Skip to main content

Bone-loading exercises versus risedronate for the prevention of osteoporosis in postmenopausal women with low bone mass: a randomized controlled trial

Abstract

Purpose

This randomized controlled trial compared changes in bone mineral density (BMD) and bone turnover in postmenopausal women with low bone mass randomized to 12 months of either risedronate, exercise, or a control group.

Methods

Two hundred seventy-six women with low bone mass, within 6 years of menopause, were included in analysis. Treatment groups were 12 months of (a) calcium and vitamin D supplements (CaD) (control), (b) risedronate + CaD (risedronate), or (c) bone-loading exercises + CaD (exercise). BMD and serum markers for bone formation (Alkphase B) and resorption (Serum Ntx) were analyzed at baseline, 6, and 12 months.

Results

Using hierarchical linear modeling, a group by time interaction was found for BMD at the spine, indicating a greater improvement in the risedronate group compared to exercise (p ≤ .010) or control groups (p ≤ .001). At 12 months, for women prescribed risedronate, changes in BMD at the spine, hip, and femoral neck from baseline were + 1.9%, + 0.9%, and + .09%; in exercise group women, + 0.2%, + 0.5%, and − 0.4%; and in control group women, − 0.7%, + 0.5%, and − 0.5%. There were also significant differences in reductions in Alkphase B (RvsE, p < .001, RvsC, p < .001) and Serum Ntx (RvsE, p = .004, RvsC, p = .007) in risedronate women compared to exercise and control groups. For risedronate, 12-month changes in Alkphase B and Serum Ntx were − 20.3% and − 19.0%; for exercise, − 6.7% and − 7.0%; and for control, − 6.3% and − 9.0%.

Conclusion

Postmenopausal women with low bone mass should obtain adequate calcium and vitamin D and participate in bone-loading exercises. Additional use of BPs will increase BMD, especially at the spine.

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

Fig. 1

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

BMD:

Bone mineral density

BPs:

Bisphosphonates

CaD:

Calcium and vitamin D supplements

CORC:

Creighton University Osteoporosis Research Center

DXA:

Dual-energy X-ray absorptiometry

ETs:

Exercise trainers

FRAX:

Fracture risk assessment

GI:

Gastrointestinal

HSA:

Hip structural assessment

Lbs.:

Pounds

LIFTMOR:

Lifting Intervention for Training Muscle and Osteoporosis Rehabilitation

NOF:

National Osteoporosis Foundation

pQCT:

Peripheral quantitative computed tomography

1RM:

One-repetition maximum

References

  1. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporosis International: A Journal Established as Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 25(10):2359–2381. https://doi.org/10.1007/s00198-014-2794-2

    CAS  Article  Google Scholar 

  2. Patel, D., Worley, J. R., Volgas, D. A., & Crist, B. D. (2018) The effectiveness of osteoporosis screening and treatment in the Midwest. Geriatric Orthopaedic Surgery & Rehabilitation, 9. https://doi.org/10.1177/2151459318765844

  3. Rizzoli R (2018) Postmenopausal osteoporosis: assessment and management. Best Prac Res Clin Endocrinol Metab 32(5):739–757

    Article  Google Scholar 

  4. Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S, Dawson-Hughes B (2014) The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. Journal of Bone and Mineral Research: The Official Journal of the American Society for Bone and Mineral Research 29(11):2520–2526. https://doi.org/10.1002/jbmr.2269

    Article  Google Scholar 

  5. Downey C, Kelly M, Quinlan JF (2019) Changing trends in the mortality rate at 1-year post hip fracture–a systematic review. World Journal of Orthopedics 10(3):166–175. https://doi.org/10.5312/wjo.v10.i3.(20166

    Article  PubMed  PubMed Central  Google Scholar 

  6. Delmas, P.D., Eastell, R., Garnero, P., Seibel, M.J. and Stepan, J. for the Committee of Scientific Advisors of the International Osteoporosis Foundation (2000) The use of biochemical markers of bone turnover in osteoporosis. Osteroporosis Int Suppl 6:S2-17

    Google Scholar 

  7. Tu KN, Lie JD, Wan CK et al (2018) Osteoporosis: a review of treatment options. P & T 43(2):92–104

    Google Scholar 

  8. Harris ST, Watts NB, Genant HK et al (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral efficacy with risedronate therapy (VERT) study group. JAMA 282(14):1344–1352

    CAS  Article  Google Scholar 

  9. Lenard L (2009) Bisphosphonates: bone strengtheners or bone hardeners? Townsend Letter. The Examiner of Alternative Medicine 312:76–81

    Google Scholar 

  10. Hellier S, Ross C (2012) Long-term bisphosphonate therapy: possible link to rare femur fracture. Nurse Pract 16(9/10):12–18

    Google Scholar 

  11. Hakestad KA, Torstveit MK, Nordsletten L, Risberg MA (2015) Effect of exercises with weight vests and a patient education programme for women with osteopenia and a healed wrist fracture: a randomized, controlled trial of the OsteoACTIVE programme. BMC Musculoskelet Disord 16:352–360. https://doi.org/10.1186/s12891-015-0811-z

