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Erschienen in: Osteoporosis International 1/2012

01.01.2012 | Review

The effect of exercise on pQCT parameters of bone structure and strength in postmenopausal women—a systematic review and meta-analysis of randomized controlled trials

verfasst von: I. Polidoulis, J. Beyene, A. M. Cheung

Erschienen in: Osteoporosis International | Ausgabe 1/2012

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Abstract

Summary

Inconsistent study findings of exercise on areal bone density highlight the need to include parameters of bone geometry and volumetric bone density measurements. Using a systematic review and meta-analysis, we found a decrease in bone loss through the maintenance of cortical and trabecular volumetric bone mineral density (BMD). Studies with longer exercise durations and larger sample sizes are needed.

Introduction

Exercise has long been recommended to prevent age-related loss of bone mass in postmenopausal women. However, inconsistent study findings on the effect of exercise on BMD preservation have highlighted the importance of extending the evaluation of bone to include the parameters of bone geometry. We conducted both a systematic review and meta-analysis of the effects of exercise on bone geometry and volumetric BMD in postmenopausal women.

Methods

We searched MEDLINE, PubMed, and EMBASE from 1950 to April 2009 and included prospective, randomized controlled trials of healthy postmenopausal women where the intervention involved exercise or sport and outcomes included quantitative or peripheral quantitative computed tomography bone parameters. Outcome variables included: total volumetric BMD, cortical volumetric BMD (CvBMD), trabecular volumetric BMD (TrvBMD), total bone mineral content, cortical BMC, total bone area, cortical area, polar stress–strain index, and bone strength index.

Results

Six studies satisfied our inclusion and exclusion criteria. Lower extremity exercises resulted in small (∼0.9%) but significant improvements in TrvBMD of the distal tibia (p = 0.0006) and in CvBMD of the tibial shaft (p = 0.0007). Studies with longer durations of exercise (12 months) and those in early postmenopausal women showed significant changes in CvBMD at the tibial shaft.

