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Exercise for Female Osteoporosis

A Systematic Review of Randomised Clinical Trials

Summary

The treatment and prevention of osteoporosis in women represents an unresolved problem. The aim of this systematic review was to determine whether exercise can be useful in this context. Various literature searches identified 21 randomised controlled trials on the subject. These are highly diverse in more than one respect. Collectively, however, they strongly suggest that regular physical exercise can reduce the risk of osteoporosis and delay the physiological decrease of bone mineral density. It is concluded that regular exercise for women of practically all ages is well advised.

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References

  1. Riggs BL, Wahner HW, Melton LJ, et al. Rates of bone loss in appendicular and axial skeletons of women: evidence of substantial vertebral bone loss before menopause. J Clin Invest 1986; 77: 1487–91

    PubMed  Article  CAS  Google Scholar 

  2. Riggs BL, Wahner HW, Dunn WL, et al. Differential changes in bone mineral density of the appendicular and axial skeleton with aging. J Clin Invest 1981; 67: 328–35

    PubMed  Article  CAS  Google Scholar 

  3. Riggs BL, Wahner HW, Seeman E, et al. Changes in bone mineral density of the proximal femur and spine with aging: differences between the postmenopausal and senile osteoporosis syndromes. J Clin Invest 1982; 70: 716–23

    PubMed  Article  CAS  Google Scholar 

  4. Lindquist O, Bengtsson C, Hansson T, et al. Bone mineral content in relation to age and menopause in middle-aged women. Scand J Clin Lab Invest 1981; 41: 215–23

    PubMed  Article  CAS  Google Scholar 

  5. Nordin BEC, Need AG, Chatterton BE, et al. The relative contributions of age and years since menopause to postmenopausal bone loss. J Clin Endocrinol Metab 1990; 70: 83–8

    PubMed  Article  CAS  Google Scholar 

  6. Dixon. Health of the nation and osteoporosis. Ann Rheum Dis 1992; 51: 914–8

    PubMed  Article  CAS  Google Scholar 

  7. Riggs BL, Melton III L. The prevention and treatment of osteoporosis. N Engl J Med 1992; 327: 620–7

    PubMed  Article  CAS  Google Scholar 

  8. Law MR, Wald NJ, Meade TW. Strategies for prevention of osteoporosis and hip fracture. BMJ 1991; 303: 453–9

    PubMed  Article  CAS  Google Scholar 

  9. Ernst E. Can exercise prevent postmenopausal osteoporosis?. Br J Sports Med 1994; 28: 5–6

    PubMed  Article  CAS  Google Scholar 

  10. Aloia JF, Cohn SH, Ostuni JA, et al. Prevention of involutional bone loss by exercise. Ann Int Med 1978; 89: 356–8

    PubMed  CAS  Google Scholar 

  11. Smith EL, Gilligan C, McAdam M, et al. Deterring bone loss by exercise intervention in premenopausal and postmenopausal women. Calcif Tissue Int 1989; 44: 312–21

    PubMed  Article  CAS  Google Scholar 

  12. Rundgren Å, Aniansson A, Ljungberg P, et al. Effects of a training programme for elderly people on mineral content of the heel bone. Arch Gerontol Geriatr 1984; 3: 243–8

    PubMed  Article  CAS  Google Scholar 

  13. Recker RR, Saville PD, Heaney RP. Effect of estrogens and calcium carbonate on bone loss in postmenopausal women. Ann Intern Med 1977; 87: 649–55

    PubMed  CAS  Google Scholar 

  14. Lindsay R, Hart DM, Aitken JM, et al. Long-term prevention of postmenopausal osteoporosis by estrogen. Lancet 1976; I: 1038–41

    Article  Google Scholar 

  15. Rasmussen H, Bordier P, Marie P, et al. Effect of combined therapy with phosphate and calcitonin on bone volume in osteoporosis. Bone 1980; 2: 107–11

    CAS  Google Scholar 

  16. Gruber HE, Ivey JL, Baylink DJ, et al. Long-term calcitonin therapy in postmenopausal osteoporosis. Metabolism 1984; 33: 295–303

    PubMed  Article  CAS  Google Scholar 

  17. Gennari C, Chierichetti SM, Bigazzi S, et al. Comparative effects on bone mineral content of calcium and calcium plus salmon calcitonin given in two different regimens in postmenopausal osteoporosis. Curr Ther Res 1985; 38: 455–64

    Google Scholar 

  18. Gutin B, Kasper MJ. Can vigorous exercise play a role in osteoporosis prevention?. A review. Osteoporos Int 1992; 2: 55–69

