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      Exercise Early and Often: Effects of Physical Activity and Exercise on Women’s Bone Health

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          Abstract

          In 2011 over 1.7 million people were hospitalized because of a fragility fracture, and direct costs associated with osteoporosis treatment exceeded 70 billion dollars in the United States. Failure to reach and maintain optimal peak bone mass during adulthood is a critical factor in determining fragility fracture risk later in life. Physical activity is a widely accessible, low cost, and highly modifiable contributor to bone health. Exercise is especially effective during adolescence, a time period when nearly 50% of peak adult bone mass is gained. Here, we review the evidence linking exercise and physical activity to bone health in women. Bone structure and quality will be discussed, especially in the context of clinical diagnosis of osteoporosis. We review the mechanisms governing bone metabolism in the context of physical activity and exercise. Questions such as, when during life is exercise most effective, and what specific types of exercises improve bone health, are addressed. Finally, we discuss some emerging areas of research on this topic, and summarize areas of need and opportunity.

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          Most cited references96

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          Predictive value of BMD for hip and other fractures.

          The relationship between BMD and fracture risk was estimated in a meta-analysis of data from 12 cohort studies of approximately 39,000 men and women. Low hip BMD was an important predictor of fracture risk. The prediction of hip fracture with hip BMD also depended on age and z score. The aim of this study was to quantify the relationship between BMD and fracture risk and examine the effect of age, sex, time since measurement, and initial BMD value. We studied 9891 men and 29,082 women from 12 cohorts comprising EVOS/EPOS, EPIDOS, OFELY, CaMos, Rochester, Sheffield, Rotterdam, Kuopio, DOES, Hiroshima, and 2 cohorts from Gothenburg. Cohorts were followed for up to 16.3 years and a total of 168,366 person-years. The effect of BMD on fracture risk was examined using a Poisson model in each cohort and each sex separately. Results of the different studies were then merged using weighted coefficients. BMD measurement at the femoral neck with DXA was a strong predictor of hip fractures both in men and women with a similar predictive ability. At the age of 65 years, risk ratio increased by 2.94 (95% CI = 2.02-4.27) in men and by 2.88 (95% CI = 2.31-3.59) in women for each SD decrease in BMD. However, the effect was dependent on age, with a significantly higher gradient of risk at age 50 years than at age 80 years. Although the gradient of hip fracture risk decreased with age, the absolute risk still rose markedly with age. For any fracture and for any osteoporotic fracture, the gradient of risk was lower than for hip fractures. At the age of 65 years, the risk of osteoporotic fractures increased in men by 1.41 per SD decrease in BMD (95% CI = 1.33-1.51) and in women by 1.38 per SD (95% CI = 1.28-1.48). In contrast with hip fracture risk, the gradient of risk increased with age. For the prediction of any osteoporotic fracture (and any fracture), there was a higher gradient of risk the lower the BMD. At a z score of -4 SD, the risk gradient was 2.10 per SD (95% CI = 1.63-2.71) and at a z score of -1 SD, the risk was 1.73 per SD (95% CI = 1.59-1.89) in men and women combined. A similar but less pronounced and nonsignificant effect was observed for hip fractures. Data for ultrasound and peripheral measurements were available from three cohorts. The predictive ability of these devices was somewhat less than that of DXA measurements at the femoral neck by age, sex, and BMD value. We conclude that BMD is a risk factor for fracture of substantial importance and is similar in both sexes. Its validation on an international basis permits its use in case finding strategies. Its use should, however, take account of the variations in predictive value with age and BMD.
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            Bone mineral accrual from 8 to 30 years of age: an estimation of peak bone mass.

            Bone area (BA) and bone mineral content (BMC) were measured from childhood to young adulthood at the total body (TB), lumbar spine (LS), total hip (TH), and femoral neck (FN). BA and BMC values were expressed as a percentage of young-adult values to determine if and when values reached a plateau. Data were aligned on biological ages [years from peak height velocity (PHV)] to control for maturity. TB BA increased significantly from -4 to +4 years from PHV, with TB BMC reaching a plateau, on average, 2 years later at +6 years from PHV (equates to 18 and 20 years of age in girls and boys, respectively). LS BA increased significantly from -4 years from PHV to +3 years from PHV, whereas LS BMC increased until +4 from PHV. FN BA increased between -4 and +1 years from PHV, with FN BMC reaching a plateau, on average, 1 year later at +2 years from PHV. In the circumpubertal years (-2 to +2 years from PHV): 39% of the young-adult BMC was accrued at the TB in both males and females; 43% and 46% was accrued in males and females at the LS and TH, respectively; 33% (males and females) was accrued at the FN. In summary, we provide strong evidence that BA plateaus 1 to 2 years earlier than BMC. Depending on the skeletal site, peak bone mass occurs by the end of the second or early in the third decade of life. The data substantiate the importance of the circumpubertal years for accruing bone mineral. Copyright © 2011 American Society for Bone and Mineral Research.
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              Young's modulus of trabecular and cortical bone material: ultrasonic and microtensile measurements.

              An ultrasonic technique and microtensile testing were used to determine the Young's modulus of individual trabeculae and micro-specimens of cortical bone cut to similar size as individual trabeculae. The average trabecular Young's modulus measured ultrasonically and mechanically was 14.8 GPa (S.D. 1.4) and 10.4 (S.D. 3.5) and the average Young's modulus of microspecimens of cortical bone measured ultrasonically and mechanically was 20.7 GPa (S.D. 1.9) and 18.6 GPa (S.D. 3.5). With either testing technique the mean trabecular Young's modulus was found to be significantly less than that of cortical bone (p < 0.0001). However, the specimens were dried before microtensile testing so Young's modulus values may have been greater than those of trabeculae in vivo. Using Young's modulus measurements obtained from 450 cubes of cancellous bone and 256 cubes of cortical bone, Wolff's hypothesis that cortical bone is simply dense cancellous bone was tested. A multiple regression analysis that controlled for group membership showed that Young's modulus of cortical bone cannot be extrapolated from the Young's modulus vs density relationship for cancellous bone, yet the Young's modulus of trabeculae can be predicted by extrapolation from the relationship between Young's modulus vs density of the cancellous bone. These results suggest that when considered mechanically, cortical and trabecular bone are not the same material.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                28 April 2018
                May 2018
                : 15
                : 5
                : 878
                Affiliations
                Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA 01545 USA; memancuso@ 123456wpi.edu (M.E.M.); tbutler@ 123456wpi.edu (T.A.B.); jejohnson@ 123456wpi.edu (J.E.J.)
                Author notes
                [* ]Correspondence: ktroy@ 123456wpi.edu ; Tel.: +1-508-831-6093
                Article
                ijerph-15-00878
                10.3390/ijerph15050878
                5981917
                29710770
                ce0a52a7-613a-493f-a836-839f509087e9
                © 2018 by the authors.

                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
                : 15 March 2018
                : 24 April 2018
                Categories
                Review

                Public health
                bone mineral density,areal bone mineral density,volumetric bone mineral density,quantitative computed tomography,high resolution peripheral quantitative computed tomography,structure,mechanical loading,bone adaptation

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