Bone geometry in response to long-term tennis playing and its relationship with muscle volume: a quantitative magnetic resonance imaging study in tennis players

The Lichfield bone study: the skeletal response to exercise in healthy young men

The skeletal response to short-term exercise training remains poorly described. We thus studied the lower limb skeletal response of 723 Caucasian male army recruits to a 12-wk training regime. Femoral bone volume was assessed using magnetic resonance imaging, bone ultrastructure by quantitative ultrasound (QUS), and bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) of the hip. Left hip BMD increased with training (mean ± SD: 0.85 ± 3.24, 2.93 ± 4.85, and 1.89 ± 2.85% for femoral neck, Ward's area, and total hip, respectively; all P < 0.001). Left calcaneal broadband ultrasound attenuation rose 3.57 ± 0.5% (P < 0.001), and left and right femoral cortical volume by 1.09 ± 4.05 and 0.71 ± 4.05%, respectively (P = 0.0001 and 0.003), largely through the rise in periosteal volume (0.78 ± 3.14 and 0.59 ± 2.58% for right and left, respectively, P < 0.001) with endosteal volumes unchanged. Before training, DXA and QUS measures were independent of limb dominance. However, the dominant femur had higher periosteal (25,991.49 vs. 2,5572 mm(3), P < 0.001), endosteal (6,063.33 vs. 5,983.12 mm(3), P = 0.001), and cortical volumes (19,928 vs. 19,589.56 mm(3), P = 0.001). Changes in DXA, QUS, and magnetic resonance imaging measures were independent of limb dominance. We show, for the first time, that short-term exercise training in young men is associated not only with a rise in human femoral BMD, but also in femoral bone volume, the latter largely through a periosteal response.

Obstacles in the optimization of bone health outcomes in the female athlete triad

Maintaining low body weight for the sake of performance and aesthetic purposes is a common feature among young girls and women who exercise on a regular basis, including elite, college and high-school athletes, members of fitness centres, and recreational exercisers. High energy expenditure without adequate compensation in energy intake leads to an energy deficiency, which may ultimately affect reproductive function and bone health. The combination of low energy availability, menstrual disturbances and low bone mineral density is referred to as the 'female athlete triad'. Not all athletes seek medical assistance in response to the absence of menstruation for 3 or more months as some believe that long-term amenorrhoea is not harmful. Indeed, many women may not seek medical attention until they sustain a stress fracture. This review investigates current issues, controversies and strategies in the clinical management of bone health concerns related to the female athlete triad. Current recommendations focus on either increasing energy intake or decreasing energy expenditure, as this approach remains the most efficient strategy to prevent further bone health complications. However, convincing the athlete to increase energy availability can be extremely challenging. Oral contraceptive therapy seems to be a common strategy chosen by many physicians to address bone health issues in young women with amenorrhoea, although there is little evidence that this strategy improves bone mineral density in this population. Assessment of bone health itself is difficult due to the limitations of dual-energy X-ray absorptiometry (DXA) to estimate bone strength. Understanding how bone strength is affected by low energy availability, weight gain and resumption of menses requires further investigations using 3-dimensional bone imaging techniques in order to improve the clinical management of the female athlete triad.

The effect of previous conditioning exercise on diaphyseal and metaphyseal bone to imposition and withdrawal of training in young Thoroughbred horses

This study recorded the response to training of the diaphysis of the proximal phalangeal bone and the third metacarpal bone (Mc3) and the Mc3 proximal metaphysis. Nineteen 2- and 3-year old horses in training were exposed either to spontaneous exercise at pasture (PASTEX group) or additional imposed exercise (CONDEX group) from a very young age. Quantitative computed tomography scans were analysed for bone mineral content, size, bone mineral density, periosteal and endosteal circumference, cortical thickness and an estimate of bone strength. The bones of the CONDEX horses were bigger and stronger than those of the PASTEX horses at the start of the observation period, and these differences were maintained after adjusting for training workload. Increase in the bone strength index was through size and not density increase. Density increased during training and decreased during paddock rest between the two training campaigns, during which time bone strength continued to increase because of the slow growth that was still occurring. The greatest variance in the response to the training exercise of diaphyseal bone mineral content, bone strength index or cortical thickness was associated with the cumulative workload index at the gallop, although statistically significant unexplained variances remained. There were no differences in bone response to training, with the exception of the endosteal circumference at 55% of the Mc3 length from the carpometacarpal joint space between CONDEX and PASTEX, which indicated that young horses may be able to be exercised slightly more vigorously than currently accepted.