    Article  CAS  Google Scholar 

  19. Drinkwater BL. Does physical activity play a role in preventing osteoprosis?. Res Q Exerc Sport 1994; 65: 197–206

    PubMed  CAS  Google Scholar 

  20. Schulz KF, Chalmers J, Hyes RJ, et al. Empirical evidence of bias. JAMA 1995; 273: 408–12

    PubMed  Article  CAS  Google Scholar 

  21. Sandler RB, Cauley JA, Hom DL, et al. The effects of walking on the cross-sectional dimensions of the radius in postmenopausal women. Calcif Tissue Int 1987; 41 (2): 65–9

    PubMed  Article  CAS  Google Scholar 

  22. Chow R, Harrison JE, Notarius C. Effect of two randomised exercise programmes on bone mass of healthy postmenopausal women. BMJ 1987; 295: 1441–4

    PubMed  Article  CAS  Google Scholar 

  23. Sinaki M, Wahner HW, Offord KP, et al. Efficacy of nonloading exercises in prevention of vertebral bone loss in postmenopausal women: a controlled trial. Mayo Clin Proc 1989; 64 (7): 762–9

    PubMed  CAS  Google Scholar 

  24. Notelovitz M, Martin D, Tesar R, et al. Estrogen therapy and variable-resistance weight training increase bone mineral in surgically menopausal women. J Bone Miner Res 1991; 6 (6): 583–90

    PubMed  Article  CAS  Google Scholar 

  25. Prince RL, Smith M, Dick IM, et al. Prevention of postmenopausal osteoporosis. A comparative study of exercise, calcium supplementation, and hormone-replacement therapy. N Engl J Med 1991; 325 (17): 1189–95

    PubMed  Article  CAS  Google Scholar 

  26. Lau EM, Woo J, Leung PC, et al. The effects of calcium supplementation and exercise on bone density in elderly Chinese women. Oseoporos Int 1992; 2 (4): 168–73

    Article  CAS  Google Scholar 

  27. Grove KA, Londeree BR. Bone density in postmenopausal women: high impact vs low impact exercise. Med Sci Sports Exerc 1992; 24 (11): 1190–4

    PubMed  CAS  Google Scholar 

  28. Snow-Harter C, Bouxsein ML, Lewis BT, et al. Effects of resistance and endurance exercise on bone mineral status of young women: A randomized exercise intervention trial. J Bone Miner Res 1992; 7 (7): 761–9

    PubMed  Article  CAS  Google Scholar 

  29. Smidt GL, Lin S-Y, O’Dwyer KD, et al. The effect of highintensity trunk exercise on bone mineral density of postmenopausal women. Spine 1992; 17: 280–5

    PubMed  Article  CAS  Google Scholar 

  30. Hatori M, Hasegawa A, Adachi H, et al. The effects of walking at the anaerobic threshold level on vertebral bone loss in postmenopausal women. Calcif Tissue Int 1993; 52 (6): 411–4

    PubMed  Article  CAS  Google Scholar 

  31. Revel M, Mayoux Benhamou MA, Rabourdin JP, et al. Oneyear psoas training can prevent lumbar bone loss in postmenopausal women: a randomized controlled trial. Calcif Tissue Int 1993; 53: 307–11

    PubMed  Article  CAS  Google Scholar 

  32. Nelson ME, Fiatarone MA, Morganti CM, et al. Effects of highintensity strength training on multiple risk factors for osteoporotic fractures: a randomized controlled trial. JAMA 1994; 272 (24): 1909–14

    PubMed  Article  CAS  Google Scholar 

  33. Lohman T, Going S, Pamenter R, et al. Effects of resistance training on regional and total bone mineral density in premenopausal women: a randomized prospective study. J Bone Miner Res 1995; 10 (7): 1015–24

    PubMed  Article  CAS  Google Scholar 

  34. Prince R, Devine A, Dick I, et al. The effects of calcium supplementation (milk powder or tablets) and exercise on bone density in postmenopausal women. J Bone Miner Res 1995; 10: 1068–75

    PubMed  Article  CAS  Google Scholar 

  35. Nichols JF, Nelson KP, Peterson KK, et al. Bone mineral density responses to high-intensity strength training in active older women. J Aging Phys Activity 1995; 3: 26–38

    Google Scholar 

  36. Bassey EJ, Ramsdale SJ. Weight-bearing exercise and ground reaction forces: a 12-month randomized controlled trial of effects on bone mineral density in healthy postmenopausal women. Bone 1995; 16 (4): 469–76

    PubMed  CAS  Google Scholar 

  37. Preisinger E, Alacamlioglu Y, Pils K, et al. Exercise therapy for osteoporosis: results of a randomised controlled trial. Br J Sports Med 1996; 30: 209–12

