High-Impact Mechanical Loading Increases Bone Material Strength in Postmenopausal Women—A 3-Month Intervention Study

Sundh, Daniel; Nilsson, Martin; Zoulakis, Michail; Pasco, Courtney; Yilmaz, Melis; Kazakia, Galateia J.; Hellgren, Martin; Lorentzon, Mattias

doi:10.1002/jbmr.3431

Cited by 45 publications

(46 citation statements)

References 41 publications

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“…This is lower than the 2.45BW per leg that resulted in femoral neck BMC increases following highimpact exercise classes (15) and less than the current study, which reports 2.37BW postintervention. (37) A similar, unilateral protocol was used in a study of postmenopausal women and reported increases in BMSi (11) but not in bone microstructure, geometry, or density measured by HR-pQCT. (10) Bone strength is determined not only by its mass but also its geometric properties.…”

Section: Discussionmentioning

confidence: 99%

“…The current study does not include quantitative computed tomography (QCT) measurements that would provide further information on cortical and trabecular bone, but this intervention has been found to stimulate greater increases in cortical BMC compared with trabecular. (37) A similar, unilateral protocol was used in a study of postmenopausal women and reported increases in BMSi (11) but not in bone microstructure, geometry, or density measured by HR-pQCT. This was a 3-month intervention, which is less than the time of a full remodeling cycle and perhaps too short to see changes in bone mineral that we have observed.…”

Section: Discussionmentioning

confidence: 99%

“…(6)(7)(8) Progressive, high-impact, unilateral exercise has improved femoral neck BMD in premenopausal women (9) and older men (10) as well as bone material strength index (BMSi) in postmenopausal women. (11) Hopping has been shown to generate ground reaction forces (GRFs) that are 72% of jumping GRF, but with force applied to a single leg. (12) The higher GRF per leg, and thus skeletal forces through the involved limb of unilateral exercise may be sufficient to produce an osteogenic response.…”

Section: Introductionmentioning

confidence: 99%

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High-Impact Exercise Increased Femoral Neck Bone Density With No Adverse Effects on Imaging Markers of Knee Osteoarthritis in Postmenopausal Women

Hartley

Folland

Kerslake

et al. 2019

Journal of Bone and Mineral Research

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High‐impact exercise can improve femoral neck bone mass but findings in postmenopausal women have been inconsistent and there may be concern at the effects of high‐impact exercise on joint health. We investigated the effects of a high‐impact exercise intervention on bone mineral density (BMD), bone mineral content (BMC), and section modulus (Z) as well as imaging biomarkers of osteoarthritis (OA) in healthy postmenopausal women. Forty‐two women aged 55 to 70 years who were at least 12 months postmenopausal were recruited. The 6‐month intervention consisted of progressive, unilateral, high‐impact exercise incorporating multidirectional hops on one randomly assigned exercise leg (EL) for comparison with the contralateral control leg (CL). Dual‐energy X‐ray absorptiometry (DXA) was used to measure BMD, BMC, and Z of the femoral neck. Magnetic resonance imaging (MRI) of the knee joint was used to analyze the biochemical composition of articular cartilage using T2 relaxometry and to analyze joint pathology associated with OA using semiquantitative analysis. Thirty‐five participants (61.7 ± 4.3 years) completed the intervention with a mean adherence of 76.8% ± 22.5%. Femoral neck BMD, BMC, and Z all increased in the EL (+0.81%, +0.69%, and +3.18%, respectively) compared to decreases in the CL (−0.57%, −0.71%, and −0.75%: all interaction effects p < 0.05). There was a significant increase in mean T2 relaxation times (main effect of time p = 0.011) but this did not differ between the EL and CL, indicating no global effect. Semiquantitative analysis showed high prevalence of bone marrow lesions (BML) and cartilage defects, especially in the patellofemoral joint (PFJ), with no indication that the intervention caused pathology progression. In conclusion, a high‐impact exercise intervention that requires little time, cost, or specialist equipment improved femoral neck BMD with no negative effects on knee OA imaging biomarkers. Unilateral high‐impact exercise is a feasible intervention to reduce hip fracture risk in healthy postmenopausal women. © 2019 American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High-Impact Exercise Increased Femoral Neck Bone Density With No Adverse Effects on Imaging Markers of Knee Osteoarthritis in Postmenopausal Women

Hartley

Folland

Kerslake

et al. 2019

Journal of Bone and Mineral Research

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“…This is unsurprising given the OsteoProbe is more user-friendly and perhaps more suitable for clinical implementation. A recent paper studied a group of 20 inactive but otherwise healthy postmenopausal women, before and after a short-term jumping exercise intervention 34 . For three months, the women were asked to jump on the same leg according to a prescribed exercise regimen.…”