Positive influence of long-lasting and intensive weight-bearing physical activity on hip structure of young adults

The aim was to analyze the associations between high-intensity and long-lasting weight-bearing sports with hip structure in young adults. One hundred and seventy-two subjects aged 17-28 yr were divided into 4 groups: 40 athlete women (10.2 ± 2.2 h/wk), 30 control women, 67 athlete men (11.4 ± 3.6 h/wk), and 35 control men. The nondominant femur, lumbar spine, and whole body were scanned by dual-energy X-ray absorptiometry to assess bone mineral content (BMC) and bone mineral density (BMD). Hip structure analysis (HSA) software was applied to evaluate cross-sectional area, cross-sectional moment of inertia, and section modulus at the femoral neck, intertrochanter, and femoral shaft regions. All the BMC and BMD values were significantly higher in athletes of both sexes compared with controls (p < 0.05). Most of the hip structural parameters were significantly higher (p < 0.05) in athletes compared with controls. Most of the differences were maintained after adjustments for height, weight, and calcium intake. Positively significant correlations were observed between HSA parameters and physical activity variables in both sexes (r > 0.32; p < 0.05). Partial correlation suggested that the hours of practice appeared to have a greater influence than the years of practice on hip bone geometry. These results suggest that external mechanical loading is a strong determinant of hip bone structure when weight-bearing physical activity is commenced before puberty and maintained during adulthood.

Fracture risk in children with a forearm injury is associated with volumetric bone density and cortical area (by peripheral QCT) and areal bone density (by DXA)

Children who sustain a forearm fracture when injured have lower bone density throughout their skeleton, and have a smaller cortical area and a lower strength index in their radius. Odds ratios per SD decrease in bone characteristics measured by peripheral quantitative computed tomography (pQCT) and dual-energy X-ray absorptiometry (DXA) were similar (1.28 to 1.41).

INTRODUCTION

Forearm fractures are common in children. Bone strength is affected by bone mineral density (BMD) and bone geometry, including cross-sectional dimensions and distribution of mineral. Our objective was to identify bone characteristics that differed between children who sustained a forearm fracture compared to those who did not fracture when injured.

METHODS

Children (5-16 years) with a forearm fracture (cases, n = 224) and injured controls without fracture (n = 200) were enrolled 28 ± 8 days following injury. Peripheral QCT scans of the radius (4% and 20% sites) were obtained to measure volumetric BMD (vBMD) of total, trabecular and cortical bone compartments, and bone geometry (area, cortical thickness, and strength strain index [SSI]). DXA scans (forearm, spine, and hip) were obtained to measure areal BMD (aBMD) and bone area. Receiver operating characteristic (ROC) analyses were used to assess screening performance of bone measurements.

RESULTS

At the 4% pQCT site, total vBMD, but not trabecular vBMD or bone area, was lower (-3.4%; p = 0.02) in cases than controls. At the 20% site, cases had lower cortical vBMD (-0.9%), cortical area (-2.8%), and SSI (-4.6%) (p < 0.05). aBMD, but not bone area, at the 1/3 radius, spine, and hip were 2.7-3.3% lower for cases (p < 0.01). Odds ratios per 1 SD decrease in bone measures (1.28-1.41) and areas under the ROC curves (0.56-0.59) were similar for all bone measures.

CONCLUSIONS

Low vBMD, aBMD, cortical area, and SSI of the distal radius were associated with an increased fracture risk. Interventions to increase these characteristics are needed to help reduce forearm fracture occurrence.

The female athlete

Over time, women have become more extensively involved in athletic programs. The female athlete presents a unique challenge to sports medicine in general. Although specific types of injuries are the same as in the male athlete, the female athlete is at higher risk for some of these injuries. Injuries may be sport specific, but gender-related injuries are also related to morphologic and physiologic differences between the male and female athlete. This article reviews some of the differences between the male and female athlete and focuses on a few prominent injuries or risks related specifically to the woman athlete.

Distal radius geometry and skeletal strength indices after peripubertal artistic gymnastics

Development of optimal skeletal strength should decrease adult bone fragility. Nongymnasts (NON): were compared with girls exposed to gymnastics during growth (EX/GYM: ), using peripheral quantitative computed tomography (pQCT) to evaluate postmenarcheal bone geometry, density, and strength. Pre- and perimenarcheal gymnastic loading yields advantages in indices of postmenarcheal bone geometry and skeletal strength.

INTRODUCTION

Two prior studies using pQCT have reported bone density and size advantages in Tanner I/II gymnasts, but none describe gymnasts' bone properties later in adolescence. The current study used pQCT to evaluate whether girls exposed to gymnastics during late childhood growth and perimenarcheal growth exhibited greater indices of distal radius geometry, density, and skeletal strength.

