Modelling Human Locomotion to Inform Exercise Prescription for Osteoporosis

Abstract

Purpose of Review We review the literature on hip fracture mechanics and models of hip strain during exercise to postulate the exercise regimen for best promoting hip strength. Recent Findings The superior neck is a common location for hip fracture and a relevant exercise target for osteoporosis. Current modelling studies showed that fast walking and stair ambulation, but not necessarily running, optimally load the femoral neck and therefore theoretically would mitigate the natural age-related bone decline, being easily integrated into routine daily activity. High intensity jumps and hopping have been shown to promote anabolic response by inducing high strain in the superior anterior neck. Multidirectional exercises may cause beneficial non-habitual strain patterns across the entire femoral neck. Resistance knee flexion and hip extension exercises can induce high strain in the superior neck when performed using maximal resistance loadings in the average population. Summary Exercise can stimulate an anabolic response of the femoral neck either by causing higher than normal bone strain over the entire hip region or by causing bending of the neck and localized strain in the superior cortex. Digital technologies have enabled studying interdependences between anatomy, bone distribution, exercise, strain and metabolism and may soon enable personalized prescription of exercise for optimal hip strength.

Exercise attenuates bone mineral density loss during diet-induced weight loss in adults with overweight and obesity: A systematic review and meta-analysis

“… 38 , 39 Thus, the prescribed exercises in the studies included in our analyses probably applied different loads across the femoral neck and other hip regions. 37 , 40 Our subanalyses at the femoral neck also demonstrated that bone loss was attenuated by exercise in adults aged ≥60 years but not in those aged <60 years. Exercise may, therefore, be particularly important for older adults with overweight and obesity when undergoing diet-induced weight loss, and this is supported by the evidence that weight loss is associated with increased likelihood of fractures in older populations.…”

Assessment of femoral neck strength and bone mineral density changes following exercise using 3D-DXA images

“…Therefore, it appears that exercise can have a remarkable effect on strength despite inducing a relatively modest BMD response. Yet, the optimal exercise type and amount for optimal hip strength in each participant remains to be determined (Martelli et al, 2020).…”

Damage Tolerance and Toughness of Elderly Human Femora

“…Preventative solutions may help understanding the causes and mitigate the burden of hip fracture. As aging typically leads to reduced bone mass particularly in bone regions subjected to infrequent (unusual) motor tasks, these observations may help explaining the beneficial effect of odd-impact activities on hip health [34] , the decreased prevalence of hip fracture in societies with higher and more variable activity levels [7] and, as part of our society's drive for healthy ageing, exercise treatments to promote bone health [35] . For example, a new generation of anabolic treatments, alongside the traditional anti-resorptive treatments, may be able to specifically target femoral regions of most pronounced bone loss in frail people.…”