    PubMed  Article  CAS  Google Scholar 

  38. Heinonen A, Kannus P, Sievänen H, et al. Randomised controlled trial of effect of high-impact exercise on selected risk factors for osteoporotic fractures. Lancet 1996; 348: 1343–7

    PubMed  Article  CAS  Google Scholar 

  39. Bravo G, Gauthier P, Roy PM, et al. Impact of a 12-month exercise program on the physical and psychological health of osteopenic women. J Am Geriatr Soc 1996; 44 (7): 756–62

    PubMed  CAS  Google Scholar 

  40. McMurdo MET, Mole PA, Paterson CR. Controlled trial of weight bearing exercise in older women in relation to bone density and falls. BMJ 1997; 314: 569

    PubMed  Article  CAS  Google Scholar 

  41. Ebrahim S, Thompson PW, Baskaran V, et al. Randomized placebo-controlled trial of brisk walking in the prevention of postmenopausal osteoporosis. Age Ageing 1997; 26: 253–60

    PubMed  Article  CAS  Google Scholar 

  42. Ernst E. Exercise and heart failure. Eur J Phys Med Rehab 1997; 7: 1

    Google Scholar 

  43. Fiatarone MA, Marks EC, Ryan ND, et al. High intensity strength training in nonagenarians. JAMA 1990; 263: 3029–34

    PubMed  Article  CAS  Google Scholar 

  44. Kendall PH, Jenkins JM. Exercises for backache: a doubleblind controlled trial. Physiotherapy 1968; 54: 154–7

    Google Scholar 

  45. Lidström I, Öhlund C, Eek C, et al. The effect of graded activity on patients with subacute low back pain: A randomised prospective clinical study with an operant-conditioning behavioral approach. Phys Ther 1992; 72: 279–93

    Google Scholar 

  46. Manniche C, Hesselsoe G, Bentzen L, et al. Clinical trial of intensive muscle training for chronic low back pain. Lancet 1988; II: 1473–6

    Article  Google Scholar 

  47. Aloia JF, Cohn SH, Babu T, et al. Skeletal mass and body composition in marathon runners. Metabolism 1978; 27: 1793–6

    PubMed  Article  CAS  Google Scholar 

  48. Heinrich CH, Going SB, Pamenter RW, et al. Bone mineral content of cyclically menstruating female resistance and endurance trained athletes. Med Sci Sports Exerc 1990; 22: 558–63

    PubMed  Article  CAS  Google Scholar 

  49. Margulies JY, Simkin S, Leichter I, et al. Effect of intense physical activity on the bone-mineral content in the lower limbs of young adults. J Bone Joint Surg Am 1986; 68: 1090–3

    PubMed  CAS  Google Scholar 

  50. Risser BL, Lee EJ, Leblanc A, et al. Bone density in eumenorrheic female college athletes. Med Sci Sports Exerc 1990; 22: 570–4

    PubMed  Article  CAS  Google Scholar 

  51. Sinaki M, Mikkelsen BA. Postmenopausal spinal osteoporosis: Flexion versus extension exercises. Arch Phys Med Rehabil 1984; 65: 593–6

    PubMed  CAS  Google Scholar 

  52. Ascenzi A. The micromechanics versus the macromechanics of cortical bone — a comprehensive presentation. J Biomech Eng 1988; 110: 357–63

    PubMed  Article  CAS  Google Scholar 

  53. Frost HM. The mechanostat: a proposed pathogenic mechanism of osteoporoses and the bone mass effects of mechanical and nonmechanical agents. Bone Miner 1987; 2: 73–85

    PubMed  CAS  Google Scholar 

  54. Lanyon LE. Functional strain as a determinant for bone remodeling. Calcif Tissue Int 1984; 36: S56–61

    PubMed  Article  Google Scholar 

  55. Fukada E, Yasuda I. On the piezoelectric effect on bone. J Phys Soc Jap 1957; 12: 1158–62

    Article  Google Scholar 

  56. Basset CA, Becker RO. Generation of electric potentials by bone in response to mechanical stress. Science 1962; 137: 1063–4

    Article  Google Scholar 

  57. Frost HM. A new direction for osteoporosis research: a review and proposal. Bone 1991; 12: 429–37

    PubMed  Article  CAS  Google Scholar 

  58. Canalis E, McCarthy TL, Centrella M. Production, regulation and effects of bone growth factors. In: Christiansen C, Overgaad K, editors. Osteoporosis 1990. Copenhagen: Osteopress, 1990; 243–7

    Google Scholar 

  59. Jilka RL, Hangoc G, Girasole G, et al. Increased osteoclast development after estrogen loss: ediation by interleukin-6. Science 1992; 257: 88–91

    PubMed  Article  CAS  Google Scholar 

  60. Evans WJ, Meredith N, Cannon JG, et al. Metabolic changes following eccentric exercise in trained and untrained men. J Appl Physiol 1986; 61: 1864–8

    PubMed  CAS  Google Scholar 

  61. Kvernmo H, Olsen JO, Østerud B. Changes in blood cell response following strenuous physical exercise. Eur J Appl Physiol 1992; 64: 318–22

    Article  CAS  Google Scholar 

  62. Lanyon LE. Mechanisms in bone’s adaptive response to loadbearing. International Symposium on Physical Loading, Exercise and Bone; 1994; Tampere, Finland, 22

    Google Scholar 

  63. Bell N, Godsen RN, Henry DP, et al. The effects of musclebuilding exercise on vitamin D and mineral metabolism. J Bone Miner Res 1988; 3: 369–73

    PubMed  Article  CAS  Google Scholar 

  64. Dawson-Hughes B, Dallal GE, Krall E, et al. Effect of vitamin D supplementation on wintertime and overall bone loss in healthy postmenopausal women. Ann Int Med 1991; 115: 505–12

    PubMed  CAS  Google Scholar 

  65. Tilyard MW, Spears GFS, Thomson J, et al. Treatment of postmenopausal osteoporosis with calcitriol or calcium. N Engl J Med 1992; 326: 357–62

    PubMed  Article  CAS  Google Scholar 

  66. Lapidus L, Bengtsson C. Socioeconomic factors and physical activity in relation to cardiovascular disease and death: a 12- year follow up of participants in a population study of women in Gothenburg, Sweden. Br Heart J 1986; 55: 295–301

    PubMed  Article  CAS  Google Scholar 

  67. Kaplan GA, Seeman TE, Cohen RD, et al. Mortality among the elderly in the Alameda County Study: behavioral and demographic risk factors. Am J Public Health 1987; 77: 307–12

    PubMed  Article  CAS  Google Scholar 

  68. Blair SN, Kohl HW III, Paffenbarger III RS, et al. Physical fitness and all-cause mortality: a prospective study of healthy men and women. JAMA 1989; 262: 2395–401

    PubMed  Article  CAS  Google Scholar 

  69. Lee D, Markides KS. Activity and mortality among aged persons over an eight-year period. J Gerontol B Psychol Sci Soc Sci 1990; 45: S39–42

    CAS  Google Scholar 

  70. Rakowski W, Mor V. The association of physical activity with mortality among older adults in the Longitudinal Study of Aging (1984-1988). J Gerontol A Biol Sci Med Sci 1992; 47: M122–9

    CAS  Google Scholar 

  71. Chang-Claude JJ, Frentzel-Beyme R. Dietary and lifestyle determinants of mortality among German vegetarians. Int J Epidemiol 1993; 22: 228–36

    PubMed  Article  CAS  Google Scholar 

  72. Simonsick EM, Lafferty ME, Phillips CL, et al. Risk due to inactivity in physically capable older adults. Am J Public Health 1993; 83: 1443–50

    PubMed  Article  CAS  Google Scholar 

  73. Weyerer S. Effects of physical inactivity on all-cause mortality risk in Upper Bavaria. Percept Mot Skills 1993; 77: 499–505

    PubMed  Article  CAS  Google Scholar 

  74. Sherman SE, D’Agostino RB, Cobb JL, et al. Does exercise reduce mortality rates in the elderly? Experience from the Framington Heart Study. Am Heart J 1993; 83: 1443–50

    Google Scholar 

  75. Davis MA, Neuhaus JM, Moritz DJ, et al. Health behaviors and survival among middle-aged and older men and women in the NHANES I Epidemiologic Follow-up Study. Prev Med 1994; 23: 369–76

    PubMed  Article  CAS  Google Scholar 

  76. Sherman SE, D’Agostino RB, Cobb JL, et al. Physical activity and mortality in women in the Framington Heart Study. Am Heart J 1994; 128: 879–84

    PubMed  Article  CAS  Google Scholar 

  77. Mensink GBM, Deketh M, Mul MDM, et al. Physical activity and its association with cardiovascular risk factors and mortality. Epidemiology 1996; 7: 391–7

    PubMed  Article  CAS  Google Scholar 

  78. Kushi LH, Fee RM, Folsom AR, et al. Physical activity and mortality in postmenopausal women. JAMA 1997; 277 (16): 1287–92

    PubMed  Article  CAS  Google Scholar 

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Correspondence to Dr Edzard Ernst.

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Ernst, D.E. Exercise for Female Osteoporosis. Sports Med 25, 359–368 (1998). https://doi.org/10.2165/00007256-199825060-00002

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Keywords

  • Bone Mineral Density
  • Osteoporosis
  • Postmenopausal Woman
  • Bone Loss
  • Adis International Limited