Conclusions

We conclude that exercise in postmenopausal women may decrease bone loss by maintaining cortical and trabecular volumetric BMD. To better understand the effect of exercise on bone geometric structure and strength, more studies of longer duration and larger sample sizes are needed.
Literatur
1.
Zurück zum Zitat Asikainen TM, Kukkonen-Harjula K, Miilunpalo S (2004) Exercise for health for early postmenopausal women: a systematic review of randomised controlled trials. Sports Med 34:753–778PubMedCrossRef Asikainen TM, Kukkonen-Harjula K, Miilunpalo S (2004) Exercise for health for early postmenopausal women: a systematic review of randomised controlled trials. Sports Med 34:753–778PubMedCrossRef
2.
Zurück zum Zitat Bérard A, Bravo G, Gauthier P (1997) Meta-analysis of the effectiveness of physical activity for the prevention of bone loss in postmenopausal women. Osteoporos Int 7:331–337PubMedCrossRef Bérard A, Bravo G, Gauthier P (1997) Meta-analysis of the effectiveness of physical activity for the prevention of bone loss in postmenopausal women. Osteoporos Int 7:331–337PubMedCrossRef
3.
Zurück zum Zitat Martyn-St JM, Carroll S (2008) Meta-analysis of walking for preservation of bone mineral denisty in postmenopausal women. Bone 43:521–531CrossRef Martyn-St JM, Carroll S (2008) Meta-analysis of walking for preservation of bone mineral denisty in postmenopausal women. Bone 43:521–531CrossRef
4.
Zurück zum Zitat Chan K, Qin L, Lau M, Woo J, Au S, Choy W, Lee K, Lee S (2004) A randomized, prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women. Arch Phys Med Rehabil 85:171–722CrossRef Chan K, Qin L, Lau M, Woo J, Au S, Choy W, Lee K, Lee S (2004) A randomized, prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women. Arch Phys Med Rehabil 85:171–722CrossRef
5.
Zurück zum Zitat Kemmler W, Engelke K, Weineck J, Hensen J, Kalender WA (2003) The Erlangen fitness osteoporosis prevention study: a controlled exercise trial in early postmenopausal women with low bone density-first-year results. Arch Phys Med Rehabil 84:673–682PubMed Kemmler W, Engelke K, Weineck J, Hensen J, Kalender WA (2003) The Erlangen fitness osteoporosis prevention study: a controlled exercise trial in early postmenopausal women with low bone density-first-year results. Arch Phys Med Rehabil 84:673–682PubMed
6.
Zurück zum Zitat Snow CM, Shaw JM, Winters KM, Witzke KA (2000) Long-term exercise using weighted vests prevents hip bone loss in postmenopausal women. J Gerontol 55A:M489–M491 Snow CM, Shaw JM, Winters KM, Witzke KA (2000) Long-term exercise using weighted vests prevents hip bone loss in postmenopausal women. J Gerontol 55A:M489–M491
7.
Zurück zum Zitat Stengel SV, Kemmler W, Pintag R, Beeskow C, Weineck J, Lauber D, Kalender WA, Engelke K (2005) Power training is more effective than strength training for maintaining bone mineral density in postmenopausal women. J Appl Physiol 99:181–188PubMedCrossRef Stengel SV, Kemmler W, Pintag R, Beeskow C, Weineck J, Lauber D, Kalender WA, Engelke K (2005) Power training is more effective than strength training for maintaining bone mineral density in postmenopausal women. J Appl Physiol 99:181–188PubMedCrossRef
8.
Zurück zum Zitat Kerr D, Ackland T, Maslen B, Moron A, Prince R (2001) Resistance training over 2 years increases bone mass in calcium-replete postmenopausal women. J Bone Miner Res 16:175–181PubMedCrossRef Kerr D, Ackland T, Maslen B, Moron A, Prince R (2001) Resistance training over 2 years increases bone mass in calcium-replete postmenopausal women. J Bone Miner Res 16:175–181PubMedCrossRef
9.
Zurück zum Zitat Kelley GA, Kelley KS, Tran ZV (2002) Exercise and lumbar spine bone mineral density in postmenopausal women: a meta-analysis of individual patient data. J Gerontol 57:M599–M604 Kelley GA, Kelley KS, Tran ZV (2002) Exercise and lumbar spine bone mineral density in postmenopausal women: a meta-analysis of individual patient data. J Gerontol 57:M599–M604
10.
