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Exercise, muscle, and the applied load-bone strength balance

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Abstract

A fracture occurs when the applied load is greater than the bone can withstand. Clinical practice guidelines for the management of osteoporosis include recommendations for exercise; one of the few therapies where the proposed anti-fracture mechanisms that include effects on both bone strength and applied loads, where applied loads can come in the form of a fall, externally applied loads, body weight, or muscle forces. The aim of this review is to provide an overview of the clinical evidence pertaining to the potential efficacy of exercise for preventing fractures in older adults, including its direct effects on outcomes along the causal pathway to fractures (e.g., falls, posture, bone strength) and the indirect effects on muscle or the muscle-bone relationship. The evidence is examined as it pertains to application in clinical practice. Considerations for future research are discussed, such as the need for trials in individuals with low bone mass or students that evaluate whether changes in muscle mediate changes in bone. Future trials should also consider adequacy of calorie or protein intake, the confounding effect of exercise-induced weight loss, or the most appropriate therapeutic goal (e.g., strength, weight bearing, or hypertrophy) and outcome measures (e.g., fracture, disability, cost-effectiveness).

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Acknowledgments

The work was assisted with funding from the Ontario Ministry of Health and Long Term Care. L. Giangregorio is the recipient of the Bloomberg Manulife Prize for the Promotion of Active Health, a Canadian Institutes of Health Research New Investigator Award, and an Early Researcher Award from the Ontario Ministry of Research and Innovation.

Conflicts of interest

Dr. Giangregorio has received funding as a co-investigator from Amgen and has consulted for ICON on behalf of Eli Lilly on unrelated projects. Rasha El-Kotob declares that she has no conflict of interest.

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Authors and Affiliations

  1. Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada

    L. Giangregorio & R. El-Kotob

  2. Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada

    L. Giangregorio & R. El-Kotob

  3. Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, Canada

    L. Giangregorio

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  1. L. Giangregorio
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  2. R. El-Kotob
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Correspondence to L. Giangregorio.

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Giangregorio, L., El-Kotob, R. Exercise, muscle, and the applied load-bone strength balance. Osteoporos Int 28, 21–33 (2017). https://doi.org/10.1007/s00198-016-3780-7

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