METHODS

Postmenarcheal subjects underwent 4% and 33% distal radius pQCT scans, yielding: 1) vBMD and cross-sectional areas (CSA) (total bone, compartments); 2) polar strength-strain index; 3) index of structural strength in axial compression. Output was compared for EX/GYM: vs. NON: , adjusting for gynecological age and stature (maturity and body size), reporting means, standard errors, and significance.

RESULTS

Sixteen postmenarcheal EX/GYM: (age 16.7 years; gynecological age 3.4 years) and 13 NON: (age 16.2 years; gynecological age 3.6 years) were evaluated. At both diaphysis and metaphysis, EX/GYM: exhibited greater CSA and bone strength indices than NON; EX/GYM: exhibited 79% larger intramedullary CSA than NON: (p < 0.05). EX/GYM: had significantly higher 4% trabecular vBMD; differences were not detected for 4% total vBMD and 33% cortical vBMD.

CONCLUSIONS

Following pre-/perimenarcheal gymnastic exposure, relative to nongymnasts, postmenarcheal EX/GYM: demonstrated greater indices of distal radius geometry and skeletal strength (metaphysis and diaphysis) with greater metaphyseal trabecular vBMD; larger intramedullary cavity size was particularly striking.

Mild exercise early in life produces changes in bone size and strength but not density in proximal phalangeal, third metacarpal and third carpal bones of foals

Exercise or lack of it in early life affects chondro-osseous development. Two groups of horses were used to investigate the effects of age and exercise regimen on bone parameters of diaphyseal, metaphyseal, epiphyseal and cuboidal bones of the distal limb of Thoroughbreds. One group had exercised only spontaneously from an early age at pasture (PASTEX group), while the other group of horses were exposed to a 30% greater workload through additional defined exercise (CONDEX). Longitudinal data from peripheral quantitative computed tomography (pQCT) were obtained from eight scan sites of the left forelimb (proximal phalangeal (P(p); 1 site), third metacarpal (Mc3; six sites) and third carpal (C(3); one site) bones) of 32 Thoroughbred foals scanned five times from ∼3 weeks to 17 months of age. The primary outcome measures were bone mineral content (BMC), bone area (BA), and periosteal circumference (Peri C) in diaphyseal bone, with cortical thickness (CortTh), volumetric bone mineral density (BMD(v)) and a bone strength index (SSI) also being analysed. At the P(p) site within the model there was a significant effect (P=0.00-0.025) of conditioning exercise increasing bone parameters, except endosteal circumference (Endo C) and BMD(v). The BMC, BA, and SSI of P(p) were significantly greater in the CONDEX than PASTEX groups at 12 and 17 months (P=0.015-0.042) and CortTh at 17 months (P=0.033). At the M55 site of Mc3 BMC, BA and SSI (P=0.02-0.04), and at the M33 site, SSI (P=0.05) were higher in the CONDEX than PASTEX group. The adaptive responses, consistent with diaphyseal strengthening, were more marked in the diaphysis of P(p) than Mc3. In the Mc3, metaphysis, trabecular BMD(v) was less in the CONDEX than PASTEX group, associated with greater bone mineral accretion in the outer cortical-sub-cortical bone in the CONDEX group. There were no significant between-group differences in any epiphyseal or cuboidal bone parameter. Although the early imposed exercise regimen was not intensive, it had significant effects on diaphyseal bone strength, through change in size but not bone density.

'Putting flesh back onto the bones?' Can we predict soft tissue properties from skeletal and fossil remains?

Estimates of muscle and other soft tissue properties derived from hominin skeletal and fossil remains would greatly enhance descriptions of body size and shape, and prior physical and metabolic capabilities. Presently, the utility of this approach is uncertain given the complex nature of the relationship between muscle and bone. To address various principal issues, peripheral quantitative computed tomography (pQCT) imaging was used to quantify these relationships at the midshaft of the arm, forearm, and lower leg of modern human athletes (runners, field hockey players, swimmers, and cricketers) and control subjects. Given the presumed behavior patterns of prehistoric hominins, the inclusion of highly active human participants was required. Soft tissue and muscle area was compared with bone area, diaphyseal shape, and torsional rigidity. Relationships were found between muscle area and bone area in the arm, and muscle area and torsional rigidity in the forearm. However, the high standard error and prediction error that define these relationships indicate that muscle or other soft tissue predictions derived from hominin fossil or skeletal remains would be untenable. In the tibia, the relationship between soft tissue properties and bone properties were primarily explained by covariation with body size. While the strength of the muscle-bone relationships in the arm and forearm vary among athletes and control subgroups, it appears that habitual upper limb loading performed throughout adolescence neither strengthens nor weakens this relationship. Future attempts to estimate soft tissue properties from osseous tissue may be improved through the use of medical CT or MRI to image complete limb segments and isolate individual muscles.