Zurück zum Zitat Wolff I, Van Croonenborg J, Kemper HCG, Kostense PJ, Twisk JWR (1999) The effect of exercise training programs on bone mass: a meta-analysis of published controlled trials in pre- and postmenopausal women. Osteoporos Int 9:1–12PubMedCrossRef Wolff I, Van Croonenborg J, Kemper HCG, Kostense PJ, Twisk JWR (1999) The effect of exercise training programs on bone mass: a meta-analysis of published controlled trials in pre- and postmenopausal women. Osteoporos Int 9:1–12PubMedCrossRef
11.
Zurück zum Zitat Dougherty G (1996) Quantitative CT in the measurement of bone quantity and bone quality for assessing osteoporosis. Med Eng Phys 18:557–568PubMedCrossRef Dougherty G (1996) Quantitative CT in the measurement of bone quantity and bone quality for assessing osteoporosis. Med Eng Phys 18:557–568PubMedCrossRef
12.
Zurück zum Zitat Bouxsein ML, Karaski D (2006) Bone geometry and skeletal fragility. Curr Osteoporos Rep 4:49–56PubMedCrossRef Bouxsein ML, Karaski D (2006) Bone geometry and skeletal fragility. Curr Osteoporos Rep 4:49–56PubMedCrossRef
13.
Zurück zum Zitat Dalle Carbonare L, Valenti MT, Bertoldo F, Zanatta M, Zenari S, Realdi G, Lo Cascio V, Giannini S (2005) Bone microarchitecture evaluated by histomorphometry. Bone Struc Health Dis 36:609–616 Dalle Carbonare L, Valenti MT, Bertoldo F, Zanatta M, Zenari S, Realdi G, Lo Cascio V, Giannini S (2005) Bone microarchitecture evaluated by histomorphometry. Bone Struc Health Dis 36:609–616
14.
Zurück zum Zitat Pang MYC, Ashe MC, Eng JJ, McKay HA, Dawson AS (2006) A 19-week exercise program for people with chronic stroke enhances bone geometry at the tibia: a peripheral quantitative computed tomography study. Osteoporos Int 17:1615–1625PubMedCrossRef Pang MYC, Ashe MC, Eng JJ, McKay HA, Dawson AS (2006) A 19-week exercise program for people with chronic stroke enhances bone geometry at the tibia: a peripheral quantitative computed tomography study. Osteoporos Int 17:1615–1625PubMedCrossRef
15.
Zurück zum Zitat Uusi-Rasi K, Kannus P, Cheng S et al (2003) Effect of alendronate and exercise on bone and physical performance of postmenopausal women: a randomized controlled trial. Bone 33:132–143PubMedCrossRef Uusi-Rasi K, Kannus P, Cheng S et al (2003) Effect of alendronate and exercise on bone and physical performance of postmenopausal women: a randomized controlled trial. Bone 33:132–143PubMedCrossRef
16.
Zurück zum Zitat Cheng S, Sipila S, Taafe DR, Puolakka J, Suominen H (2002) Change in bone mass distribution induced by hormone replacement therapy and high-impact physical exercise in post-menopausal women. Bone 31:126–135PubMedCrossRef Cheng S, Sipila S, Taafe DR, Puolakka J, Suominen H (2002) Change in bone mass distribution induced by hormone replacement therapy and high-impact physical exercise in post-menopausal women. Bone 31:126–135PubMedCrossRef
17.
Zurück zum Zitat Karinkanta S, Heinonen A, Sievanen H, Uusi-Rasi K, Pasanen M, Ojala K, Fogelholm M, Kannus P (2006) A multi-component exercise regimen to prevent functional decline and bone fragility in home-dwelling elderly women: randomized, controlled trial. Osteoporos Int 18:453–462PubMedCrossRef Karinkanta S, Heinonen A, Sievanen H, Uusi-Rasi K, Pasanen M, Ojala K, Fogelholm M, Kannus P (2006) A multi-component exercise regimen to prevent functional decline and bone fragility in home-dwelling elderly women: randomized, controlled trial. Osteoporos Int 18:453–462PubMedCrossRef
18.
Zurück zum Zitat Liu-Ambrose TY, Khan KM, Eng JJ, Heinonen A, McKay HA (2004) Both resistance and agility training increase cortical bone density in 75- to 85-year-old women with low bone mass. J Clin Densitom 7:390–398PubMedCrossRef Liu-Ambrose TY, Khan KM, Eng JJ, Heinonen A, McKay HA (2004) Both resistance and agility training increase cortical bone density in 75- to 85-year-old women with low bone mass. J Clin Densitom 7:390–398PubMedCrossRef
19.
Zurück zum Zitat Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12PubMedCrossRef Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12PubMedCrossRef
20.
