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



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.


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.


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%.


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.

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Fig. 1

Data availability

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



Bone mineral density




Calcium and vitamin D supplements


Creighton University Osteoporosis Research Center


Dual-energy X-ray absorptiometry


Exercise trainers


Fracture risk assessment




Hip structural assessment




Lifting Intervention for Training Muscle and Osteoporosis Rehabilitation


National Osteoporosis Foundation


Peripheral quantitative computed tomography


One-repetition maximum


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

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Authors and Affiliations



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.

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Correspondence to Nancy Waltman.

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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).

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