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Exercise: A Prevention and Treatment for Osteoporosis and Injurious Falls in the Older Adult

Everett L. Smith and Lorri Tommerup

Osteoporosis is a major public health problem in persons over the age of 65, and it leads to approximately 250,000 hip fractures per year. Contributing risk factors for osteoporosis and hip fractures in the aging population include insufficient nutrient intake, inadequate dietary calcium, muscular weakness, decreased physical activity, and changes in hormonal homeostasis. Physical activity especially plays an important role in the prevention of falls and fractures. Physically active older adults with greater muscular strength experience fewer and less injurious falls than older people who are inactive. The effects of physical activity on bone strength and metabolism have only recently been investigated. When bone is mechanically stimulated, the cells respond by producing many local hormones and growth factors, including prostaglandin E2 (PGE2), a mediator of bone modeling and remodeling. Current research continues to show that physical activity significantly affects the geometry and architecture of bone as well as increasing bone mineral density, all of which contribute to an increase in bone strength.

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Differences in Gait Performance, Quadriceps Strength, and Physical Activity Between Fallers and Nonfallers in Women with Osteoporosis

Felix Stief, Anna Schäfer, Lutz Vogt, Marietta Kirchner, Markus Hübscher, Christian Thiel, Winfried Banzer, and Andrea Meurer

The present study should reveal differences in gait performance, quadriceps strength, and physical activity (PA) between fallers and nonfallers in women with osteoporosis. Forty-one women with osteoporosis (17 fallers, 24 nonfallers) participated. Gait analysis shows that fallers were walking with a slower walking speed (−9%, p = .033) and had a shorter stride length (−7%, p = .039). Moreover, fallers showed a decreased ankle power generation (−18%, p = .045). The quadriceps strength was decreased by 24% for fallers (p = .005) while PA showed no significant differences. Although a decrease in ankle power generation could have an effect on floor clearance for limb advancement in the swing phase, the causal relationship between spatiotemporal parameters (walking speed, stride length) and walking ankle joint power generation remains unknown and warrants further investigation. In conclusion, walking speed, stride length, ankle power generation, and quadriceps strength can be used to differentiate between fallers and nonfallers in women with osteoporosis.

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Effect of Aerobic/Strength Training on RANKL Gene DNA Methylation Levels

Ameni Chelly, Amal Bouzid, Fadoua Neifar, Ines Kammoun, Adel Tekari, Saber Masmoudi, Hamdi Chtourou, and Ahmed Rebai

inhibiting RANKL has emerged as a viable strategy for treating osteoporosis based on preclinical and clinical studies. A recent study demonstrated the effectiveness of denosumab, an inhibitor of bone resorption via RANKL signaling, in managing osteoporosis in postmenopausal women. 4 Osteoporosis, a

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Childhood Physical Activity May or May Not Provide Sustained Effects to Protect Adults From Osteoporosis

Kathleen F. Janz and Shelby L. Francis

Although there is strong and consistent evidence that childhood and adolescent physical activity is osteogenic, the evidence concerning its sustained effects to adult bone health is not conclusive. Therefore the value of interventions, in addition to beneficial bone adaptation, could be exposure to activities children enjoy and therefore continue. As such, interventions should provide skills, pleasure, and supportive environments to ensure continued bone-strengthening physical activity with age. Until the dose-response as well as timing of physical activity to bone health is more fully understood, it is sensible to assume that physical activity is needed throughout the lifespan to improve and maintain skeletal health. Current federal guidelines for health-related physical activity, which explicitly recommend bone-strengthening physical activities for youth, should also apply to adults.

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Do Older Adults With Reduced Bone Mineral Density Benefit From Strength Training? A Critically Appraised Topic

Maja Zamoscinska, Irene R. Faber, and Dirk Büsch

Clinical Scenario Reduced bone mineral density (BMD) and as a consequence a reduced bone strength is a serious health impairment in older adults. 1 Generally, 2 states within the reduction range of BMD are distinguished: osteopenia and osteoporosis. 2 , 3 Osteopenia is the mild state in which BMD

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Osteoporosis Knowledge, Attitudes, and Behaviors of Female Collegiate Athletes

Lori W. Turner and Martha A. Bass

Female athletes often engage in harmful dietary and weight control practices that can impair bone health and hinder performance. To promote related positive health behavior practices, nutrition educators may be more effective if they understand the osteoporosis knowledge, attitudes, and behaviors among female athletes. A questionnaire including items related to osteoporosis and dietary calcium knowledge, attitudes, and behavioral practices was administered to 114 female collegiate athletes (19.6 ± 1.4 years). Self-reported intakes of dairy product consumption were also obtained; subjects were asked how many times per week they drank milk and ate cheese, yogurt, and ice cream. The mean score for osteoporosis knowledge was 7.1 ± 1.9 (out of 10 items). The mean score for favorable responses to attitude items was 2.1 ± 0.8 (out of 3 items). Correct responses to dietary calcium knowledge items were 2.2 ± 0.7 (out of 3 items). On average, subjects consumed 2.4 ± 1.6 servings of dairy products per day; 31% of subjects consumed the recommended 3 or more servings per day. Osteoporosis knowledge, osteoporosis attitudes, and dietary calcium knowledge were not correlated (p > .05) with dairy product intake. Because of the importance of achieving a high peak bone mass to prevent osteoporosis, our data suggest that further research is needed regarding other factors that might influence dairy product intake among female athletes.