Zurück zum Zitat Brouwers MC, Johnston ME, Charette ML, Hanna SE, Jadad AR, Browman GP (2005) Evaluating the role of quality assessment of primary studies in systematic reviews of cancer practice guidelines. BMC Med Res Methodol 5:8PubMedCrossRef Brouwers MC, Johnston ME, Charette ML, Hanna SE, Jadad AR, Browman GP (2005) Evaluating the role of quality assessment of primary studies in systematic reviews of cancer practice guidelines. BMC Med Res Methodol 5:8PubMedCrossRef
21.
22.
Zurück zum Zitat Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF, Group ftQ (2008) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Lancet 354:1896–1900CrossRef Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF, Group ftQ (2008) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Lancet 354:1896–1900CrossRef
23.
Zurück zum Zitat Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560PubMedCrossRef Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560PubMedCrossRef
24.
Zurück zum Zitat Hamilton CJ, Swan VJ, Jamal SA (2010) The effects of exercise and physical activity participation on bone mass and geometry in postmenopausal women: a systematic review of pQCT studies. Osteoporos Int 21:11–23PubMedCrossRef Hamilton CJ, Swan VJ, Jamal SA (2010) The effects of exercise and physical activity participation on bone mass and geometry in postmenopausal women: a systematic review of pQCT studies. Osteoporos Int 21:11–23PubMedCrossRef
25.
Zurück zum Zitat Nikander R, Sievänen H, Heinonen A, Daly RM, Uusi-Rasi K, Kannus P (2010) Targeted exercise against osteoporosis: a systematic review and meta-analysis for optimising bone strength throughout life. BMC Med 8:47PubMedCrossRef Nikander R, Sievänen H, Heinonen A, Daly RM, Uusi-Rasi K, Kannus P (2010) Targeted exercise against osteoporosis: a systematic review and meta-analysis for optimising bone strength throughout life. BMC Med 8:47PubMedCrossRef
26.
Zurück zum Zitat Adami S, Gatti D, Braga V, Bianchini D, Rossini M (1999) Site-specific effects of strength training on bone structure and geometry of ultradistal radius in postmenopausal women. J Bone Miner Res 14:120–124PubMedCrossRef Adami S, Gatti D, Braga V, Bianchini D, Rossini M (1999) Site-specific effects of strength training on bone structure and geometry of ultradistal radius in postmenopausal women. J Bone Miner Res 14:120–124PubMedCrossRef
27.
Zurück zum Zitat Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B (2005) Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 293:2257–2264PubMedCrossRef Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B (2005) Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 293:2257–2264PubMedCrossRef
28.
Zurück zum Zitat Bunout D, Barrera G, Leiva L, Gattas V, Pia de la Maza M, Avendano M, Hirsch S (2006) Effects of vitamin D supplementation and exercise training on physical performance in Chilean vitamin D deficient elderly subjects. Exper Gerontol 41:746–752CrossRef Bunout D, Barrera G, Leiva L, Gattas V, Pia de la Maza M, Avendano M, Hirsch S (2006) Effects of vitamin D supplementation and exercise training on physical performance in Chilean vitamin D deficient elderly subjects. Exper Gerontol 41:746–752CrossRef
29.
Zurück zum Zitat Cranney A, Horsley T, O’Donnell S, et al. (2007) Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess 1–235 Cranney A, Horsley T, O’Donnell S, et al. (2007) Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess 1–235
30.
Zurück zum Zitat Mezquita-Raya P, Munoz-Torres M, De Dios LJ, Luna V, Lopez-Rodriguez F, Torres-Vela E, Escobar-Jimenez F (2001) Relation between vitamin D insufficiency, bone density, and bone metabolism in healthy postmenopausal women. J Bone Miner Res 16:1408–1415PubMedCrossRef Mezquita-Raya P, Munoz-Torres M, De Dios LJ, Luna V, Lopez-Rodriguez F, Torres-Vela E, Escobar-Jimenez F (2001) Relation between vitamin D insufficiency, bone density, and bone metabolism in healthy postmenopausal women. J Bone Miner Res 16:1408–1415PubMedCrossRef
31.
Zurück zum Zitat Trivedi DP, Doll R, Khaw KT (2003) Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ 326(7387):469PubMedCrossRef Trivedi DP, Doll R, Khaw KT (2003) Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ 326(7387):469PubMedCrossRef
