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Exploring thoracic kyphosis and incident fracture from vertebral morphology with high-intensity exercise in middle-aged and older men with osteopenia and osteoporosis: a secondary analysis of the LIFTMOR-M trial

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Abstract

Summary

Our aim was to explore change in kyphosis and vertebral fracture incidence following 8 months of high-intensity resistance and impact training (HiRIT) or machine-based isometric axial compression (IAC) training in men with osteopenia and osteoporosis. HiRIT and IAC improved posture. HiRIT participants did not experience progression or incident vertebral fracture. IAC participants did experience progression and incident vertebral fracture.

Introduction

The Lifting Intervention For Training Muscle and Osteoporosis Rehabilitation for Men (LIFTMOR-M) trial examined efficacy and safety of an eight-month, supervised, high-intensity progressive resistance and impact training (HiRIT) program compared with machine-based isometric axial compression (IAC) training in middle-aged and older men with low areal bone mineral density (aBMD). The primary purpose of the current work was to explore change in thoracic kyphosis and incident fracture from vertebral morphology following eight-months of HiRIT or IAC training. The secondary purpose was to explore change in clinical kyphosis measures for HiRIT, IAC and a non-randomized, matched control group.

Methods

Men (≥ 45 yrs), with low aBMD, were recruited and randomized to HiRIT or IAC, or designated control. Clinical measures of thoracic kyphosis with inclinometry were determined. Cobb angle of kyphosis and vertebral fracture assessment using the Genant semi-quantitative method were determined from lateral thoracolumbar DXA (Medix DR, Medilink, France). Per-protocol (n = 40) and intention-to-treat (n = 93) analyses were conducted.

Results

Forty participants (HiRIT n = 20, IAC n = 20; 66.1 ± 7.8 yrs.; lumbar spine T-score − 0.1 ± 0.8; femoral neck T-score − 1.5 ± 0.5) underwent clinical kyphosis measures and thoracolumbar DXA at baseline and follow-up. No between-group differences were detected in kyphosis change, however, within-group improvements in neutral (HiRIT − 2.3 ± 0.8°; IAC − 2.5 ± 0.8°) and ‘standing tall’ (HiRIT − 2.4 ± 0.8°; IAC − 2.0 ± 0.8°) postures were observed (p < 0.05). HiRIT improved Cobb angle (− 3.5 ± 1.5°, p = 0.027) from baseline. Over the 8 months, no incident vertebral fractures nor progression of prevalent vertebral fractures occurred for HiRIT participants. Five incident fractures of thoracic vertebrae occurred for IAC and one wedge fracture progressed. Ninety-three participants underwent clinical kyphosis measures at both time-points (HiRIT n = 34, IAC n = 33, control n = 26). HiRIT exhibited a reduction in ‘standing tall’ kyphosis compared to control (− 2.3 ± 0.6° versus 1.4 ± 0.7°, p < 0.05), but no other between-group differences were detected.

Conclusions

Although there was no difference in change between intervention groups, thoracic kyphosis appeared to improve in both HiRIT and IAC with exercise exposure. HiRIT improved 'standing tall' posture in comparison to usual activities. HiRIT was not associated with vertebral fracture progression or incident vertebral fracture, but for some IAC participants there was evidence of progression of vertebral fracture severity and incident vertebral fractures, in our small sample. Larger trials are required to confirm the observations of the current work, which was exploratory in nature.

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Acknowledgements

The authors wish to thank the participants who took part in the study for their valuable contribution, Sports Medicine Australia for its support for exercise equipment, and Osteoporosis Australia for the bioDensity™ equipment grant.

Registration

Australian New Zealand Clinical Trials Registry (#12616000344493).

Protocol

Harding AT, Weeks BK, Watson SL, Beck BR. The LIFTMOR–M (Lifting Intervention For Training Muscle and Osteoporosis Rehabilitation for Men) trial: Protocol for a semi-randomized controlled trial of supervised targeted exercise to reduce risk of osteoporotic fracture in older men with low bone mass. BMJ Open (Rehabilitation Medicine), 2017, 7 (e014951).

Funding

Performance Health Systems (Northbrook, IL, USA) supplied and installed the bioDensity™ isometric exercise machine through an equipment grant brokered by Osteoporosis Australia. The authors wish to acknowledge the support of the 2016 Sports Medicine Australian Research Foundation Grant for the purchase of HiRIT training equipment, and the Australian Government Research Training Program Scholarship support of Amy T Harding and Conor Lambert. The above funding sources had no role in the study design, analysis or interpretation of data, or in writing the manuscript.

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Authors and Affiliations

  1. Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia

    A. T. Harding, B. K. Weeks, C. Lambert, S. L. Watson & B. R. Beck

  2. School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, 4222, Australia

    A. T. Harding, B. K. Weeks, C. Lambert, S. L. Watson & B. R. Beck

  3. The Bone Clinic, Brisbane, Queensland, Australia

    L. J. Weis & B. R. Beck

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  1. A. T. Harding
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Correspondence to B. R. Beck.

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Belinda R. Beck is a Director of The Bone Clinic, Brisbane, QLD, Australia. Amy T. Harding, Conor Lambert, Steven L. Watson and Benjamin K. Weeks declare that they have no conflicts of interest.

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Harding, A.T., Weeks, B.K., Lambert, C. et al. Exploring thoracic kyphosis and incident fracture from vertebral morphology with high-intensity exercise in middle-aged and older men with osteopenia and osteoporosis: a secondary analysis of the LIFTMOR-M trial. Osteoporos Int 32, 451–465 (2021). https://doi.org/10.1007/s00198-020-05583-x

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