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Exercise and bone health
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There can be no debate about the overall health benefits of exercise, but I am concerned about what appears to me to be a concept that exercise alone can be an appropriate to minimize the risk of an osteoporosis related fracture.
The current issue of the Journal of Bone and Mineral Research (July 2008) has an editorial and four primary research articles on this topic with a focus on children and skeletal development. The data is very solid and confirms that exercise is indeed of importance in optimizing peak adult bone mass. One article provides an important caveat — children aged between 9 and 11 years who reported daily vigorous exercise sustained twice as many fractures during two years of follow up than those who exercised four or fewer days a week.
This is not a message to cut down on exercise but a message to be careful.
The concern I have is whether exercise is sufficient to minimize menopause or age-related bone loss and increase bone mineral density as measured by dual X-ray absorptometry. Several meta-analyses (I located 13 on Medline) reported that, women who exercised regularly had very modest increases in BMD at the spine that would be within the variability of the measurement in individual women. The effects at the hip were even less marked. The obvious corollary to this is that if your patient already has a low BMD exercise is important but not sufficient to restore bone health.
Lack of regular exercise is likely to make a bad situation worse. The same issue of the journal had an article confirming that poor physical performance, assessed by fairly simple and straightforward in-office exams — leg power, grip strength, usual walking pace, narrow walk balance, and chair stands — is a predictor of hip fracture risk in “older” men (> 65 years). During five years of follow up, 64% of the hip fractures occurred in men with poor performance, with the chair stand test the most predictive.
(The abstracts of the articles discussed in this blog are available online at www.jbmronline.org and the full text should be available to you at the medical library you frequent. If your library does not yet subscribe to JBMR tell them to do so — it is the most highly rated journal in the field.)