Skip to main content
Top
Published in: Osteoporosis International 8/2009

01-08-2009 | Original Article

Targeted exercises against hip fragility

Authors: R. Nikander, P. Kannus, P. Dastidar, M. Hannula, L. Harrison, T. Cervinka, N. G. Narra, R. Aktour, T. Arola, H. Eskola, S. Soimakallio, A. Heinonen, J. Hyttinen, H. Sievänen

Published in: Osteoporosis International | Issue 8/2009

Login to get access

Abstract

Summary

Compared to high-impact exercises, moderate-magnitude impacts from odd-loading directions have similar ability to thicken vulnerable cortical regions of the femoral neck. Since odd-impact exercises are mechanically less demanding to the body, this type of exercise can provide a reasonable basis for devising feasible, targeted bone training against hip fragility.

Introduction

Regional cortical thinning at the femoral neck is associated with hip fragility. Here, we investigated whether exercises involving high-magnitude impacts, moderate-magnitude impacts from odd directions, high-magnitude muscle forces, low-magnitude impacts at high repetition rate, or non-impact muscle forces at high repetition rate were associated with thicker femoral neck cortex.

Methods

Using three-dimensional magnetic resonance imaging, we scanned the proximal femur of 91 female athletes, representing the above-mentioned five exercise-loadings, and 20 referents. Cortical thickness at the inferior, anterior, superior, and posterior regions of the femoral neck was evaluated. Between-group differences were analyzed with ANCOVA.

Results

For the inferior cortical thickness, only the high-impact group differed significantly (~60%, p = 0.012) from the reference group, while for the anterior cortex, both the high-impact and odd-impact groups differed (~20%, p = 0.042 and p = 0.044, respectively). Also, the posterior cortex was ~20% thicker (p = 0.014 and p = 0.006, respectively) in these two groups.

Conclusions

Odd-impact exercise-loading was associated, similar to high-impact exercise-loading, with ~20% thicker cortex around the femoral neck. Since odd-impact exercises are mechanically less demanding to the body than high-impact exercises, it is argued that this type of bone training would offer a feasible basis for targeted exercise-based prevention of hip fragility.
Literature
2.
3.
4.
go back to reference Frost HM (2003) Bone’s mechanostat: a 2003 update. Anat Rec 275A:1081–1101CrossRef Frost HM (2003) Bone’s mechanostat: a 2003 update. Anat Rec 275A:1081–1101CrossRef
5.
go back to reference Ruff C, Holt B, Trinkaus E (2006) Who’s afraid of the big bad Wolff?: ‘‘Wolff’s law’’ and bone functional adaptation. Am J Phys Anthropol 129:484–498PubMedCrossRef Ruff C, Holt B, Trinkaus E (2006) Who’s afraid of the big bad Wolff?: ‘‘Wolff’s law’’ and bone functional adaptation. Am J Phys Anthropol 129:484–498PubMedCrossRef
6.
go back to reference Mayhew PM, Thomas CD, Clement JG, Loveridge N, Beck TJ, Bonfield W, Burgoyne CJ, Reeve J (2005) Relation between age, femoral neck cortical stability, and hip fracture risk. Lancet 366:129–135PubMedCrossRef Mayhew PM, Thomas CD, Clement JG, Loveridge N, Beck TJ, Bonfield W, Burgoyne CJ, Reeve J (2005) Relation between age, femoral neck cortical stability, and hip fracture risk. Lancet 366:129–135PubMedCrossRef
7.
go back to reference Bell KL, