Exercise patterns and trabecular bone density in college women

Assessing patterns of variation in BV/TV in the calcaneus and C2 vertebra of Gorilla gorilla, Pan troglodytes, and populations of Homo sapiens from the Pleistocene and Holocene that differ in physical activity levels

OBJECTIVES

Because trabecular bone volume fraction (BV/TV) is influenced by variations in physical activity recent declines in BV/TV in humans are often attributed to modern sedentary lifestyles. This study tests the hypothesis that presumed variations in mechanical loading between groups can predict the observed BV/TV patterns in humans, chimpanzees and gorillas in two bones: the calcaneus which experiences high and well characterized impact forces, and the C2 vertebrae which experiences reduced locomotor forces.

MATERIALS AND METHODS

BV/TV and other structural variables were quantified from high-resolution microCT scans in gorillas, chimpanzees, and four Homo sapiens populations: Pleistocene, semi-sedentary Natufians; Holocene hunter-gatherers from Point Hope, Alaska; Holocene nomadic pastoralists from medieval Europe; and modern, sedentary Americans.

RESULTS

In the calcaneal tuberosity, Natufian BV/TV was 36, 46, and 46% greater than Alaskans (p = .02), Europeans (p = .005) and modern Americans (p = .002), respectively, but not significantly different from apes. BV/TV was not significantly different between modern Americans and Alaskans or Europeans. In the C2, Natufian BV/TV was 53 and 25% greater than in the Alaskan (p = .0001) and European (p = .048) populations.

DISCUSSION

These results suggest that phenomena other than or in addition to variations in physical activity are needed to explain BV/TV patterns observed in H. sapiens, and point to a systemic decline in H. sapiens BV/TV after the Pleistocene.

A review of the effect of swim training and nutrition on bone mineral density in female athletes

PURPOSE

The present paper reviews the physiological adaptation to swim training and dietary supplementation relating to bone mineral density (BMD) in female swimmers. Swim training still seems to have conflicting effects on bone health maintenance in athletes.

METHODS

This review article focuses on swim training combined with dietary supplementation with respect to BMD in female athletes.

RESULTS

Upon review of previous studies, it became obvious that the majority of studies did not collect physical activity data on the swimmers outside of their swimming activities. These activities may have some influence on the BMD of swimmers and therefore, future studies need to examine additional physical activity history data as well as swim training. This additional information may help to explain why swimmers' BMD tends to be lower than the BMD of control individuals in many studies. Moreover, dietary supplementation such as calcium, magnesium, and vitamin D also affect bone health in swimmers, and it is extremely important to evaluate BMD in the context of dietary supplementation.

CONCLUSION

A review of the literature suggests that exercise intervention studies, including longitudinal and randomized control trials, need to attempt to introduce various exercise programs to female swimmers in order to determine the optimal exercise prescription for bone health.

1H-NMR analysis of the human urinary metabolome in response to an 18-month multi-component exercise program and calcium–vitamin-D3supplementation in older men

The musculoskeletal benefits of calcium and vitamin-D3supplementation and exercise have been extensively studied, but the effect on metabolism remains contentious. Urine samples were analyzed by1H-NMR spectroscopy from participants recruited for an 18-month, randomized controlled trial of a multi-component exercise program and calcium and vitamin-D3fortified milk consumption. It was shown previously that no increase in musculoskeletal composition was observed for participants assigned to the calcium and vitamin-D3intervention, but exercise resulted in increased bone mineral density, total lean body mass, and muscle strength. Retrospective metabolomics analysis of urine samples from patients involved in this study revealed no distinct changes in the urinary metabolome in response to the calcium and vitamin-D3intervention, but significant changes followed the exercise intervention, notably a reduction in creatinine and an increase in choline, guanidinoacetate, and hypoxanthine (p < 0.001, fold change > 1.5). These metabolites are intrinsically involved in anaerobic ATP synthesis, intracellular buffering, and methyl-balance regulation. The exercise intervention had a marked effect on the urine metabolome and markers of muscle turnover but none of these metabolites were obvious markers of bone turnover. Measurement of specific urinary exercise biomarkers may provide a basis for monitoring performance and metabolic response to exercise regimes.

Effects of isometric strength training followed by no exercise and Humulus lupulus L-enriched diet on bone metabolism in old female rats

We investigated in female rats the effects on bone metabolism of a prolonged no-training period, subsequent to an isometric exercise program, performed during young adulthood and those of a long-term consumption of Humulus lupulus L-enriched diet (genistein 1.92 and daidzein 1.24 mg/kg diet) combined or not with isometric training. Forty-eight rats (4 weeks old) were randomly divided into 4 groups: trained (C-Tr) or nontrained rats (C-NTr) fed with control diet and trained (H-Tr) or nontrained rats (H-NTr) fed with Humulus lupulus L-enriched diet. The diets lasted 100 weeks. Training was followed over a 25-week period. Bone parameters were measured at week 100. Our results showed that no significant difference was observed among the 4 groups in uterine relative weight, calcium (Ca) intake, fecal Ca, urinary Ca excretion, net Ca absorption, plasma Ca, and bone Ca content. Calcium balance was significantly enhanced in H-NTr rats in comparison with C-NTr and C-Tr rats. Isometric strength training led to a significant increase in total bone mineral density (BMD), diaphyseal BMD, and osteocalcin-deoxypyridinoline ratio in C-Tr rats compared with the other groups. The main findings of the present study indicate that in female rats, a 25-week isometric strength training performed during young adulthood followed by a prolonged no-training period increases BMD values and osteocalcin-deoxypyridinoline ratio, whereas long-term consumption of Humulus lupulus L-enriched diet does not improve bone parameters. It suggests that bone gains induced by exercise do not decrease immediately after cessation of training and also confirms the importance of the practice of physical activity during puberty and young adulthood to maximize the achieved peak bone density.

Fracture incidence in GH-deficient patients on complete hormone replacement including GH

Fracture risk in GHD patients is not definitely established. Studying fracture incidence in 832 patients on GH therapy and 2581 matched population controls, we recorded a doubled fracture risk in CO GHD women, but a significantly lower fracture risk in AO GHD men.

INTRODUCTION

The objective of this study was to evaluate fracture incidence in patients with confirmed growth hormone deficiency (GHD) on replacement therapy (including growth hormone [GH]) compared with population controls, while also taking potential confounders and effect modifiers into account.

MATERIALS AND METHODS

Eight hundred thirty-two patients with GHD and 2581 matched population controls answered a questionnaire about fractures and other background information. Incidence rate ratio (IRR) and 95% CI for first fracture were estimated. The median time on GH therapy for childhood onset (CO) GHD men and women was 15 and 12 yr, respectively, and 6 and 5 yr for adult onset (AO) GHD men and women, respectively.

RESULTS

A more than doubled risk (IRR, 2.29; 95% CI, 1.23-4.28) for nonosteoporotic fractures was recorded in women with CO GHD, whereas no risk increase was observed among CO GHD men (IRR, 0.61) and AO GHD women (IRR, 1.08). A significantly decreased incidence of fractures (IRR, 0.54; 95% CI, 0.34-0.86) was recorded in AO GHD men.

CONCLUSIONS

Increased fracture risk in CO GHD women can most likely be explained by interaction between oral estrogen and the GH-IGF-I axis. The adequate substitution rate of testosterone (90%) and GH (94%) may have resulted in significantly lower fracture risk in AO GHD men.

Osteoporosis, falls and exercise

Osteoporosis, a manifestation of bone atrophy that leads to great susceptibility to fractures, is a very important public health problem today because of its great morbidity, mortality and important economic repercussions. It is a problem that will tend to become more serious with the increase in the number of elderly persons. Bone mass is gained during adolescence, reaches a plateau during the third decade and remains stable until approximately age 50, after which a progressively gradual loss is observed. There is no real cure for osteoporosis, but a series of strategies can be used to reduce bone loss and improve bone mass. Osteoporosis has been considered a disease that accompanies the process of ageing; however, this fatalistic attitude should be discarded, as it is possible to correct and decrease the risk factors. Intervention strategies are based on three pillars: nutrition, physical activity and pharmacological agents. Physical activities and exercise programmes are important because they not only can counter the loss of bone mass but also improve neuromuscular capacity, maintaining and increasing strength and muscle mass, which can help to avoid falls and reduce their impact and consequences. The general principles that apply to any exercise programme also apply to preventing bone mass loss. They also can be applied to persons with osteoporosis. However, to understand the peculiarities of these programmes, the propensity for suffering fractures of these former groups should be kept in mind. Special care should be taken to avoid falls and injuries. Weight-bearing exercise and resistance training are recommended for the prevention programmes. Other activities such as tai-chi, dancing, gymnastic or callisthenic exercises can help to improve balance, gait and muscle coordination and diminish the risk of falling. These programmes should be complemented with postural education and a series of safety precautions.

Genetic determination in onset age of wrist fracture

The onset age of fracture may be useful to explore the clinical and genetic heterogeneity of fracture study. In the present study, we investigated the heritability of the onset age of wrist fracture (OAWF) in 30 female full-sib pairs. The phenotypic correlation coefficient of OAWF was 0.309 (P=0.09) for this cohort of female sib pairs, and the narrow-sense heritability (h2) was estimated to be 0.618 (P=0.09). In addition, the h2 derived from the variance component model implemented in SOLAR was 0.722 (P<0.05). This study, for the very first time, suggested that OAWF is under genetic control and thus potentially helps clarify genetic heterogeneity of wrist fracture.

Osteoporosis and exercise

Osteoporosis is a common medical problem. Lifestyle measures to prevent or help treat existing osteoporosis often only receive lip service. The evidence for the role of exercise in the prevention and treatment of osteoporosis is reviewed.

Dose-response of physical activity and low back pain, osteoarthritis, and osteoporosis

PURPOSE

The purpose of this study was to examine the evidence for causal relationships between physical activity (PA) and low back pain (LBP), osteoarthritis (OA), and osteoporosis (OP), and for dose-response relations involved.

METHODS

Computer database searches and personal retrieval systems were used to locate relevant literature.

RESULTS

PA can be effective in preventing LBP (Category A) but prolonged, heavy loading can lead to LBP (Category C). Specific exercises have not been found effective in treatment of acute LBP (Category A), but PA can be effective in chronic LBP (Category B), especially for diminishing the effects of deconditioning. No evidence indicates that PA directly prevents OA. Large amounts of intensive PA involving high impacts or torsional loadings or causing injuries increases risk of OA (Category C). Light or moderate PA does not increase the risk of OA (Category C). PA can be effective in the treatment and rehabilitation of OA (Category B). High-intensity loading is osteogenic and possibly useful in prevention of OP (Category A) at the loaded site, but low to moderate loading is not osteogenic (Category D). Static efforts and slow movements are ineffective or less effective than fast application of force (Category B). The types of PA to attain the effects mentioned above are known except in the case of prevention of LBP, but dose-response relationships are poorly known; at best, semiquantitatively on the basis of just a few studies.

CONCLUSION

Given the shown primary and/or secondary preventative effectiveness of PA regarding LBP, OA, and OP, research to elucidate the inadequately known dose-response relations should be given high priority.

Weight-bearing exercise and markers of bone turnover in female athletes

Weight-bearing activity provides an osteogenic stimulus, while effects of swimming on bone are unclear. We evaluated bone mineral density (BMD) and markers of bone turnover in female athletes (n = 41, age 20.7 yr) comparing three impact groups, high impact (High, basketball and volleyball, n = 14), medium impact (Med, soccer and track, n = 13), and nonimpact (Non, swimming, n = 7), with sedentary age-matched controls (Con, n = 7). BMD was assessed by dual-energy X-ray absorptiometry at the lumbar spine, femoral neck (FN), Ward's triangle, and trochanter (TR); bone resorption estimated from urinary cross-linked N-telopeptides (NTx); and bone formation determined from serum osteocalcin. Adjusted BMD (g/cm; covariates: body mass index, weight, and calcium and calorie intake) was greater at the FN and TR in the High group (1.27 +/- 0.03 and 1.05 +/- 0.03) than in the Non (1.05 +/- 0.04 and 0.86 +/- 0.04) and Con (1.03 +/- 0.05 and 0.85 +/- 0.05) groups and greater at the TR in the Med group (1.01 +/- 0.03) than in the Non (0.86 +/- 0.04) and Con (0.85 +/- 0.05) groups. Total body BMD was higher in the High group (4.9 +/- 0.12) than in the Med (4.5 +/- 0.12), Non (4.2 +/- 0.14), and Con (4.1 +/- 0.17) groups and greater in the Med group than in the Non and Con groups. Bone formation was lower in the Non group (19.8 +/- 2.6) than in the High (30.6 +/- 3.0) and Med (32.9 +/- 1.9, P < or = 0.05) groups. No differences in a marker of bone resorption (NTx) were noted. This indicates that women who participate in impact sports such as volleyball and basketball had higher BMDs and bone formation values than female swimmers.

Effects of tower climbing exercise on bone mass, strength, and turnover in growing rats

To determine the effects of tower climbing exercise on mass, strength, and local turnover of bone, 50 Sprague-Dawley rats, 10 weeks of age, were assigned to five groups: a baseline control and two groups of sedentary and exercise rats. Rats voluntarily climbed the 200-cm tower to drink water from the bottle set at the top of it. In 4 weeks, the trabecular bone formation rate (BFR/bone surface [BS]), bone volume (BV/TV), and trabecular thickness (Tb.Th) of both the lumbar vertebra and tibia and the bone mineral density (BMD) of the tibia increased, while the osteoclast surface (Oc.S) decreased. The parameter values in the midfemur, such as the total cross-sectional area, the moment of inertia, the periosteal mineralizing surface (MS/BS), mineral apposition rate (MAR), BFR/BS, and bending load increased, while the endosteal MAR decreased. In 8 weeks, the increases in the bone mineral content (BMC), BMD of the femur and tibia, and the bending load values of the femur were significant, but the climbing exercise did not increase BMC, BMD, or the compression load of the lumbar vertebra. Although the periosteal MS/BS, MAR, and BFR/BS increased, the endosteal MS/BS, MAR, and BFR/BS decreased. These results show that climbing exercise has a beneficial effect on the femoral cortex and tibia trabecular, rather than the vertebral trabecular. In the midfemur, effects on bone formation are site specific, supporting accelerated cortical drift by mechanical stimulation.

Daily physical activity program increases bone mineralization and growth in preterm very low birth weight infants

OBJECTIVE

A study of daily physical activity was performed with 32 preterm infants to evaluate changes in body weight and bone mineralization.

STUDY DESIGN

Subjects were matched by birth weight and gestational age and randomly assigned to the physical activity (PA; n = 16) or to the control (C; n = 16) program. PA consisted of range of motion against passive resistance to all extremities for 5 to 10 minutes daily. Peripheral dual-energy x-ray of the right forearm (ulna and radius); biomarkers of bone formation (serum type I collagen C-terminal propeptide [PICP]) and resorption (urine pyridinoline cross-links of collagen [Pyd]); serum calcium, phosphate, alkaline phosphatase, parathyroid hormone (PTH), and 1, 25-(OH)(2) vitamin D; and urine levels of calcium, phosphate, and creatinine were obtained. All measurements were made at study entry and at 2.0 kg of body weight.

RESULTS

Despite a similar nutrient intake at advised levels for preterm infants, gains in body weight (g) and forearm bone length (cm), bone area (BA; cm(2)), bone mineral content (BMC; mg), and fat-free mass (g) were greater in PA infants. Forearm bone mineral density and fat mass gains did not differ between groups. Serum PICP levels remained constant in PA infants but decreased in C infants suggesting a slower rate of bone formation. Urine Pyd or bone resorption activity was similar between groups. A higher level of serum PTH was observed in PA infants at 2. 0 kg of body weight; however, the change from study entry to completion did not differ between groups. All other serum and urine values were similar and within normal limits.

CONCLUSION

A daily PA program promotes greater gains in body weight, forearm length, BA, BMC, and fat-free mass in premature infants.

Serum IGF-I is higher in gymnasts than runners and predicts bone and lean mass

INTRODUCTION

We examined the relationships between insulin-like growth factor I (IGF-I), its binding protein (IGFBP-3), body composition, and bone mineral density (BMD) in collegiate runners (N = 13), gymnasts (N = 10), and noncompetitive women (N = 10).

METHODS

Subjects were evaluated by dual-energy x-ray absorptiometry for body composition and BMD of the spine, hip, and whole body, fasting serum levels of IGF-I and IGFBP-3, and dietary intake. The ratio IGF-I/IGFBP-3 was calculated as a marker of IGF-I bioavailability.

RESULTS

In ANOVA, IGF-I and IGF-I/IGFBP-3 in athletes with oligomenorrhea and amenorrhea did not differ from eumenorrheic athletes; thus, values were pooled. Lean/height2 and bone mass at the hip and spine were higher in gymnasts than runners and controls. Total caloric intake was similar between groups. IGF-I and IGF-I/IGFBP-3 differed between groups with gymnasts having higher IGF-I values than runners (397+/-58 vs 288+/-73 ng x mL(-1), P < 0.001) and higher IGF-I/IGFBP-3 than controls and runners (0.065+/-0.009 vs 0.056+/-0.008 vs 0.045+/-0.009, P = 0.0001). In simple regression, IGF-I and IGF-/IGFBP-3 were related to lean/height2 and BMD of the lumbar spine and hip (P < 0.01-0.0001). IGF-I and IGF-I/IGFBP-3 were multicollinear; thus, the ratio was used in subsequent stepwise regression. Lean mass, corrected for body surface area (height2), independently predicted spine and trochanteric BMD (R2 = 0.26, 0.28, respectively), whereas IGF-I/IGFBP-3 and lean/height2 together contributed to 48% of the variance in femoral neck BMD.

CONCLUSION

We conclude that, in this group of young adult women, lower BMD in runners may be due, in part, to lower levels of IGF-I and the ratio of IGF-I-to-IGFBP-3 and that IGF-I may mediate the relationship between bone and lean mass.

Energetic factors, ovarian steroids and the risk of breast cancer

In industrial countries, women often have excess metabolic energy due to high food consumption and low physical activity. High lifetime energy availability results in high lifetime levels of ovarian steroid hormones. Oestrogens and progesterone are hypothesized to play a crucial role in the development and prognosis of breast cancer. Epidemiological studies document the importance of physical activity and caloric limitations in reducing breast cancer risk. The risk of breast cancer is much higher in industrial countries than in developing countries, where women are characterized by lower energy intake and higher energy expenditure. It is likely, that the beneficial effects of physical activity and of negative energy balance are mediated by the reduced levels of ovarian steroids. While both weight loss and physical activity may have similar efficacy in suppressing ovarian function and, therefore, in reducing the risk of breast cancer, we suggest that it may be more advantageous for premenstrual women to achieve lifetime reduction in steroid levels by increasing their physical activity, rather than by weight loss due to caloric restriction alone.

Genetic determination of Colles' fracture and differential bone mass in women with and without Colles' fracture

Osteoporotic fractures (OFs) are a major public health problem. Direct evidence of the importance and, particularly, the magnitude of genetic determination of OF per se is essentially nonexistent. Colles' fractures (CFs) are a common type of OF. In a metropolitan white female population in the midwestern United States, we found significant genetic determination of CF. The prevalence (K) of CF is, respectively, 11.8% (+/- SE 0.7%) in 2471 proband women aged 65.55 years (0.21), 4.4% (0.3%) in 3803 sisters of the probands, and 14.6% (0.7%) in their mothers. The recurrence risk (K0), the probability that a woman will suffer CF if her mother has suffered CF is 0.155 (0.017). The recurrence risk (Ks), the probability that a sister of a proband woman will suffer CF given that her proband sister has suffered CF is 0.084 (0.012). The relative risk lambda (the ratio of the recurrence risk to K), which measures the degree of genetic determination of complex diseases such as CF, is 1.312 (0.145; lambda 0) for a woman with an affected mother and 1.885 (0.276; lambda s) for a woman with an affected sister. A lambda-value significantly greater than 1.0 indicates genetic determination of CF. The terms lambda 0 and lambda s are related to the genetic variances of CF. These parameters translate into a significant and moderately high heritability (0.254 [0.118]) for CF. These parameters were estimated by a maximum likelihood method that we developed, which provides a general tool for characterizing genetic determination of complex diseases. In addition, we found that women without CF had significantly higher bone mass (adjusted for important covariates such as age, weight, etc.) than women with CF.

Stress fractures and the female athlete

Stress injury to bone is the result of a temporary disturbance in the equilibrium between bone resorption and bone regeneration. Knowledge of the pathophysiology of bone in health and disease currently encompasses an interactive mode that includes biomechanical, hormonal, nutritional, and genetic factors. The current study will review possible etiologic theories for stress injuries to bone with a special emphasis on gender-related factors. Females may be more at risk for a stress injury to bone because of their unique hormonal environment, and other anatomic and gender factors.

The effects of an educational intervention on calcium intake and bone mineral content in young women with low calcium intake

PURPOSE

This study evaluated whether a combined behavioral and dietary intervention would affect young women's calcium intake and bone mineral content (BMC).

DESIGN

The design was a two by three mixed design with one between-subjects factor (treatment vs. control) and one within-subjects factor (time--baseline, 3-month, and 6-month).

SETTING

The study was conducted in a university setting in Memphis, Tennessee.

PARTICIPANTS

A total of 80 premenopausal women (ages 18 to 30) with low baseline calcium intake (< 700 mg/d) were included in the analyses. There were 40 women in the treatment group and 40 women in the control group.

MEASURES

Hertzler and Frary's rapid assessment questionnaire was employed to evaluate calcium intake, and dual-energy x-ray absorptiometry (DEXA) was employed to assess BMC.

RESULTS

Repeated measures analysis of variance (RM ANOVA) was employed to analyze results. Results indicated that women in the treatment group made greater increases in total calcium intake and supplemental calcium than women in the control group and that all women made significant increases in dietary calcium intake. Additionally, analyses of BMC revealed that women in the treatment group did not experience significant changes in total BMC, and women in the control group experienced significant losses in total BMC.

CONCLUSIONS

In the current study, women were losing BMC, and the women who made the largest increases in calcium intake were able to retard this bone loss. There is increasing evidence that dietary calcium intake in young people is extremely low, and the results of the current study highlight the need for much more intensive evaluations investigating the factors that are positively associated with premenopausal bone mineral change.

The oral contraceptive pill: a revolution for sportswomen?

OBJECTIVES

To determine the effects of the oral contraceptive pill (OCP) on skeletal health, soft tissue injury, and performance in female athletes.

METHODS

A literature review was performed using literature retrieval methods to locate relevant studies.

RESULTS

Most female athletes primarily choose to use the OCP for contraceptive purposes, but cycle manipulation and control of premenstrual symptoms are secondary advantages of its use. The effect of the OCP on bone density in normally menstruating women is unclear, with some studies reporting no effect, others a positive effect, and some even a negative effect. The OCP is often prescribed for the treatment of menstrual disturbances in female athletes, and improvements in bone density may result. Whether the OCP influences the risk of stress fracture and soft tissue injuries is not clear from research to date. Effects of the OCP on performance are particularly relevant for elite sportswomen. Although a reduction in Vo2MAX has been reported in some studies, this may not necessarily translate to impaired performance in the field. Moreover, some studies claim that the OCP may well enhance performance by reducing premenstrual symptoms and menstrual blood loss. A fear of weight gain with the use of the OCP is not well founded, as population studies report no effect on weight, particularly with the lower dose pills currently available.

CONCLUSIONS

Overall, the advantages of the pill for sportswomen would appear to outweigh any potential disadvantages. Nevertheless, there is individual variation in response to the OCP and these should be taken into account and monitored in the clinical situation. Women should be counselled as to the range of potential benefits and disadvantages in order to make an informed decision based on individual circumstances.

Osteoporosis and eating disorders

Osteoporosis is a common complication of anorexia nervosa. Multiple factors increase risk, including decreased body weight and fat content, elevated cortisol levels, inadequate vitamin D and calcium intake, and amenorrhea and hypoestrogenemia. There is both decreased bone formation and increased bone resorption in the osteoporosis of anorexia nervosa. Treatment includes weight normalization and supplemental calcium and vitamin D. Unlike postmenopausal osteoporosis, estrogen replacement does not prevent or correct the osteoporosis that occurs in anorexia nervosa. Patients with bulimia nervosa or an eating disorder not otherwise specified may also be at risk of osteoporosis, especially if they have had a prior episode of anorexia nervosa.

Lifetime physical activity is associated with bone mineral density in premenopausal women

Osteoporosis causes premature disability among millions of elderly people in the United States, particularly women. Exercise helps to maintain bone mass, yet it remains unclear what type of physical activity during what age periods is most beneficial for bone mass and density. This cross-sectional study investigated the relationship between different measures of lifetime physical activity and bone mineral density (BMD) in 25 premenopausal women (mean age 41 years, range 28-50 years). BMD of the total, entire axial, and entire peripheral skeleton were measured by dual energy x-ray absorptiometry (DXA). Lifetime history of physical activity was obtained by a structured interview, and estimates of lifetime weight-bearing exercise, total exercise, total weight-bearing physical activity (including occupational and household activities), and perceived physical activity were computed. Adjustments were made for current body weight and height and lifetime milk consumption. Lifetime weight-bearing exercise was significantly correlated with total and peripheral BMD (total BMD: r = 0.54; peripheral BMD: r = 0.54, all p < 0.05). Total weight-bearing physical activity, including occupational and household activity, was associated with total BMD (r = 0.51, p < 0.05). Physical activity during early age periods was more strongly associated with BMD at all sites than was physical activity in the past 2 years. Our findings suggest that lifetime weight-bearing exercise is more strongly related to BMD of the total and peripheral skeleton than is nonweight-bearing exercise. The inclusion of nonweight-bearing activity resulted in a weakening of the association. Weight-bearing household and occupational activity appeared to be related to BMD. Our results support recommendations to increase physical activity throughout life, particularly during early ages, as a means of osteoporosis prevention.

Genetic determination of variation and covariation of peak bone mass at the hip and spine

The likelihood of low trauma fracture in the elderly is highly predictable by peak bone mass (PBM) at age approximately 25-50 yr. We estimated the magnitude of genetic determination of the variation and covariation of PBM of the spine and hip (adjusted by age, gender, and ethnicity) in 47 independent healthy full-sib pairs and 27 healthy mother-offspring pairs. For the spine and hip, the narrow-sense heritabilities (h(2)) (mean +/- SE) were 0.76 +/- 0.34 and 0.84 +/- 0.36, respectively, when estimated from full sibs, and 0.86 +/- 0.38 and 0.84 +/- 0.39, respectively, when estimated from parent-offspring. Some genetic loci underlying PBM variation at the hip and spine are the same or closely linked, as is reflected by the high genetic correlation of 0.95 +/- 0.05 between them when estimated from full sibs, and 0.57 +/- 0.27 when estimated from parent-offspring, respectively. Generally, common familial environmental effects shared by relatives may bias these estimates. However, these effects may be small, since our results reported herein and those in other earlier studies indicate that common familial environmental effects are probably negligible in causing similarity of bone mass among family members. The correlation of bone mass among randomly sampled couples living in the same household is small and nonsignificant as measured either by densitometry at the radius and ulna or by quantitative ultrasound at the patella. The problem of shared environmental effects notwithstanding, we conclude that much of the PBM variation and covariation at the hip and spine is determined genetically.

Perspectives on bone mechanical properties and adaptive response to mechanical challenge

The bones of the human skeleton serve a mechanical function besides providing a reservoir for calcium and hematopoietic homeostatis. When mechanically challenged, they usually respond and adapt; failure to do so can result in fracture. The mechanical behavior of bone is determined by bone mass and its material properties and by its geometry and architecture. Therefore, in vivo noninvasive measurements of bone mass, geometry, and structure can predict bone strength and are usually employed as a useful-if not always reliable-way to estimate bone fragility, whereas direct bone biomechanical testing in vitro can provide detailed information about mechanical strength. Because bone strains are likely to be regulators of bone mass and strength, exercise protocols designed to counteract the effects of osteoporosis should load the target bone with repeated high peak forces and high strain rates or high impacts on a long-term basis. Such a protocol creates varied strain distributions throughout the bone structure, producing short, repeated strains on the bone in directions to which it is unaccustomed. Exercise in this manner can maintain and perhaps increase bone mass and improve mechanical properties and neuromuscular competency, reducing skeletal fragility and the predisposition to falls.

The effects of progressive resistance training on bone density: a review

Osteoporosis is a major public health problem that is characterized by low bone mass and increased susceptibility to fractures, primarily of the hip, spine, and wrist. It is estimated to cause 1.5 million fractures annually in the United States in people aged 50 yr and older. Physical activity, particularly weight-bearing exercise, is thought to provide the mechanical stimuli or "loading" important for the maintenance and improvement of bone health, whereas physical inactivity has been implicated in bone loss and its associated health costs. Both aerobic and resistance training exercise can provide weight-bearing stimulus to bone, yet research indicates that resistance training may have a more profound site specific effect than aerobic exercise. Over the past 10 years, nearly two dozen cross-sectional and longitudinal studies have shown a direct and positive relationship between the effects of resistance training and bone density. Conversely, a handful of other studies have reported little or no effect on bone density. However, these results may be partially attributable to the study design, intensity and duration of the exercise protocol, and the bone density measurement techniques used. High-intensity resistance training, in contrast to traditional pharmacological and nutritional approaches for improving bone health in older adults, has the added benefit of influencing multiple risk factors for osteoporosis including improved strength and balance and increased muscle mass.

Nutritional status of the Finnish elite ski jumpers

PURPOSE

The aim of this study was to determine the nutritional status of Finnish elite male ski jumpers (N = 21) and age-matched controls (N = 20).

METHODS

Nutritional status was assessed by estimating body composition with dual-energy x-ray absorptiometry (DXA), dietary intake with 4-d food records, and assessment of nutritional status was complemented with biochemical and hematological indices.

RESULTS

Mean (SD) age (19.7 (3.6) vs 19.8 (3.9) yr, P = 0.675) and stature (176.4 (6.0) vs 178.5 (5.5) cm, P = 0.259) were similar in ski jumpers and in controls, respectively. However, ski jumpers had a lower mean (SD) body weight (61.9 (4.8) vs 71.5 (9.0) kg, P < 0.001) and body fat percentage (8.6 (1.9) vs 16.1 (7.2)%, P < 0.001) than controls. The amount of bone-free lean soft tissue and bone mineral content (BMC) did not differ between the groups, but age- and bone-free lean soft tissue-adjusted bone mineral density (BMD) in lumbar spine (L2-4) and in proximal femur was greater in ski jumpers. Mean (SD) energy intake was lower in ski jumpers than in controls (7.4 (3.3) vs 11.0 (2.6) MJ, P = 0.001), respectively, whereas the percentage of energy derived from carbohydrates was higher in athletes. Despite the markedly lower energy consumption, intake of thiamin, riboflavin, folate, vitamin C, calcium, and iron was similar in both groups, whereas intake of vitamins D and E, magnesium, and zinc was lower in ski jumpers than in controls (P-values range from 0.012 to 0.004). Biochemical and hematological indices showed no abnormalities in either group.

CONCLUSIONS

These data suggest that despite the lower body weight and energy intake, nutritional status of the elite Finnish ski jumpers was not compromised as compared with that of nonathletic controls.

Longitudinal changes in college students' exercise participation

A 4-page questionnaire was mailed to 708 randomly selected 1st-year university students to assess changes in the students' exercise behavior from the 1st year of college to the 2nd year. The questionnaire assessed student demographics and participation in vigorous and moderate exercise over the preceding 7 days. Three hundred thirty-two students responded. A year later, a similar questionnaire was mailed to the same 332 students; responses were obtained from 242 students. Although no changes in reported exercise participation were found in the group as a whole, subgroups of students who either increased or decreased exercise participation were identified. Implications for exercise intervention programs among college students are presented.

Can the effects of exercise on bone quality be detected using the CUBA clinical ultrasound system?

OBJECTIVES

To determine whether the CUBA clinical quantitative ultrasound bone analyser was able to distinguish variations in bone quality between groups categorised according to activity level.

METHOD

Eighty one white women aged 32 to 89 completed a confidential questionnaire on general health, diet, and exercise participation and underwent ultrasound testing at the right calcaneus utilising a CUBA clinical ultrasound system.

RESULTS

The results confirmed the inverse relationship between age and the ultrasound indicators of bone quality: broadband ultrasound attenuation (BUA) (r = -0.52) and velocity of sound (VOS) (r = -0.68). Subject height weakly but significantly correlated with BUA (r = 0.39) and VOS (r = 0.35), and subject weight only correlated significantly with BUA (r = 0.37). Activity level was significantly associated (p < 0.05) with the changes in ultrasound attenuation (BUA). The use of hormone replacement therapy or the contraceptive pill, a family history of osteoporosis, and gross indicators of calcium consumption did not yield significant results.

CONCLUSION

Data obtained from the CUBA clinical system were sensitive enough to allow women to be classified into groups according to activity level. These data were within the range of "normal" ultrasound data and hence it is suggested that the machine has research as well as clinical value.

Inhibitory effects of YM175, a bisphosphonate, on the progression of experimental periodontitis in beagle dogs

This study examined the efficacy of YM175 [disodium dihydrogen (cycloheptylamino) methylene-1, 1-bisphosphonate] in reducing alveolar bone loss caused by experimental periodontitis in beagle dogs. Thirty-six dogs were used and divided into 6 groups. Periodontitis was induced in 30 dogs (groups 2-6) by ligating the bilateral mandibular third and fourth premolar teeth with silk ligatures and by feeding a soft diet. Six dogs were sham-operated (group 1). Saline (placebo), flurbiprofen (0.02 mg/kg) and YM175 (0.01, 0.1 and 1.0 mg/kg) were administered to the dogs (groups 2-6) 5 d/wk for 25 wk. Radiographic and morphometric analyses were performed. In placebo-treated animals (group 2), the ligation caused a significant decrease in the alveolar bone height by 0.57 and 1.91 mm at 2 and 25 wk, respectively. YM175 (1.0 mg/kg) prevented the decrease in bone height by 47 and 31% at 2 and 25 wk. YM175 (0.1 mg/kg) and flurbiprofen tended to prevent bone loss after 15 wk. Although the ligation elicited no significant change in bone mineral density, it significantly decreased bone volume. YM175 (1.0 mg/kg) and flurbiprofen tended to increase the bone volume. The number of formative or resorptive Haversian canals and the bone turnover through the periosteal bone surface were increased by the ligation, indicating the increased turnover of the cortical bone. YM175 (1.0 mg/kg) reduced the increased bone turnover. The gingival index was maximally increased at 2 wk and was suppressed by YM175. These results suggest that YM175 prevents alveolar bone loss by reducing the increased alveolar bone turnover in dogs with periodontitis.

Effect of physical training on bone mineral density in prepubertal girls: a comparative study between impact-loading and non-impact-loading sports

Physical activity is known to have an anabolic effect on bone tissue. It has been shown to increase the bone mineral density (BMD) in young adults, as well as in teenagers. But there is little information about the effect of intensive physical activity in childhood, particularly at the prepubertal stage. To examine the influence of an early intensive physical training on BMD, we have studied a group of elite prepubertal girls, at the starting phase of their peak bone mass acquisition. Subjects were engaged either in sport requiring significant impact loading on the skeleton, or in sport without impact loading. Forty-one healthy prepubertal girls took part in this study. The sport group consisted of 10 swimmers (10.5 +/- 1.4 years old) and 18 gymnasts (10.4 +/- 1.3 years old), who had performed 3 years of high-level sport training (8-12 h per week for swimmers, 10-15 h per week for gymnasts). Thirteen girls (10.7 +/- 1 years old) doing less than 3 h per week of physical activity served as a control group. BMD measurements were done using dual-energy X-ray absorptiometry. There was no statistical significant difference between groups as regards age, body height and weight, and body composition. There was no statistical significant difference between swimmers and controls for all the BMD measurements. Mean BMD in gymnasts was statistically higher than in the control group for mid-radius (+15.5%, p < 0.001), distal radius (+33%, p < 0.001), L2-4 vertebrae (+11%, p < 0.05), femoral neck (+15%, p < 0.001) and Ward's triangle (+15%, p < 0.01). Moreover, in gymnasts, BMD at radius, trochanter and femoral neck was above normative values. We conclude that physical activity in childhood could be an important factor in bone mineral acquisition in prepubertal girls, but only if the sport can induce bone strains during a long-term program: gymnastics has such characteristics, unlike swimming. Such acquisition could provide protection against risks of osteoporosis in later life, but this remains debatable.

Aerobic workout and bone mass in females

This cross-sectional study aimed to investigate bone mass in females participating in aerobic workout. Twenty-three females (age 24.1 +/- 2.7 years), participating in aerobic workout for about 3 hours/week, were compared with 23 age-, weight- and height-matched non-active females. Areal bone mineral density (BMD) was measured in total body, head, whole dominant humerus, lumbar spine, right femoral neck, Ward's triangle, trochanter femoris, in specific sites in right femur diaphysis, distal femur, proximal tibia and tibial diaphysis, and bone mineral content (BMC) was measured in the whole dominant arm and right leg, using dual energy X-ray absorptiometry. The aerobic workout group had significantly (P < 0.05-0.01) higher BMD in total body (3.7%), lumbar spine (7.8%), femoral neck (11.6%), Ward's triangle (11.7%), trochanter femoris (9.6%), proximal tibia (6.8%) and tibia diaphysis (5.9%) compared to the non-active controls. There were no differences between the groups concerning BMD of the whole dominant humerus, femoral diaphysis, distal femur and BMC and lean mass of the whole dominant arm and right leg. Leaness of the whole dominant arm and leg was correlated to BMC of the whole dominant arm and right leg in both groups. In young females, aerobic workout containing alternating high and low impact movements for the lower body is associated with a higher bone mass in clinically important sites like the lumbar spine and hip, but muscle strengthening exercises like push-ups and soft-glove boxing are not associated with a higher bone mass in the dominant humerus. It appears that there is a skeletal adaptation to the loads of the activity.

Effect of resistance exercise training on bone formation and resorption in young male subjects assessed by biomarkers of bone metabolism

We studied the effects of high intensity resistance exercise training on bone metabolism in 17 young adult Oriental males (23-31 years) by measuring sensitive biomarkers of bone formation and resorption. The subjects were assigned to a training group and a sedentary group. The training group followed a weight training program three times per week for 4 months. In the training group, serum osteocalcin concentration and serum bone-specific alkaline phosphatase activity were significantly increased within the first month after the beginning of resistance exercise training, and the elevated levels remained throughout the training period, while there was no significant change in plasma procollagen type-I C-terminal concentration. Urinary deoxypyridinoline excretion was transiently suppressed and returned to the initial value but was never stimulated during the 4 months. These results suggest that the resistance exercise training enhanced bone formation without prior bone resorption. In the sedentary group, there was no significant difference in bone metabolic markers except plasma procollagen type-I C-terminal, which continuously decreased during the experimental period. There were no significant changes in total and regional bone mineral density in either group. In conclusion, (1) resistance exercise training increased markers of bone formation, while it transiently suppressed a marker of bone resorption, and (2) such adaptive changes of bone metabolism to resistance exercise training occurred during the early period of the training, before changes in bone density were observable through densitometry.

The female athlete

Since the passage of Title IX in 1972, women's participation in physical activity and sports has increased significantly. A concurrent expansion in the body of knowledge regarding women and sports has occurred. Questions regarding menstrual dysfunction and exercise continue, while new questions about menstrual dysfunction and its effect on bone mineral density have arisen. Physical and physiological differences between men and women not only guide treatment, but help fuel policy decisions regarding competition between males and females. It is essential for the physical therapist to remain current on issues related to women and sports in order to better advise and treat the female athlete.

Systematic strength training as a model of therapeutic intervention. A controlled trial in postmenopausal women with osteopenia

Physical exercise is often recommended as a therapeutic tool to combat pre- and postmenopausal loss of bone density. However, the relationship between training dosage (intensity, duration, frequency) and the effect on bone density still is undergoing discussion. Furthermore, the exercise quantification programs are often described so inadequately that they are neither quantitatively nor qualitatively reproducible. The aim of this investigation was to determine whether a clearly defined training of muscle strength, under defined safety aspects, performed only twice weekly, can counteract bone density loss in women with postmenopausal osteopenia. Data from 16 women in the training group (age, 63.6 +/- 6.2 yr) and 15 women in the control group (age, 67.4 +/-9.7 yr), of comparable height and weight, were evaluated. Strength training was performed for 6 mo as continually adapted strength training, providing an intensity of about 70% of each test person's one repetition maximum. Bone mineral density of lumbar vertebrae 2 to 4 and the femoral neck was measured by dual-energy x-ray absorptiometry. Maximum performance in watts and parameters of hemodynamics were controlled with a bicycle ergometer test to maximal effort. In addition, metabolic data were assessed. In the lumbar spine and femoral neck, the training group showed no significant changes, whereas the control group demonstrated a significant loss of bone mineral density, especially in the femoral neck (P<0.05). The strength increase was highly significant in all exercised muscle groups, rising to about 70% above the pretraining status (P<0.001). Heart rate and blood pressure data indicated a slight economization, metabolism was not significantly influenced. Based on these findings, we conclude that continually adapted strength training is an effective, safe, reproducible, and adaptable method of therapeutic strength training, following only two exercise sessions per week.

Previous physical activity relates to bone mineral measures in young women

Exercise may increase accretion of bone, potentially reducing the risk of osteoporosis. Previous physical activity was assessed in 204 minimally active young women (18-31 yr). Bone mineral content (BMC) and bone mineral density (BMD) for the total body, femoral neck, and spine were assessed by a dual x-ray absorptiometer, and the radius by a single photon absorptiometer. Self-reported occupation and leisure activity for the 5 yr before enrollment in the study, as well as high school and college sports participation, were assigned energy expenditure (EE) values. From this information, EE variables were created as follows: 1) occupation EE + leisure EE + high school sport and/or college sport EE if within prior 5 yr (5-yr EE); 2) occupation EE + leisure EE (occupation + leisure EE); and 3) high school sport EE (high school EE). These variables were correlated with bone mineral measures and significant results follow (P < 0.05). Five-year EE and occupation + leisure EE correlated with all measures of bone health (r from 0.13 to 0.39). High school EE correlated with total body BMD (r = 0.25) and BMC (r = 0.28), femoral neck BMD (r = 0.28), radius BMC (r = 0.20), as well as spine BMD (r = 0.20) and BMC (r = 0.27). When weight was controlled, 5-yr EE and occupation + leisure EE remained correlated with all BMC measures (r from 0.14 to 0.22). When controlled for weight, high school EE remained associated with femoral neck BMD (r = 0.24), total body BMD (r = 0.20) and BMC (r = 0.26), and spine BMC (r = 0.17). To partially control for selection bias, data were also controlled for total body BMD. Five-year EE and occupation + leisure EE remained positively correlated with all measures of BMC. High school EE remained correlated both with femoral neck BMD and total body BMC. In multiple regression analyses, 5-yr EE or occupation + leisure EE were significant predictors of all measures of bone health, except femoral neck BMD. High school EE was a significant predictor for total body BMD and BMC, femoral neck BMD, and spine BMC.

Is bone mineral density advantage maintained long-term in previous weight lifters?

This cross-sectional study was done in order to ascertain whether there is a lifelong beneficial effect on bone mineral density (BMD) of early, long-lasting, and intense physical exercise. Forty-eight male ex-weight lifters, mean age 64 years (range 50-79) participated. They had followed a training program of an average of 10 hours/week (range 4-20) for an average of 13 years (range 1-34). They had all retired from competitive sport an average of 30 years (range 7-50) ago. Sixty-six age-matched volunteers served as controls. The bone mineral density (BMD, areal density, g/cm2) in the total body, spine, and hips and the fat content and lean body mass were measured with the LUNAR DPX bone mass scanner. In ex-weight lifters 50-64 years of age, the BMD was greater than in controls. After 65 years, no difference was found between the former weight lifters and their controls.

Additive effects of weight-bearing exercise and estrogen on bone mineral density in older women

The separate and combined effects of weight-bearing exercise and hormone replacement therapy (HRT) on bone mineral density (BMD) were studied in 32 women, 60 to 72 years of age. HRT consisted of continuous conjugated estrogens 0.625 mg/day and trimonthly medroxyprogesterone acetate 5 mg/day for 13 days. Exercise consisted of 2 months of low-intensity exercise followed by 9 months of more vigorous weight-bearing exercise approximately 45 minutes/day, > or = 3 days/week, at 65-85% of maximal heart rate. Lumbar spine and proximal femur BMD were significantly increased in response to exercise and to HRT, and total body BMD was significantly increased in response to HRT; neither exercise nor HRT had an effect on wrist BMD. The combination of exercise + HRT resulted in increased BMD at all sites except the wrist, with effects being additive for the lumbar spine and Ward's triangle and synergistic for the total body. Based on reductions in serum osteocalcin levels, it appears that increases in BMD in response to HRT and exercise + HRT were due to decreased bone turnover. The lack of change in serum osteocalcin and IGF-I in response to exercise alone suggests that increases in BMD were due to decreased bone resorption and not increased formation. Results indicate that weight-bearing exercise + HRT may be effective in preventing and/or treating osteoporosis. It is likely that the additive effects of weight-bearing exercise and HRT on bone mineral accretion, coupled with other adaptations to the exercise (i.e., increased strength and functional capacity), could effectively reduce the incidence of falls and osteoporotic fractures.