Cancellous bone adaptation to tibial compression is not sex dependent in growing mice

Mechanical loading can be used to increase bone mass and thus attenuate pathological bone loss. Because the skeleton's adaptive response to loading is most robust before adulthood, elucidating sex-specific responses during growth may help maximize peak bone mass. This study investigated the effect of sex on the response to controlled, in vivo mechanical loading in growing mice. Ten-week-old male and female C57Bl/6 mice underwent noninvasive compression of the left tibia. Peak loads of -11.5 N were applied, corresponding to +1,200 microepsilon at the tibial midshaft in both sexes. Cancellous bone mass, architecture, and dynamic formation in the proximal metaphysis were compared between loaded and control limbs via micro-computed tomography and histomorphometry. The strain environment of the proximal metaphysis during loading was characterized using finite element analysis. Both sexes responded to tibial compression through increased bone mass and altered architecture. Cancellous bone mass and tissue density were enhanced in loaded limbs relative to control limbs in both sexes through trabecular thickening and reduced separation. Changes in mass were due to increased cellular activity in loaded limbs compared with control limbs. Adaptation to loading increased the proportion of load transferred by the cancellous bone in the proximal metaphysis. For all cancellous measures, the response to tibial compression did not differ between male and female mice. When similar strains are engendered in males and females, the adaptive response in cancellous bone to mechanical loading does not depend on sex.

Computed tomographic measurements of thigh muscle cross-sectional area and attenuation coefficient predict hip fracture: the health, aging, and body composition study

Fatty infiltration of muscle, myosteatosis, increases with age and results in reduced muscle strength and function and increased fall risk. However, it is unknown if increased fatty infiltration of muscle predisposes to hip fracture. We measured the mean Hounsfield unit (HU) of the lean tissue within the midthigh muscle bundle (thigh muscle HU, an indicator of intramuscular fat), its cross-sectional area (CSA, a measure of muscle mass) by computed tomography (CT), bone mineral density (BMD) of the hip and total-body percent fat by dual X-ray absorptiometry (DXA), isokinetic leg extensor strength, and the Short Physical Performance Battery (SPPB) in 2941 white and black women and men aged 70 to 79 years. Sixty-three hip fractures were validated during 6.6 years of follow-up. Proportional hazards regression analysis was used to assess the relative risk (RR) of hip fracture across variations in thigh muscle attenuation, CSA, muscle strength, and physical function for hip fracture. In models adjusted by age, race, gender, body mass index, and percentage fat, decreased thigh muscle HU resulted in increased risk of hip fracture [RR/SD = 1.58; 95% confidence interval (CI) 1.10-1.99], an association that continued to be significant after further adjustment for BMD. In models additionally adjusted by CSA, muscle strength, and SPPB score, decreased thigh muscle HU but none of the other muscle parameters continued to be associated with an increased risk of hip fracture (RR/SD = 1.42; 95% CI 1.03-1.97). Decreased thigh muscle HU, a measure of fatty infiltration of muscle, is associated with increased risk of hip fracture and appears to account for the association between reduced muscle strength, physical performance, and muscle mass and risk of hip fracture. This characteristic captures a physical characteristic of muscle tissue that may have importance in hip fracture etiology.

Throwing induces substantial torsional adaptation within the midshaft humerus of male baseball players

Athletes participating in unilateral dominant sports are useful models for investigating skeletal responses to mechanical loading as they provide controlled evidence in the absence of completing a randomized controlled trial. Throwing athletes may be an additional model for this purpose as they overload their dominant upper extremity enabling the contralateral side to act as an internal control and load the bones of the upper extremity purely via the generation of internal (i.e. muscular) forces without superposition of externally applied loads (i.e. impact with an external object). The aim of this study was to investigate upper extremity bone adaptation in throwing athletes and explore factors that predict this adaptation. Two cohorts were recruited-male baseball players (throwers; n=15) and matched controls (controls; n=15). Each subject was assessed for shoulder range and strength, and upper extremity bone mass, structure and estimated strength. Throwers had substantially greater skeletal differences between their dominant and nondominant upper extremities than controls, indicating that throwing induces greater adaptation than induced by habitual loading of the dominant upper extremity. Bone adaptation in throwers was localized to the humerus, with the midshaft humerus in the dominant upper extremity of throwers having enhanced bone mass, structure and estimated strength. The largest effect was for estimated strength of the midshaft humerus which had 30% greater polar moment of inertia (I(P)) in throwers and suggests adaptation to resist torsional loads. The skeletal effect of throwing at the midshaft humerus was influenced by playing position with pitchers and catchers displaying greater dominant-to-nondominant differences than fielders, and was predicted by years throwing and dominant-to-nondominant difference in upper arm lean cross-sectional area. The latter two variables explained 67% of the variance in dominant-to-nondominant differences in I(P). Collectively, these data indicate that throwing induces substantial adaptation within the midshaft humerus. Adaptation was primarily in the direction of torsion which is consistent with biomechanical and injury data suggesting throwing introduces high magnitude torsional forces. As the magnitude of adaptation in throwers was equivalent to that observed in athletes participating in other unilateral dominant sports, throwers represent an alternative model for investigating the skeletal effects of mechanical loading.