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  12. Kemmler W, Bebenek M, Kohl M, von Stengel S (2015) Exercise and fractures in postmenopausal women. Results of the controlled Erlangen Fitness and Osteoporosis Prevention Study (EFOPS). Osteoporos Int 26(10):2491–2499. https://doi.org/10.1007/s00198-015-3165-3

    CAS  Article  PubMed  Google Scholar 

  13. Martyn-St James M, 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(12):898–908. https://doi.org/10.1136/bjsm.2008.052704

    CAS  Article  PubMed  Google Scholar 

  14. Watson S, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck B (2017) 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 34(3):572–572. https://doi.org/10.1002/jbmr.3284

    Article  Google Scholar 

  15. Polit, D. & Beck, C. (2018) Essentials of nursing research, 9th ed. Lippincott, Williams & Wilkins

  16. Ji MX, Yu Q (2015) Primary osteoporosis in postmenopausal women. Chronic Diseases and Translational Medicine 1(1):9–13. https://doi.org/10.1016/j.cdtm.2015.02.006

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kanis JA, Hans D, Cooper C, Baim S, Bilezikian JP, Binkley N, Cauley JA, Compston JE, Dawson-Hughes B, El-Hajj Fuleihan G, Johansson H, Leslie WD, Lewiecki EM, Luckey M, Oden A, Papapoulos SE, Poiana C, Rizzoli R, Wahl DA, McCloskey EV (2011) Interpretation and use of FRAX in clinical practice. Osteoporos Int 22(9):2395–2411. https://doi.org/10.1007/s00198-011-1713-z

    CAS  Article  PubMed  Google Scholar 

  18. Kanis JA, Adachi JD, Cooper C, Clark P, Cummings SR, Diaz-Curiel M et al (2013) Standardizing the descriptive epidemiology of osteoporosis: recommendations from the Epidemiology and Quality of Life Working Group of IOF. Osteoporosis Int 24(11):2763–2764. https://doi.org/10.1007/s00198-013-2413-7

    CAS  Article  Google Scholar 

  19. Waltman NL, Smith KM, Kupzyk KA, Lappe JM, Mack LR, Bilek LD (2019) Approaches to recruitment of postmenopausal women for a community-based study. Nurs Res 68(4):307–316. https://doi.org/10.1097/NNR.0000000000000356

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bilek LD, Waltman NL, Lappe JM, Kupzyk KA, Mack LR, Cullen DM, Berg K, Langel M, Meisinger M, Portelli-Trinidad A, Lang M (2016) Protocol for a randomized controlled trial to compare bone-loading exercises with risedronate for preventing bone loss in osteopenic postmenopausal women. BMC Women’s Health. https://doi.org/10.1186/s12905-016-0339-x

    Article  PubMed  PubMed Central  Google Scholar 

  21. Choplin RH, Lenchik L, Wuertzer S (2014) A practical approach to interpretation of Dual-Energy X-ray Absorptiometry (DXA) for assessment of bone density. Curr Radiol Rep 2:48. https://doi.org/10.1007/s40134-014-0048-x

    Article  Google Scholar 

  22. Waltman N, Cole M, Kupzyk K, Lappe J, Mack L, Bilek L (2021) Promoting adherence to bone loading exercises in postmenopausal women with low bone mass. Journal of American Association of Nurse Practitioners. https://doi.org/10.1097/jXX.00000000000564

    Article  Google Scholar 

  23. Waltman NL, Twiss JJ, Ott CD, Gross GJ, Lindsey AM, Moore TE, Berg K, Kupzyk K (2010) The effect of weight training on bone mineral density and bone turnover in postmenopausal breast cancer survivors with bone loss: a 24-month randomized controlled trial. Osteoporos Int 21(8):1361–1369. https://doi.org/10.1007/s00198-009-1083-y

    CAS  Article  PubMed  Google Scholar 

  24. Siris ES, Simon JA, Barton P, McClung MR, Grauer A (2008) Effects of risedronate on fracture risk of postmenopausal women with osteopenia. Osteoporos Int 19:681–686. https://doi.org/10.1007/s00198-007-0493-y

    CAS  Article  PubMed  Google Scholar 

  25. Cefalu CA (2004) Is bone mineral density predictive of fracture risk reduction? Curr Med Res Opin 20(3):341–349

    Article  Google Scholar 

  26. Black DM, Schwartz AV, Ensrud KE et al (2006) Effects of continuing or stopping alendronate after 5 years of treatment: the fracture intervention trial long-term extension (FLEX): a randomized trial. JAMA 296:2927–2938

    CAS  Article  Google Scholar 

  27. Khosla, S. & Shane, E. (2016). A crisis in the treatment of osteoporosis. Journal of Bone and Mineral Research. 101002/jbmr.2888

  28. Jha S, Wang Z, Laucis N, Bhattacharyya T (2015) Trends in media reports, oral bisphosphonate prescriptions, and hip fractures 1996–2012: an ecological analysis. Bone Miner Res 30(12):2179–2187

    CAS  Article  Google Scholar 

  29. Garnero P, Hausherr E, Chapuy MC et al (1996) Markers of bone resorption predict hip fracture in elderly women: the EPIDOS prospective study. J Bone Miner Res 11(10):1541–1538. https://doi.org/10.1002/jbmr.5650111021