Bone metabolism and osteopenia in eating disorders

Bone loss is a potentially debilitating condition in women with eating disorders. Complications may include failure to achieve peak bone mass, increased risk of premature fractures, and inability to reach the height potential. We therefore conducted a comprehensive evaluation of 58 women with anorexia nervosa (AN), bulimia (BUL) and anorexia/bulimia (AB), comparing bone mineral density (BMD) to physical parameters, biochemical indices, and markers for bone formation and resorption. BMDs were significantly lower in patients with AN than in those with AB and BUL, and overt osteopenia was uncommon in AB and BUL. Hypercortisolism was the best laboratory marker to assess the risk of osteopenia in patients with AN. However, there were no associated changes in bone formation or resorption parameters. No direct correlation was found between BMD and body mass index, estrogen deficiency, tubular reabsorption of phosphorus, serum vitamin D, PTH, BGP, or alkaline phosphatase levels. Although the prognosis for complete recovery to normal BMD is poor, treatment of the underlying depressive disorder, improvement in nutrition with increased weight, and spontaneous resumption of menses are associated with restoring bone health.

A randomized double-blind controlled calcium supplementation trial, and bone and height acquisition in children

There is limited information relating Ca intake to bone and height acquisition among Oriental children who consume little or even no milk. The present controlled study investigated the acquisition of bone mass and height of Chinese children with an initial Ca intake of approximately 567 mg/d who were supplemented to about 800 mg/d. Eighty-four 7-year-old Hong Kong Chinese children underwent an 18-month randomized, double-blind, controlled Ca-supplementation trial. The children were randomized to receive either 300 mg elemental Ca or a placebo tablet daily. Bone mass of the distal one-third radius was measured by single-photon absorptiometry, lumbar spine and femoral neck were determined using dual-energy X-ray absorptiometry. Measurements were repeated 6-monthly. Baseline serum 25-hydroxycholecalciferol concentration and physical activity were also assessed. Baseline Ca intakes of the study group and controls were respectively 571 (SD 326) and 563 (SD 337) mg/d. There were no significant differences in baseline serum 25-hydroxycholecalciferol concentration (P = 0.71) and physical activity (P = 0.36) between the study and control groups. After 18 months the study group had significantly greater increases in lumbar-spinal bone mineral content (20.9 v. 16.34%; P = 0.035), lumbar-spinal area (11.16 v. 8.71%; P = 0.049), and a moderately greater increment in areal bone mineral density of the radius (7.74 v. 6.00%; P = 0.081) when compared with the controls. The results confirm a positive effect of Ca on bone mass of the spine and radius but no effects on femoral-neck and height increase. A longer trial is warranted to confirm a positive Ca effect during childhood that may modify future peak bone mass.

A stages of change approach to understanding college students' physical activity

This study examined self-reports of physical activity behavior among college students from a stages of change perspective. A questionnaire on health needs was administered to a random sample of 800 students at a private university; 217 completed questionnaires were analyzed, using chi-square statistics. In addition to examining activity behavior from a stages of change approach, the authors explored the relationship of demographic variables to activity behavior. Forty-six percent of the students were inactive or were exercising irregularly. Gender and year in school were unrelated to stage of exercise adoption. Results from this pilot study indicate the need for stage-matched interventions to increase activity levels in young adults.

Relative rates of fracture of the hip in the United States. Geographic, sex, and age variations

We studied the Medicare data from 1984 through 1987 for 687,850 fractures of the hip that had occurred in the United States. Our purpose was to determine the geographic, sex-specific, and age-interval variations in the relative risk of fracture of the hip in elderly white individuals. The rates of cervical, trochanteric, and subtrochanteric fracture, and the over-all rate of fracture at any of the three levels, increased with age, were greater for women than for men, and were higher in the Southern part of the country. However, there were regional, sex, and age variations. The ratio of cervical to trochanteric fractures was significantly higher in the East South Central region and lower in the Middle Atlantic and New England regions (p < 0.05). These were the same areas with the highest and lowest over-all rates, respectively, of fracture of the hip. The ratio of cervical to trochanteric fractures decreased from 1.52 in women who were sixty-five to sixty-nine years old to 0.81 in women who were at least eighty-five years old, but it stayed at approximately 1.00 for the corresponding age-groups of men. The ratio of fracture of the hip in women to fracture of the hip in men varied depending on the level of the fracture.

A two-year program of aerobics and weight training enhances bone mineral density of young women

Previous research suggests that physical activity may have a beneficial effect on bone mineral density (BMD) in women. This relationship was explored in a 2-year, randomized, intervention trial investigating the efficacy of exercise and calcium supplementation on increasing peak bone mass in young women. One hundred and twenty-seven subjects (ages of 20-35 years) were randomly assigned either to an exercise program that contained both aerobics and weight training components or to a stretching program. Calcium supplementation (up to 1500 mg/day including dietary intake) or placebo was given in a double-blinded design to all subjects. Spinal trabecular BMD was determined using quantitative computed tomography (QCT). Spinal integral, femoral neck, and trochanteric BMD were measured by dual X-ray absorptiometry (DXA) and calcaneal BMD by single photon absorptiometry (SPA). Fitness variables included maximal aerobic capacity (VO2max), and isokinetic muscle performance of the trunk and thigh. Measurements were made at baseline, 1 year, and 2 years. Sixty-three subjects (32 exercise, 31 stretching) completed the study, and all the measured bone parameters indicated a positive influence of the exercise intervention. There were significant positive differences in BMD between the exercise and stretching groups for spinal trabecular (2.5%), femoral neck (2.4%), femoral trochanteric (2.3%), and calcaneal (6.4%) measurements. The exercise group demonstrated a significant gain in BMD for spinal integral (1.3 +/- 2.8%, p < 0.02), femoral trochanteric (2.6 +/- 6.1%, p < 0.05), and calcaneal (5.6 +/- 5.1, p < 0.01) measurements. In contrast to exercise, the calcium intervention had no positive effect on any of the bone parameters. In regard to fitness parameters, the exercise group completed the study with significant gains in VO2max and isokinetic (peak torque) values for the knee flexion and extension and trunk extension. This study indicates that over a 2-year period, a combined regimen of aerobics and weight training has beneficial effects on BMD and fitness parameters in young women. However, the addition of daily calcium supplementation does not add significant benefit to the intervention.