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      Prescribing Physical Activity for the Prevention and Treatment of Osteoporosis in Older Adults

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          Abstract

          Osteoporosis is an age-related disease, characterised by low bone mineral density (BMD) and compromised bone geometry and microarchitecture, leading to reduced bone strength. Physical activity (PA) has potential as a therapy for osteoporosis, yet different modalities of PA have varying influences on bone health. This review explores current evidence for the benefits of PA, and targeted exercise regimes for the prevention and treatment of osteoporosis in older adults. In particular, the outcomes of interventions involving resistance training, low- and high-impact weight bearing activities, and whole-body vibration therapy are discussed. Finally, we present recommendations for future research that may maximise the potential of exercise in primary and secondary prevention of osteoporosis in the ageing population.

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          Objectively measured sedentary time, physical activity, and metabolic risk: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab).

          Genevieve N Healy, Katrien Wijndaele, David Dunstan … (2008)
          We examined the associations of objectively measured sedentary time and physical activity with continuous indexes of metabolic risk in Australian adults without known diabetes. An accelerometer was used to derive the percentage of monitoring time spent sedentary and in light-intensity and moderate-to-vigorous-intensity activity, as well as mean activity intensity, in 169 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) participants (mean age 53.4 years). Associations with waist circumference, triglycerides, HDL cholesterol, resting blood pressure, fasting plasma glucose, and a clustered metabolic risk score were examined. Independent of time spent in moderate-to-vigorous-intensity activity, there were significant associations of sedentary time, light-intensity time, and mean activity intensity with waist circumference and clustered metabolic risk. Independent of waist circumference, moderate-to-vigorous-intensity activity time was significantly beneficially associated with triglycerides. These findings highlight the importance of decreasing sedentary time, as well as increasing time spent in physical activity, for metabolic health.
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            Bone "mass" and the "mechanostat": a proposal.

            H. Frost (1987)
            The observed fit of bone mass to a healthy animal's typical mechanical usage indicates some mechanism or mechanisms monitor that usage and control the three longitudinal growth, bone modeling, and BMU-based remodeling activities that directly determine bone mass. That mechanism could be named a mechanostat. Accumulated evidence suggests it includes the bone itself, plus mechanisms that transform its mechanical usage into appropriate signals, plus other mechanisms that detect those signals and then direct the above three biologic activities. In vivo studies have shown that bone strains in or above the 1500-3000 microstrain range cause bone modelling to increase cortical bone mass, while strains below the 100-300 microstrain range release BMU-based remodeling which then removes existing cortical-endosteal and trabecular bone. That arrangement provides a dual system in which bone modeling would adapt bone mass to gross overloading, while BMU-based remodeling would adapt bone mass to gross underloading, and the above strain ranges would be the approximate "setpoints" of those responses. The anatomical distribution of those mechanical usage effects are well known. If circulating agents or disease changed the effective setpoints of those responses their bone mass effects should copy the anatomical distribution of the mechanical usage effects. That seems to be the case for many agents and diseases, and several examples are discussed, including postmenopausal osteoporosis, fluoride effects, bone loss in orbit, and osteogenesis imperfecta. The mechanostat proposal is a seminal idea which fits diverse evidence but it requires critique and experimental study.
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              Osteoporosis: impact on health and economics.

              Nicholas J.A. Harvey, Elaine Dennison, Cyrus Cooper (2010)
              Osteoporosis is a major public health problem through associated fragility fractures. The most common sites of fracture are the hip, spine and wrist, and these have an enormous health and economic impact. All fractures result in some degree of morbidity, but fractures at the hip are associated with the worst outcomes. The worldwide direct and indirect annual costs of hip fracture in 1990 were estimated at US$34.8 billion, and are expected to increase substantially over the next 50 years. Fracture incidence varies between populations, and is set to increase over coming decades as the global population becomes more elderly. This effect will be particularly marked in the developing world, which is additionally assuming more-westernized lifestyles that predispose to increased fracture risk. Strategies to target those at high risk of fracture have been developed, but preventative measures at the public health level are also urgently needed to reduce the burden of this devastating disease.
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                Author and article information

                Contributors
                Susanne Iwarsson: Role: Academic Editor
                Journal
                Journal ID (nlm-ta): Healthcare (Basel)
                Journal ID (iso-abbrev): Healthcare (Basel)
                Journal ID (publisher-id): healthcare
                Title: Healthcare
                Publisher: MDPI
                ISSN (Electronic): 2227-9032
                Publication date (Electronic): 06 November 2017
                Publication date Collection: December 2017
                Volume: 5
                Issue: 4
                Electronic Location Identifier: 85
                Affiliations
                [1 ]School of Clinical Sciences at Monash Health, Monash Medical Centre, Monash University, Clayton, VIC 3168, Australia; ayse.zengin@ 123456monash.edu (A.Z.); peter.ebeling@ 123456monash.edu (P.R.E.); david.scott@ 123456monash.edu (D.S.)
                [2 ]Department of Medicine, Melbourne Medical School (Western Campus), The University of Melbourne, St Albans, Melbourne, VIC 3021, Australia
                [3 ]Australian Institute for Musculoskeletal Science (AIMSS), Sunshine Hospital, St Albans, Melbourne, VIC 3021, Australia
                Author notes
                [* ]Correspondence: lachlan.mcmillan@ 123456monash.edu ; Tel.: +61-412-467-039
                Author information
                https://orcid.org/0000-0002-0954-8406
                https://orcid.org/0000-0001-5226-1972
                Article
                Publisher ID: healthcare-05-00085
                DOI: 10.3390/healthcare5040085
                PMC ID: 5746719
                PubMed ID: 29113119
                SO-VID: 50a77ad0-4b8b-4211-b79a-c66074f0ba4e
                Copyright © © 2017 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 22 September 2017
                Date accepted : 31 October 2017
                Categories
                Subject: Review

                Keywords: physical activity,exercise,bone mineral density,osteoporosis,resistance training,weight-bearing
                Data availability:
                Keywords: physical activity, exercise, bone mineral density, osteoporosis, resistance training, weight-bearing

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