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Physical Activity Context Preferences in People With Arthritis and Osteoporosis

Geeske Peeters, Wendy Brown, and Nicola Burton


Patient-group specific preferences can be used to design physical activity programs. This study compared physical activity context preferences between (1) people with musculoskeletal conditions (ie, arthritis and/or osteoporosis) and people without these conditions, and (2) people with arthritis only and people with osteoporosis only.


Data were from 1684 participants (57.2 ± 6.6 years) with self-reported arthritis and/or osteoporosis and 4550 participants (52.9 ± 6.9 years) without these conditions. Participants indicated the extent to which they disagreed/agreed with a preference for each of 14 contexts. Marginal means and 95% confidence intervals are presented, differences were tested with ANCOVA.


Compared with participants without musculoskeletal conditions, those with arthritis and/or osteoporosis indicated a slightly stronger preference for activities that are not just about exercise [3.55 (3.51–3.59) vs. 3.49 (3.46–3.52), P = .02], and a weaker preference for vigorous activities [3.02 (2.97–3.06) vs. 3.08 (3.06–3.11), P = .02], and activities with a set routine or format [3.29 (3.24–3.33) vs. 3.35 (3.32–3.38), P = .02]. Participants with arthritis only [n = 1063, 2.64, (2.59–2.70)] had a stronger preference against supervision than those with osteoporosis only [n = 146, 2.84 (2.69–2.99); P = .02].


Only small differences were found in the activity context preferences between people with and without musculoskeletal conditions, and between people with osteoporosis and people with arthritis. The context of physical activity interventions for people with arthritis and/or osteoporosis does not have to be different from those for people without these conditions.

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Effects of Balance-Coordination, Strengthening, and Aerobic Exercises to Prevent Falls in Postmenopausal Patients With Osteoporosis: A 6-Month Randomized Parallel Prospective Study

Meltem Dizdar, Jale Fatma Irdesel, Oguzhan Sıtkı Dizdar, and Mine Topsaç

Osteoporosis (OP) is a systemic disease characterized by the increase of bone fragility and fracture risk. ( Herlund et al., 2013 ). Falls among patients with OP are associated with high morbidity and mortality and can involve high-cost medical intervention ( Sinaki, Brey, Hughes, Larson, & Kaufman

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Mobilization With Movement as Therapy to Reduce Knee Pain and Increase Knee Range of Motion

Steve Plummer and Julie Leonard

Clinical Scenario: Knee pain and limited knee range of motion (ROM) are among the most common conditions found in individuals who report lower body health-related issues. Factors such as weight gain, lack of mobility, balance issues, and pain can lead to a more sedentary lifestyle, which, in turn, causes knee stiffness or knee limited ROM. As a result, the patient will be at higher risk of osteoporosis, patellofemoral pain syndrome, reduced quadriceps strength, heart disease, and even depression. Clinical Question: Is mobilization with movement (MWM) an effective method of treatment for reducing knee pain and increasing knee ROM in individuals being treated for knee pain and limited knee ROM? Summary of Key Findings: (1) The literature searched were peer-reviewed articles that investigated the effects of MWM as a therapy to reduce knee pain and increase knee ROM. (2) MWM was shown to be an effective treatment for reducing knee pain and increasing knee ROM. Clinical Bottom Line: There is conclusive evidence that MWM is an effective method of treatment for reducing knee pain and increasing knee ROM in individuals who experience knee pain and knee limited ROM. Strength of Recommendation: Grade (“A”) evidence exists showing that MWM therapy results are greater when performed either alone or in combination with a current conventional therapy for decreasing knee pain and increasing knee ROM.

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The Effects of Walking or Nordic Walking in Adults 50 Years and Older at Elevated Risk of Fractures: A Systematic Review and Meta-Analysis

Isabel B. Rodrigues, Matteo Ponzano, Debra A. Butt, Joan Bartley, Zahra Bardai, Maureen C. Ashe, Philip D. Chilibeck, Lehana Thabane, John D. Wark, Jackie Stapleton, and Lora M. Giangregorio

Osteoporosis is a bone disease that affects about 1.5 million Canadians aged 40 years and older ( Public Health Agency of Canada, 2010 ). Osteoporosis increases the risk of fractures, with one in three women and one in five men experiencing an osteoporotic fracture during their lifetime ( Kanis