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.
Everett L. Smith and Lorri Tommerup
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.
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.
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
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.
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.
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
Edward Archer, Amanda E. Paluch, Robin P. Shook and Steven N. Blair
Successful aging encompasses more than just the prevention of disease and disability; the truly well-lived life is demonstrated by a sense of vitality and independence, freedom from bodily pain, and the continued involvement in meaningful activities. While physical inactivity and sedentary behaviors accelerate the aging process, deliberate exercise and other forms of activity delay and/or prevent the onset of age-related pathologies such as frailty, osteoporosis, sarcopenia, and cardiovascular disease. This review surveys the evidence that supports the position that physical activity is a necessary component for the development and maintenance of the physiological resources that are foundational to physical and cognitive functioning and ‘living well’ in one's later years.
Martin Benka Wallén, Ing-Mari Dohrn, Agneta Ståhle, Erika Franzén and Maria Hagströmer
To compare self-reported pedometer steps with accelerometer steps under free-living conditions in individuals with Parkinson’s disease (PD) or osteoporosis (OP).
Seventy-three individuals with PD and 71 individuals with OP wore a pedometer (Yamax LS2000) and an accelerometer (ActiGraph GT1M/GT3X+) simultaneously for one week.
Fifty-one individuals with PD (72.6 ± 5.3 years) and 61 with OP (75.6 ± 5.3 years) provided simultaneously recorded data for 3–7 consecutive days. Pedometer steps were significantly lower than accelerometer steps in the PD group (p = .002) but not in the OP group (p = .956). Bland-Altman plots demonstrated wide limits of agreement between the instruments in both PD (range = 6,911 steps) and OP (range = 6,794 steps).
These results suggest that the ActiGraph GT1M/GT3X+ should be preferred over the Yamax LS2000 for the assessment of steps in both research and clinical evaluations, particularly in individuals with PD or altered gait.
Richard D. Lewis and Christopher M. Modlesky
Calcium and vitamin D can significantly impact bone mineral and fracture risk in women. Unfortunately, calcium intakes in women are low and many elderly have poor vitamin D status. Supplementation with calcium (~1000 mg) can reduce bone loss in premenopausal and late postmenopausal women, especially at sites that have a high cortical bone composition. Vitamin D supplementation slows bone loss and reduces fracture rates in late postmenopausal women. While an excess of nutrients such as sodium and protein potentially affect bone mineral through increased calcium excretion, phytoestrogens in soy foods may attenuate bone loss ihrough eslrogenlike activity. Weight-bearing physical activity may reduce the risk of osteoporosis in women by augmenting bone mineral during the early aduli years and reducing the loss of bone following menopause. High-load activities, such as resistance training, appear to provide the best stimulus for enhancing bone mineral; however, repetitive activities, such as walking, may have a positive impact on bone mineral when performed at higher intensities. Irrespective of changes in bone mineral, physical activities that improve muscular strength, endurance, and balance may reduce fracture risk by reducing the risk of falling. The combined effect of physical activity and calcium supplementation on bone mineral needs further investigation.