Section: Osteoprobe Studiesmentioning

confidence: 99%

Clinical Measurements of Bone Tissue Mechanical Behavior Using Reference Point Indentation

Chang

Easson

Tang

2018

Clinic Rev Bone Miner Metab

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Over the last thirty years, it has become increasingly clear the amount of bone (e.g. ‘bone quantity’) and the quality of the bone matrix (e.g. ‘bone quality’) both critically contribute to bone’s tissue-level mechanical behavior and the subsequent ability of bone to resist fracture. Although determining the tissue-level mechanical behavior of bone through mechanical testing is relatively straightforward in the laboratory, the destructive nature of such testing is unfeasible in humans and in animal models requiring longitudinal observation. Therefore, surrogate measurements are necessary for quantifying tissue-level mechanical behavior for the pre-clinical and clinical evaluation of bone strength and fracture risk in vivo. A specific implementation of indentation known as reference point indentation (RPI) enables the mechanical testing of bone tissue without the need to excise and prepare the bone surface. However, this compromises the ability to carefully control the specimen geometry that is required to define the bone tissue material properties. Yet the versatility of such measurements in clinical populations is provocative, and to date there are a number of promising studies that have utilized this tool to discern bone pathologies and to monitor the effects of therapeutics on bone quality. Concurrently, on-going efforts continue to investigate the aspects of bone material behavior measured by RPI, and the compositional factors that contribute to these measurements. There are currently two variants, cyclic- and impact- RPI, that have been utilized in pre-clinical and clinical studies. This review surveys clinical studies that utilize RPI, with particular emphasis on the clinical instrument, as well as the endeavors to understand the fundamental mechanisms of such measurements. Ultimately, an improved awareness in the tradeoffs and limitations of in vivo RPI is critical towards the effective and successful utilization of this tool for the overall improvement of fragility determination in the clinic.

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“…These results strongly suggested that BMSi could detect early, treatment-induced changes in bone material properties in glucocorticoid-treated patients. In addition, increases in BMSi have been reported in postmenopausal women 3 months after a high impact exercise program [13], and in HIV-infected patients after 1 year treatment with antiretroviral agents [14] or following gastric bypass surgery in obese subjects with and without type 2 diabetes [15]. However, the effect of antiosteoporotic treatments on BMSi in patients at increased risk of fractures not receiving glucocorticoids has not been investigated.…”

Section: Introductionmentioning

confidence: 99%

Treatments of osteoporosis increase bone material strength index in patients with low bone mass

et al. 2020

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Effects on bone material properties of two-year antiosteoporotic treatment were assessed using in vivo impact microindentation (IMI) in patients with low bone mineral density (BMD) values. Antiresorptive treatment, in contrast to vitamin D ± calcium treatment alone, induced BMD-independent increases in bone material strength index, measured by IMI, the magnitude of which depended on pretreatment values. Introduction Bone material strength index (BMSi), measured by IMI in vivo, is reduced in patients with fragility fractures, but there is no information about changes in values during long-term therapy. In the present study, we assessed changes in BMSi in patients receiving antiosteoporotic treatments for periods longer than 12 months. Methods We included treatment-naive patients with low bone mass who had a BMSi measurement with OsteoProbe® at presentation and consented to a repeat measurement after treatment. Results We studied 54 patients (34 women), median age 58 years, of whom 30 were treated with bisphosphonates or denosumab (treatment group) and 24 with vitamin D ± calcium alone (control group). There were no differences in clinical characteristics between the two groups with the exception of a higher number of previous fragility fractures in the treatment group. Baseline hip BMD and BMSi values were lower in the treatment group. After 23.1 ± 6.6 months, BMSi increased significantly in the treatment group (82.4 ± 4.3 vs 79.3 ± 4.1; p < 0.001), but did not change in the control group (81.5 ± 5.2 vs 82.2 ± 4.1; p = 0.35). Changes in BMSi with antiresorptives were inversely related with baseline values (r = − 0.43; p = 0.02) but not with changes in BMD. Two patients in the control group with large decreases in BMSi values sustained incident fractures. Conclusion In patients at increased fracture risk, antiresorptive treatments induced BMD-independent increases in BMSi values, the magnitude of which depended on pretreatment values.

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High-Impact Mechanical Loading Increases Bone Material Strength in Postmenopausal Women—A 3-Month Intervention Study

Cited by 45 publications

References 41 publications

High-Impact Exercise Increased Femoral Neck Bone Density With No Adverse Effects on Imaging Markers of Knee Osteoarthritis in Postmenopausal Women

High-Impact Exercise Increased Femoral Neck Bone Density With No Adverse Effects on Imaging Markers of Knee Osteoarthritis in Postmenopausal Women

Clinical Measurements of Bone Tissue Mechanical Behavior Using Reference Point Indentation

Treatments of osteoporosis increase bone material strength index in patients with low bone mass

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