Does the demand for asymmetric functional lower body postures in lateral sports relate to structural asymmetry of the pelvis?

Pelvic asymmetry has been thought to alter body mechanics and result in increased strain on bony and soft tissues possibly producing asymmetrical skeletal adaptations. The purpose of the present study was to determine if there is a greater prevalence of pelvic skeletal asymmetry in athletes who participate in a sport that requires a lateral dominance combined with increased spinal flexion and rotation. This is a descriptive laboratory study using a cross-sectional design. Sixty healthy female university age elite athletes and non-athletes participated in the study. The height and width of the anterior superior iliac spine (ASIS) and posterior superior iliac spine (PSIS) were measured using an electromagnetic tracking device with stylus. Using these measures a pelvic asymmetry ratio (PAR) was calculated for each athlete based on the difference in slope between the two ASIS and between the two PSIS. PAR was first assessed as a continuous variable to determine any differences in range of asymmetry between groups. All athletes were then assessed for prevalence of asymmetry as defined by a PAR score greater than 0.05. The results showed that there was a significant group effect in the magnitude and prevalence of asymmetry, with the lateral dominant group having significantly more of both. This study demonstrates that potentially there is an association between the asymmetrical nature of lateral dominant sports and pelvic skeletal asymmetry. However, there are possibly two confounding variables in age of initial participation and presence of low back pain that require further exploration.

Long-term rugby practice enhances bone mass and metabolism in relation with physical fitness and playing position

We attempted to clarify whether rugby was able to enhance bone mineral density (BMD) and content (BMC) of weight-bearing bones by modifying bone remodelling in relation to physical fitness in male rugby players compared to controls. 22 male international rugby players aged 20-31 years (forwards, n = 12 and backs, n = 10) were compared to 14 age-matched controls of the same ethnic origin aged 21-33 years. BMD and BMC were measured by DEXA and bone metabolism was evaluated by specific makers. Physical fitness level was analysed in parallel. Both forwards and backs exhibited significantly higher BMD (+15%, +6%, respectively) and BMC (+36%, +18%, respectively) for whole body and all examined sites, regions and segments than controls, with more pronounced difference at forwards. The difference between both groups of rugby players and controls noted for BMD became more pronounced for BMC (+52% for lower limbs). BMD and BMC values were higher in forwards than backs at total body (+9, +16%) and at stressed sites such as spine (+12%, +13%), pelvis (+10%, +11%), upper (+17% for BMC) and lower limbs (+9%, +18%). Athletes, especially forwards, presented higher concentrations of OC and CTX resulting in positive values of the uncoupling index. Total body lean mass as well as muscular strength strongly correlated with total and stressed regional sites such as spine, pelvis, and lower limbs BMD and BMC (r = 0.59, p < 0.01 to r = 0.84, p < 0.001). Similarly, OC, but not CTX, is highly correlated with the same regional and total BMD and BMC (r = 0.67 to r = 0.81, p < 0.001). Rugby participation is associated with improved physical fitness, enhanced axial and appendicular bone mass and increased bone turnover in adult athletes. Moreover, the positive bone adaptation of these athletes may be related to an increase of bone remodelling rate in favour of bone formation, especially in forwards.

Weight-bearing bones are more sensitive to physical exercise in boys than in girls during pre- and early puberty: a cross-sectional study

We carried out a cross-section study of the sex-specific relationship between bone mineral content and physical activity at sites with different loading in pre- and early pubertal girls and boys. There was significant sensitivity of bone mineral content of the hip to physical exercise in boys, but not in girls.

BACKGROUND

Since little is known whether there are sex differences in sensitivity of bone to loading, we investigated sex differences in the cross-sectional association between measures of physical activity (PA) and bone mass and size in pre- and early pubertal children of both sexes.

METHODS

We measured bone mineral content/density (BMC/BMD) and fat-free mass (FFM) in 269 6- to 13-year-old children from randomly selected schools by dual-energy X-ray absorptiometry. Physical activity (PA) was measured by accelerometers and lower extremity strength by a jump-and-reach test.

RESULTS

Boys (n = 128) had higher hip and total body BMC and BMD, higher FFM, higher muscle strength and were more physically active than girls (n = 141). Total hip BMC was positively associated with time spent in total and vigorous PA in boys (r = 0.20-0.33, p < 0.01), but not in girls (r = 0.02-0.04, p = ns), even after adjusting for FFM and strength. While boys and girls in the lowest tertile of vigorous PA (22 min/day) did not differ in hip BMC (15.62 vs 15.52 g), boys in the highest tertile (72 min/day) had significantly higher values than the corresponding girls (16.84 vs 15.71 g, p < 0.05).

CONCLUSIONS

Sex differences in BMC during pre- and early puberty may be related to a different sensitivity of bone to physical loading, irrespective of muscle mass.

Whole bone geometry and bone quality in distal forearm fracture

Fracture of the distal radius is a sentinel for future increased risk of other "osteoporotic" fractures, in which the peak age for incidence of distal radius fracture is 5 to 10 years before that for spine and hip fractures. Mean bone mineral density (BMD) of the distal radius was lower in patients with osteoporosis compared with age- and sex-matched normal subjects. However, it has been shown that to predict the strength of the distal radius at the site where fractures occur requires more than measurement of bone mineral content (BMC) or BMD. Only moderate correlations have been found between forearm sites, which may be a result of differences in bone composition between sites. Different forearm sites may be used interchangeably for diagnostic purposes, but the prognostic value is not known. Using the distal radius as a screening tool for identifying individuals at risk of "osteoporotic" fracture shows that forearm site selection and accuracy of measurement can be important confounders in group studies.Improving resolution of computed tomography (CT) scanners has enabled quantitation of cortical bone density and cortical thickness. These measurements have enabled the mechanism of bone loss in the distal radius to be elucidated and show that, after menopause, bone loss is primarily through thinning of the cortex. CT imaging allows the precise localization of bone changes in individuals and should be of value in the assessment of the severity of osteoporosis. It also shows that this technology has the potential to determine the efficacy of therapeutic interventions. A concerted effort has been made to elucidate the interrelationships between the amount of bone and the geometry and that clinical imaging of BMC and/or cross-sectional area in the radius would provide improved prediction of an individual's risk of fracture.The technological tools are available, in the clinic, to accurately measure the 3-dimensional (3D) geometry of the distal radius and the amount of bone. In addition, the cortical and cancellous bone compartments can be analyzed separately. This capability, along with the easy accessibility of the distal radius to clinical imaging modalities, provides an excellent framework for longitudinal prospective studies to determine morphologic risk factors for osteoporotic fractures of the distal radius.

The bone-muscle ratio of fetal lambs is affected more by maternal nutrition during pregnancy than by maternal size

Bone formation and loss are related to the strain imposed on bone by muscle forces. Bone mineral content (BMC) and lean mass (LM) of fetal lambs was determined at day 140 of pregnancy in 8 groups of ewes, which were of either large or small body size, on either high (ad libitum) or maintenance pasture intake from day 21 of pregnancy, or carrying either singletons or twins. BMC and LM (using DXA scanning) of fetal hindquarters/spine were corrected to leg length. BMC and LM were less in twin than singleton groups (P < 0.001). Large ewes on high intake produced single fetuses with a (group mean) BMC/LM ratio that was higher (P < 0.002) than that in fetuses of large ewes with singletons on maintenance intake or twins on either high or maintenance intakes, the ratios of which were not different. In single fetuses from small ewes on high intake, the BMC/LM ratio was higher than those from small ewes with singletons on maintenance intake or twins on either high or maintenance intakes, the ratios of which were not different. The ratio was not different in singleton fetuses of ewes on high intake, whether they were large or small. Different fetal environments resulted in a given amount of muscle being associated with a higher or lower bone mass. Dietary intake during pregnancy was more important than maternal size in affecting the ratio. We conclude that intrauterine environmental factors may be important in determining bone mass postnatally, and possibly later in life.

Similar effects of long-term exogenous growth hormone (GH) on bone and muscle parameters: a pQCT study of GH-deficient and small-for-gestational-age (SGA) children

BACKGROUND AND AIMS

Treatment with GH in short children has focused on height development. Little is known about the concomitant changes in muscle mass, bone structure and bone strength.

METHODS

Muscle area as well as parameters of bone architecture (bone mineral content, BMC; volumetric cortical density, total bone area, TBA; cortical area, cortical thickness, CT; and marrow area) were measured by means of pQCT (Stratec) at 65% of the proximal length of the forearm. The strength-strain index (SSI) was calculated as an indicator of bone strength.

RESULTS

Prepubertal children with GHD (mean values: age; 7.2 years; height SDS=-2.9 SDS; GH dose: 30 microg/kg/d) were followed at 0, 6, 12 (n=74) and 24 (n=55) months. Prepubertal children with SGA (mean values: age: 7.1 years; height SDS=-3.4 SDS; GH dose: 55 mug/kg/d) were followed at 0, 6, 12 (n=47) and 24 (n=35) months. Both groups showed a similar increase in height. At GH start, muscle mass and bone characteristics were lower than normal but similar in SGA vs. GHD. Muscle area (mean values, SDS) increased from -3.0 to -1.5 in SGA and from -2.4 to -1.0 in GHD. Bone geometry changed in a biphasic mode, with an increase in total bone area and lowering of bone mineral content (BMC) during the first 12 months, followed by an increase of BMC and CT thereafter. SSI (mean values, mm(3)) improved from 78 to 114 in GHD and from 62 to 101 in SGA after 24 months on GH. The increment in terms of SDS did not reach significance in SGA. SSI correlated positively with muscle area before and during GH treatment.

CONCLUSIONS

Bone strength and muscle mass are impaired in prepubertal children with GHD and SGA. Exogenous GH can indirectly improve bone structure and strength by inducing an increase in muscle mass. Our findings support the assumption that, in SGA, there is impaired tissue responsiveness to GH.

The role of physical activity in bone health: a new hypothesis to reduce risk of vertebral fracture

Locomotion has always been a major criterion for human survival. Thus, it is no surprise that science supports the dependence of bone health on weight-bearing physical activities. The effect of physical activity on bone is site-specific. Determining how to perform osteogenic exercises, especially in individuals who have osteopenia or osteoporosis, without exceeding the biomechanical competence of bone always poses a dilemma and must occur under medical advice. This article presents the hypothesis that back exercises performed in a prone position, rather than a vertical position, may have a greater effect on decreasing the risk for vertebral fractures without resulting in compression fracture. The risk for vertebral fractures can be reduced through improvement in the horizontal trabecular connection of vertebral bodies.

Health benefits of tennis

The aim of the study was to explore the role of tennis in the promotion of health and prevention of disease. The focus was on risk factors and diseases related to a sedentary lifestyle, including low fitness levels, obesity, hyperlipidaemia, hypertension, diabetes mellitus, cardiovascular disease, and osteoporosis. A literature search was undertaken to retrieve relevant articles. Structured computer searches of PubMed, Embase, and CINAHL were undertaken, along with hand searching of key journals and reference lists to locate relevant studies published up to March 2007. These had to be cohort studies (of either cross sectional or longitudinal design), case-control studies, or experimental studies. Twenty four studies were identified that dealt with physical fitness of tennis players, including 17 on intensity of play and 16 on maximum oxygen uptake; 17 investigated the relation between tennis and (risk factors for) cardiovascular disease; and 22 examined the effect of tennis on bone health. People who choose to play tennis appear to have significant health benefits, including improved aerobic fitness, a lower body fat percentage, a more favourable lipid profile, reduced risk for developing cardiovascular disease, and improved bone health.

Effect of impact exercise and its intensity on bone geometry at weight-bearing tibia and femur

INTRODUCTION

Physical activity is known to enhance the mechanical competence of bone. However, information about the optimal type of exercise is limited. The aim of this study was to evaluate the contribution of jumping exercise to changes in bone geometry.

METHODS

We carried out a 12-month population-based trial with 120 women (aged 35-40 years), randomly assigned to an exercise group or to a control group. The exercise regimen consisted of supervised, progressive high-impact exercises three times per week and an additional home program. The intensity of impact loading was assessed as the magnitude of acceleration peaks using an accelerometer-based body movement monitor. The activity was analyzed as the daily number of impacts within five acceleration ranges (0.3-1.0g, 1.1-2.4g, 2.5-3.8g, 3.9-5.3g and 5.4-9.2g; g=acceleration of gravity, 9.81 m/s(2)). Bone geometry was assessed with spiral quantitative computed tomography (QCT) scanner at mid-femur, proximal tibia and distal tibia.

RESULTS

Thirty-nine women (65%) in the exercise group and 41 women (68%) in the control group completed the study. QCT and physical activity data were available from 65 subjects. The exercise group showed a significant 0.2% (p=0.033) higher gain in bone circumference compared to the control group at mid-femur. Subgroup analyses revealed geometric changes indicating up to a 2.5% increment in bone strength in favor of the most active exercisers (>66 exercise sessions during the 12 months) compared to the least active exercisers (<19 sessions). In pooled groups, the changes in cortical attenuation and cross-sectional moment of inertia correlated positively (p<0.05-p<0.01) with the number of impacts exceeding 1.1g, while changes in cortical thickness (p<0.05) and bone circumference (p<0.05-p<0.01) were positively associated with impacts 3.9g, or more. The number and intensity of impacts during the 12 months were the most significant predictors of changes in bone geometry explaining up to 36% of changes.

CONCLUSIONS

Bone geometry adapts to impact exercise and the adaptation is most marked at the mid-femur. The changes in bone geometry are associated with the number and intensity of daily impacts while the redistribution of bone mineral appears to be the main mechanism in the skeletal adaptation to varying intensities of exercise.

Phenotypic plasticity and functional asymmetry in response to grip forces exerted by intercollegiate tennis players

This study examined phenotypic and functional responses to extreme asymmetry in hand use, and recorded the grip forces that occur during the tennis serve to assess the forces that contribute to asymmetry. Compressive grip performance was measured for Division I collegiate tennis players (24 female, 24 male) and nonathlete college students (18 females, 17 males) during three experiments: single-repetition maximum voluntary contraction, 30 consecutive repetitions, and a 30-s static hold. Tennis players had significant asymmetry in both forearm circumference and grip strength. The dominant hand of female tennis players produced 25% more force than the opposite hand, while the difference between hands of male tennis players was 18%. However, endurance over 30-repetitions and during the 30-s hold did not significantly differ between the limbs of tennis players. No significant asymmetry in forearm measurements, grip strength, or endurance was detected between the limbs of nonathletes. Grip forces generated during the tennis serve were recorded for 4 male tennis players, using a racket with a dynamometer incorporated into the handle. Peak handgrip forces generated during the serve (150-250 N) averaged 31-44% of the maximum grip force of the participant. Tennis players have increased muscle mass and strength of the dominant limb. Moderate forces, occurring hundreds of times each match and practice, are likely the primary forces contributing to this morphological and functional asymmetry.

Fluctuating asymmetry and developmental instability in evolutionary biology: past, present and future

The role of developmental instability (DI), as measured by fluctuating asymmetry (FA), in evolutionary biology has been the focus of a wealth of research for more than half a century. In spite of this long period and many published papers, our current state of knowledge reviewed here only allows us to conclude that patterns are heterogeneous and that very little is known about the underlying causes of this heterogeneity. In addition, the statistical properties of FA as a measure of DI are only poorly grasped because of a general lack of understanding of the underlying mechanisms that drive DI. If we want to avoid that this area of research becomes abandoned, more efforts should be made to understand the observed heterogeneity, and attempts should be made to develop a unifying statistical protocol. More specifically, and perhaps most importantly, it is argued here that more attention should be paid to the usefulness of FA as a measure of DI since many factors might blur this relationship. Furthermore, the genetic architecture, associations with fitness and the importance of compensatory growth should be investigated under a variety of stress situations. In addition, more focus should be directed to the underlying mechanisms of DI as well as how these processes map to the observable phenotype. These insights could yield more efficient statistical models and a unified approach to the analysis of patterns in FA and DI. The study of both DI and canalization is indispensable to obtain better insights in their possible common origin, especially because both have been suggested to play a role in both micro- and macro-evolutionary processes.

Short-term and long-term site-specific effects of tennis playing on trabecular and cortical bone at the distal radius

Mechanical loading during growth magnifies the normal increase in bone diameter occurring in long bone shafts, but the response to loading in long bone ends remains unclear. The aim of the study was to investigate the effects of tennis playing during growth at the distal radius, comparing the bone response at trabecular and cortical skeletal sites. The influence of training duration was examined by studying bone response in short-term (children) and long-term (young adults) perspectives. Bone area, bone mineral content (BMC), and bone mineral density (BMD) of the radius were measured by DXA in 28 young (11.6 +/- 1.4 years old) and 47 adult tennis players (22.3 +/- 2.7 years old), and 70 age-matched controls (12 children, 58 adults) at three sites: the ultradistal region (trabecular), the mid-distal region, and the third-distal region (cortical). At the ultradistal radius, young and adult tennis players displayed similar side-to-side differences, the asymmetry in BMC reaching 16.3% and 13.8%, respectively (P < 0.0001). At the mid- and third-distal radius, the asymmetry was much greater in adults than in children (P < 0.0001) for all the bone parameters (mid-distal radius, +6.6% versus +15.6%; third-distal radius, +6.9% versus +13.3%, for BMC). Epiphyseal bone enduring longitudinal growth showed a great capacity to respond to mechanical loading in children. Prolonging tennis playing into adulthood was associated with further increase in bone mineralization at diaphyseal skeletal sites. These findings illustrate the benefits of practicing impact-loading sports during growth and maintaining physical activity into adulthood to enhance bone mass accrual and prevent fractures later in life.