    Article  Google Scholar 

  30. Hlaing TT, Compston JE (2014) Biochemical markers of bone turnover–uses and limitations. The Association of Clinical Biochemistry & Laboratory medicine 51(2):189–202. https://doi.org/10.1177/000456321351515190

    Article  Google Scholar 

  31. Moayyeri A (2008) The association between physical activity and osteoporotic fractures: a review of the evidence and implications for future research. Ann Epidemiol 18(11):827–835. https://doi.org/10.1016/j.annepidem.2008.08.007

    Article  PubMed  Google Scholar 

  32. Varahra A, Rodrigues IB, MacDermid JC, Bryant D, Birmingham T (2018) Exercise to improve functional outcomes in persons with osteoporosis: a systematic review and meta-analysis. Osteoporos Int 29(2):265–286

    CAS  Article  Google Scholar 

  33. Abrahamsen B (2017) The calcium and vitamin D controversy. Therapeutic advances in musculoskeletal disease 9(5):107–114

    CAS  Article  Google Scholar 

  34. Tai V, Leung W, Grey A, Reid IR, Bolland MJ (2015) Calcium intake and bone mineral density: systematic review and meta-analysis. BMJ 351:h4183. https://doi.org/10.1136/bmjh4183

    Article  PubMed  PubMed Central  Google Scholar 

  35. Bolland MJ, Leung W, Tai V et al (2015) Calcium intake and risk of fracture: systematic review. BMJ 351:h4580. https://doi.org/10.1136/bmj.h4580

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  36. Murad MH, Elamin KB, Abu Elnour NO et al (2011) The effect of vitamin D on falls: a systematic review and meta-analysis. J Clin Endocrinol Metab 96(10):2997–3006

    CAS  Article  Google Scholar 

  37. Linnebur SA, Vondracek SF, Vande Griend JP, Ruscin JM, McDermott MT (2007) Prevalence of vitamin D insufficiency in elderly ambulatory outpatients in Denver. Colorado Am J Geriatr Pharmacother 5(1):1–8

    CAS  Article  Google Scholar 

  38. Beck TJ, Kohlmeier LA, Petit MA et al (2010) Cofounders in the Association between exercise and femur bone in postmenopausal women. Med Sci Sports Exerc 43(1):80–89

    Article  Google Scholar 

  39. Mai HT, Tran TS, Ho-Le TP, Center JR, Eisman JA, Nguyen TV (2019) Two-thirds of all fractures are not attributable to osteoporosis and advancing age: implications for fracture prevention. J Clin Endocrinol Metab 104:3514–3520

    Article  Google Scholar 

  40. Hurley B, Armstrong TJ (2012) Bisphosphonates vs exercise for the prevention and treatment of osteoporosis. The Journal for Nurse Practitioners 8(3):217–224. https://doi.org/10.1016/j.nurpra.2011.07.029

    Article  Google Scholar 

  41. NIH Osteoporosis and Related bone Diseases: National Resource Center (2018). Osteoporosis and Hispanic women. NIH Pub. No. 18–7924 https://www.bones.nih.gov

  42. Eastell R, Rosen CJ, Black DM, Cheung AM, Murad MH, Shoback D (2019) Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 104(5):1594–1622

    Article  Google Scholar 

Download references

Funding

Research reported in this publication was supported by the National Institute of Nursing Research of the National Institutes of Health under award number R01NR015029.

Author information

Authors and Affiliations

Authors

Contributions

All authors were involved in the implementation of this R01-funded study. All authors read and approved this final manuscript. Dr. Waltman1 developed the research project, wrote the initial draft of the manuscript, and assisted in analyzing and interpreting results of the study. Dr. Kevin Kupzyk2 was a co-investigator in the study, conducted the power analysis to determine sample size for the study, assisted in data analysis for this study, and reviewed and critiqued the final writing of this manuscript. Laura Flores3 provided valuable information on bone mineral density and bone structure during the analysis of study results and reviewed and critiqued the drafts of the manuscript. Dr. Lynn Mack4 and Dr. Joan Lappe5 were co-investigators for the study and assisted in designing and implementing the study. They reviewed and critiqued the final writing of this manuscript. Dr. Laura Bilek6 was co-principal investigator for the study. In addition to development of this research project, she participated in and supervised recruitment of subjects, data collection, and data entry for the study. She reviewed and critiqued the statistical analysis and the final writing for this manuscript.

Corresponding author

Correspondence to Nancy Waltman.

Ethics declarations

Conflicts of interest

None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Waltman, N., Kupzyk, K.A., Flores, L.E. et al. Bone-loading exercises versus risedronate for the prevention of osteoporosis in postmenopausal women with low bone mass: a randomized controlled trial . Osteoporos Int 33, 475–486 (2022). https://doi.org/10.1007/s00198-021-06083-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-021-06083-2

Keywords

  • Postmenopausal women
  • Low bone mass
  • Risedronate
  • Bone-loading exercises
  • Bone mineral density (BMD)
  • Bone formation and resorption