32.
Zurück zum Zitat Moher D, Jadad AR, Tugwell P (1996) Assessing the quality of randomized controlled trials. Int J Tech Assess Health Care 12:195–208CrossRef Moher D, Jadad AR, Tugwell P (1996) Assessing the quality of randomized controlled trials. Int J Tech Assess Health Care 12:195–208CrossRef
33.
Zurück zum Zitat Moher D, Pham B, Jones A, Cook DJ, Jadad AR (1998) Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet 352:609–613PubMedCrossRef Moher D, Pham B, Jones A, Cook DJ, Jadad AR (1998) Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet 352:609–613PubMedCrossRef
34.
Zurück zum Zitat Schulz KF, Chalmers I, Hayes RJ, Altman DG (1995) Empirical evidence effects in controlled trials of bias: dimensions of methodological quality associated with estimates of treatment. JAMA 273:408–412PubMedCrossRef Schulz KF, Chalmers I, Hayes RJ, Altman DG (1995) Empirical evidence effects in controlled trials of bias: dimensions of methodological quality associated with estimates of treatment. JAMA 273:408–412PubMedCrossRef
35.
Zurück zum Zitat Irwin ML, Tworoger SS, Yasui Y et al (2004) Influence of demographic, physiologic, and psychosocial variables on adherence to a yearlong moderate-intensity exercise trial in postmenopausal women. Prev Med 39:1080–1086PubMedCrossRef Irwin ML, Tworoger SS, Yasui Y et al (2004) Influence of demographic, physiologic, and psychosocial variables on adherence to a yearlong moderate-intensity exercise trial in postmenopausal women. Prev Med 39:1080–1086PubMedCrossRef
36.
Zurück zum Zitat Resnick B, Magaziner J, Orwig D, Zimmerman S (2002) Evaluating the components of the exercise plus program: rationale, theory and implementation. Health Educ Res 17:648–658PubMedCrossRef Resnick B, Magaziner J, Orwig D, Zimmerman S (2002) Evaluating the components of the exercise plus program: rationale, theory and implementation. Health Educ Res 17:648–658PubMedCrossRef
37.
Zurück zum Zitat Ryan RM, Deci EL (2007) Active human nature: self-determination theory and the promotion and maintenance of sport, exercise, and health. In: Hagger MS (ed) Intrinsic motivation and self-determination in exercise and sport. Human Kinetics Europe Ltd., Pudsey, pp 1–19 Ryan RM, Deci EL (2007) Active human nature: self-determination theory and the promotion and maintenance of sport, exercise, and health. In: Hagger MS (ed) Intrinsic motivation and self-determination in exercise and sport. Human Kinetics Europe Ltd., Pudsey, pp 1–19
38.
Zurück zum Zitat Riggs BL, Melton LJ (1995) The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 17:S505–S511CrossRef Riggs BL, Melton LJ (1995) The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 17:S505–S511CrossRef
40.
Zurück zum Zitat Dalsky GP, Stocke KS, Ehsani AA, Slatopolsky E, Lee WC, Birge SJJ (1988) Weight-bearing exercise training and lumbar bone mineral content in postmenopausal women. Ann Intern Med 108:824–828PubMed Dalsky GP, Stocke KS, Ehsani AA, Slatopolsky E, Lee WC, Birge SJJ (1988) Weight-bearing exercise training and lumbar bone mineral content in postmenopausal women. Ann Intern Med 108:824–828PubMed
41.
Zurück zum Zitat Jiang Y, Zhao J, Rosen C, Geusens P, Genant HK (1999) Perspectives on bone mechanical properties and adaptive response to mechanical challenge. J Clin Densitom 2:423–433PubMedCrossRef Jiang Y, Zhao J, Rosen C, Geusens P, Genant HK (1999) Perspectives on bone mechanical properties and adaptive response to mechanical challenge. J Clin Densitom 2:423–433PubMedCrossRef
Metadaten
Titel
The effect of exercise on pQCT parameters of bone structure and strength in postmenopausal women—a systematic review and meta-analysis of randomized controlled trials
verfasst von
I. Polidoulis
J. Beyene
A. M. Cheung
Publikationsdatum
01.01.2012
Verlag
Springer-Verlag
Erschienen in
Osteoporosis International / Ausgabe 1/2012
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-011-1734-7

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