Long-Term Exercise and Bone Mineral Density Changes in Postmenopausal Women—Are There Periods of Reduced Effectiveness?

Abstract

There is increasing evidence that physical exercise can prevent fractures in postmenopausal women. However, even with careful adaptation of the exercise program to subjects' changing bone, health, and fitness status, effectivity may still decrease over the time. This could be specifically the case where the limitations of higher age collide with the specification of the exercise program. Thus, the aim of this study was to monitor bone mineral density (BMD) changes over a 16-year period of supervised exercise. Our hypothesis was that BMD differences at lumbar spine (LS) and femoral neck (FN) between exercisers (EG) and nontraining controls (CG) increased throughout the intervention with significant differences for each of the four 4-year observation periods. Sixty-seven (EG, n ¼ 39 versus CG, n ¼ 28) initially early-postmenopausal osteopenic women of the Erlangen Fitness and Osteoporosis Prevention Study (EFOPS) with complete BMD data sets for baseline (1998) and 4-, 8-, 12-, and 16-year follow-up were included in the analysis. The exercise protocol initially focused on a high-intensity strategy that addressed bone but increasingly shifted to a more comprehensive intervention. LS-BMD differences between the EG and CG continuously increased (year 4: 2.4% (95%-Confidence Interval 1.0% to 3.8%), year 8: 3.1% (1.6% to 4.7%), year 12: 3.9% (1.9% to 5.8), year 16: 4.5% (2.5% to 6.6%). Correspondingly, rising differences for FN-BMD (0.9% (-0.2% to 2.1%) versus 1.9% (0.4% to 3.3%) versus 2.0% (0.5% to 3.8%) versus 3.0% (1.0% to 5.0%)) were observed. However, in contrast to our hypothesis, group differences within the four 4-year periods were not consistently significant (LS, p ¼ 0.001 to 0.097; FN, p ¼ 0.026 to 0.673); further, BMD kinetics among the groups varied between LS and FN. Of particular importance, significant differences (p 0.030) for both regions were still found in the final period. We conclude that exercise-even when adapted for subjects' decreasing bone, health, and fitness status-is consistently effective in favorably affecting BMD in (initially) early-postmenopausal osteopenic women without any leveling-off effect after 16 years of exercise.

Association between Dietary Carotenoid Intake and Bone Mineral Density in Korean Adults Aged 30–75 Years Using Data from the Fourth and Fifth Korean National Health and Nutrition Examination Surveys (2008–2011)

“…Bone mineral density (BMD) is associated with various lifestyle factors, such as physical activity, smoking, diet, and alcohol consumption [ 7 , 8 ]. Among various dietary factors, minerals [ 9 , 10 , 11 ], including calcium and vitamin D, antioxidant vitamins (vitamins C and E), flavonoids [ 12 , 13 , 14 ], and dietary patterns rich in milk and dairy products, green tea, and fruits and vegetables [ 15 , 16 , 17 , 18 ] have effects on bone metabolism in both younger and older age groups.…”

<p>Osteoporosis in Primary Biliary Cholangitis: Prevalence, Impact and Management Challenges</p>

“…In fact, exercise is associated with significant improvement in BMD in a 16-year prospective study evaluating postmenopausal women with osteopenia compared to controls. 36 Other data suggest lifestyle factors such as alcohol consumption, tobacco use, low levels of exercise and reduced dietary calcium intake can lead to reduced bone density and portend an increased fracture risk. 11 In patients with liver disease, we recommend alcohol and smoking cessation, in addition to practicing routine weightbearing exercises and consuming a balanced diet.…”

Körperliches Training zur Frakturprophylaxe des älteren Menschen

“…Betrachtet man in diesem Zusammenhang die Entwicklung der Knochendichte an LWS und Schenkelhalsregion [48] über die unterschiedlichen 4-jährigen Messintervalle (basal, Jahr 4, Jahr 8, Jahr 12, Jahr 16; Details in [48]), so zeigen sich keine Phasen reduzierter Sensibilität oder Levelling-off Effekte. Insgesamt zeigen sich signifikante Zwischengruppenunterschiede (p < 0,001) für die LWS (TG: -1,5 ± 5,0 %; p = 0,027 versus KG -5,8 ± 6,4 %; p < 0,001) und die Schenkelhalsregion (-6,5 ± 4,6 %; p < 0,001 vs. -9,6 ± 5,0 %; p < 0,001).…”