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Sedentary behaviour and bone health in older adults: a systematic review

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Older adults spend more than 8 h/day in sedentary behaviours. Detrimental effects of sedentary behaviour (SB) on health are established, yet little is known about SB and bone health (bone mineral density; BMD) in older adults. The purpose of this review is to examine associations of SB with BMD in older adults. Five electronic databases were searched: Web of Science (Core Collection); PubMed; EMBASE; Sports Medicine and Education and PsycInfo. Inclusion criteria were healthy older adults mean age ≥ 65 years; measured SB and measured BMD using dual-energy X-ray absorptiometry. Quality was assessed using National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. After excluding duplicates 17813 papers were assessed; 17757 were excluded on title/abstract, 49 at full text, resulting in two prospective and five cross-sectional observational studies reviewed. Four were rated ‘good’ and three were rated ‘fair’ using the quality assessment criteria. Findings varied across the studies and differed by gender. In women, four studies reported significant positive associations of SB with BMD at different sites, and two found significant negative associations. Five studies which examined both men and women, men reported negative or no associations of SB with femoral neck, pelvic, whole body, spine or leg BMD. Whilst these findings suggest differences between men and women in the associations of SB with BMD, they may be due to the varying anatomical sections examined for BMD, the different methods used to measure SB, the varied quality of the studies included and the limited number of published findings.

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Fig. 1

Similar content being viewed by others



Bone mineral density


Dual-X-ray absorptiometry


Femoral neck


Light physical activity


Lumbar spine


Moderate-to-vigorous physical activity


Physical activity


Sedentary behaviour


Sedentary time


Total body


Total femur


Total hip


Total spine


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This study was supported by a grant from the Royal Osteoporosis Society.

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Correspondence to L. McMichan.

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Dawn A. Skelton is a Director of a not for profit training company, Later Life Training, which provides training to health and leisure professionals to deliver strength and balance training.

Neville Owen is supported by a National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence Grant (#1057608), NHMRC Senior Principal Research Fellowship (#1118225), and the Victorian Government’s Operational Infrastructure Support Program. David W. Dunstan is supported by a NHMRC Senior Research Fellowship #1078360 and the Victorian Government’s Operational Infrastructure Support Program.

Lauren McMichan, Michael Dick, Sebastien F.M. Chastin, Neville Owen, David W. Dunstan, William D. Fraser, Jonathan C.Y. Tang, Carolyn A. Greig, Sandra Agyapong-Badu, and Alexandra Mavroeidi declare no conflict of interests.

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McMichan, L., Dick, M., Skelton, D. et al. Sedentary behaviour and bone health in older adults: a systematic review. Osteoporos Int 32, 1487–1497 (2021).

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