmenopausal women with low to very low bone mass.

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  1. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 22(3):465–475.

    Article  PubMed  Google Scholar 

  2. 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:CD000333.

    Article  Google Scholar 

  3. Kemmler W, von Stengel S (2018) Bone: high-intensity exercise to prevent fractures—risk or gain? Nat Rev Endocrinol 14(1):6–8

    Article  PubMed  Google Scholar 

  4. Milne JS, Lauder IJ (1976) The relationship of kyphosis to the shape of vertebral bodies. Ann Hum Biol 3(2):173–179

    Article  CAS  PubMed  Google Scholar 

  5. Eastell R, Cedel SL, Wahner HW, Riggs BL, Melton LJ 3rd (1991) Classification of vertebral fractures. J Bone Miner Res 6(3):207–215.

    Article  CAS  PubMed  Google Scholar 

  6. Ballane G, Cauley JA, Luckey MM, El-Hajj Fuleihan G (2017) Worldwide prevalence and incidence of osteoporotic vertebral fractures. Osteoporos Int 28(5):1531–1542.

    Article  CAS  PubMed  Google Scholar 

  7. Gold DT, Shipp KM, Pieper CF, Duncan PW, Martinez S, Lyles KW (2004) Group treatment improves trunk strength and psychological status in older women with vertebral fractures: results of a randomized, clinical trial. J Am Geriatr Soc 52(9):1471–1478

    Article  PubMed  Google Scholar 

  8. Rubin CT, Lanyon LE (1985) Regulation of bone mass by mechanical strain magnitude. Calcif Tissue Int 37(4):411–417

    Article  CAS  PubMed  Google Scholar 

  9. O'Connor JA, Lanyon LE, MacFie H (1982) The influence of strain rate on adaptive bone remodelling. J Biomech 15(10):767–781

    Article  CAS  PubMed  Google Scholar 

  10. Rubin CT, McLeod KJ (1994) Promotion of bony ingrowth by frequency-specific, low-amplitude mechanical strain. Clin Orthop Relat Res 298:165–174

    Google Scholar 

  11. Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR (2018) High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. J Bone Miner Res 33(2):211–220.

    Article  PubMed  Google Scholar 

  12. Maddalozzo GF, Widrick JJ, Cardinal BJ, Winters-Stone KM, Hoffman MA, Snow CM (2007) The effects of hormone replacement therapy and resistance training on spine bone mineral density in early postmenopausal women. Bone 40(5):1244–1251.

    Article  CAS  PubMed  Google Scholar 

  13. Mosti MP, Kaehler N, Stunes AK, Hoff J, Syversen U (2013) Maximal strength training in postmenopausal women with osteoporosis or osteopenia. J Strength Cond Res 27(10):2879–2886.

    Article  PubMed  Google Scholar 

  14. 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(24):1909–1914

    Article  CAS  PubMed  Google Scholar 

  15. Kado DM, Christianson L, Palermo L, Smith-Bindman R, Cummings SR, Greendale GA (2006) Comparing a supine radiologic versus standing clinical measurement of kyphosis in older women: the Fracture Intervention Trial. Spine (Phila Pa 1976) 31(4):463–467

    Article  Google Scholar 

  16. Briggs AM, Wrigley TV, Tully EA, Adams PE, Greig AM, Bennell KL (2007) Radiographic measures of thoracic kyphosis in osteoporosis: Cobb and vertebral centroid angles. Skelet Radiol 36(8):761–767

    Article  CAS  Google Scholar 

  17. Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8(9):1137–1148

    Article  CAS  PubMed  Google Scholar 

  18. Mika A, Unnithan VB, Mika P (2005) Differences in thoracic kyphosis and in back muscle strength in women with bone loss due to osteoporosis. Spine (Phila Pa 1976) 30(2):241–246

    Article  Google Scholar 

  19. Barrett E, McCreesh K, Lewis J (2013) Intrarater and interrater reliability of the flexicurve index, flexicurve angle, and manual inclinometer for the measurement of thoracic kyphosis. Rehabil Res Pract 2013:475870

  20. Yanagawa T, Maitland M, Burgess K, Young L, Hanley D (2000) Assessment of thoracic kyphosis using the flexicurve for individuals with osteoporosis. Hong Kong Physiother J 18(2):53–57

    Article  Google Scholar 

  21. Barrett E, Lenehan B, O'Sullivan K, Lewis J, McCreesh K (2018) Validation of the manual inclinometer and flexicurve for the measurement of thoracic kyphosis. Physiother Theory Pract 34(4):301–308

    Article  PubMed  Google Scholar 

  22. Hinman M (2004) Interrater reliability of flexicurve postural measures among novice users. J Back Musculoskelet Rehabil 17(1):33–36

    Article  Google Scholar 

  23. Bruno AG, Burkhart K, Allaire B, Anderson DE, Bouxsein ML (2017) Spinal loading patterns from biomechanical modeling explain the high incidence of vertebral fractures in the thoracolumbar region. J Bone Miner Res 32(6):1282–1290.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Nevitt MC, Ross PD, Palermo L, Musliner T, Genant HK, Thompson DE (1999) Association of prevalent vertebral fractures, bone density, and alendronate treatment with incident vertebral fractures: effect of number and spinal location of fractures. The Fracture Intervention Trial Research Group. Bone 25(5):613–619

    Article  CAS  PubMed  Google Scholar 

  25. Moro M, Hecker AT, Bouxsein ML, Myers ER (1995) Failure load of thoracic vertebrae correlates with lumbar bone mineral density measured by DXA. Calcif Tissue Int 56(3):206–209

    Article  CAS  PubMed  Google Scholar 

  26. Groenen KHJ, Janssen D, van der Linden YM, Kooloos JGM, Homminga J, Verdonschot N, Tanck E (2018) Inducing targeted failure in cadaveric testing of 3-segment spinal units with and without simulated metastases. Med Eng Phys 51:104–110.

    Article  PubMed  Google Scholar 

  27. Alkalay RN (2015) Effect of the metastatic defect on the structural response and failure process of human vertebrae: an experimental study. Clin Biomech 30(2):121–128.

    Article  Google Scholar 

  28. Myers ER, Wilson SE (1997) Biomechanics of osteoporosis and vertebral fracture. Spine (Phila Pa 1976) 22(24 Suppl):25S–31S

    Article  CAS  Google Scholar 

  29. Katzman WB, Sellmeyer DE, Stewart AL, Wanek L, Hamel KA (2007) Changes in flexed posture, musculoskeletal impairments, and physical performance after group exercise in community-dwelling older women. Arch Phys Med Rehabil 88(2):192–199.

    Article  PubMed  Google Scholar 

  30. Katzman WB, Wanek L, Shepherd JA, Sellmeyer DE (2010) Age-related hyperkyphosis: its causes, consequences, and management. J Orthop Sports Phys Ther 40(6):352–360.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Bansal S, Katzman WB, Giangregorio LM (2014) Exercise for improving age-related hyperkyphotic posture: a systematic review. Arch Phys Med Rehabil 95(1):129–140.

    Article  PubMed  Google Scholar 

  32. Itoi E, Sinaki M (1994) Effect of back-strengthening exercise on posture in healthy women 49 to 65 years of age. Mayo Clin Proc 69(11):1054–1059

    Article  CAS  PubMed  Google Scholar 

  33. Bautmans I, Van Arken J, Van Mackelenberg M, Mets T (2010) Rehabilitation using manual mobilization for thoracic kyphosis in elderly postmenopausal patients with osteoporosis. J Rehabil Med 42(2):129–135.

    Article  PubMed  Google Scholar 

  34. Greendale GA, Huang M-H, Karlamangla AS, Seeger L, Crawford S (2009) Yoga decreases kyphosis in senior women and men with adult-onset hyperkyphosis: results of a randomized controlled trial. J Am Geriatr Soc 57(9):1569–1579

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ross PD, Davis JW, Epstein RS, Wasnich RD (1991) Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 114(11):919–923

    Article  CAS  PubMed  Google Scholar 

  36. Tran TH, Wing D, Davis A, Bergstrom J, Schousboe JT, Nichols JF, Kado DM (2016) Correlations among four measures of thoracic kyphosis in older adults. Osteoporos Int 27(3):1255–1259.

    Article  CAS  PubMed  Google Scholar 

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The authors acknowledge Sports Medicine Australia for its support for exercise equipment and Griffith University for Postgraduate Research Scholarship support of Steven Watson.

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Correspondence to B. R. Beck.

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Watson, S.L., Weeks, B.K., Weis, L.J. et al. High-intensity exercise did not cause vertebral fractures and improves thoracic kyphosis in postmenopausal women with low to very low bone mass: the LIFTMOR trial. Osteoporos Int 30, 957–964 (2019).

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  • Exercise
  • Vertebral fracture
  • Osteoporosis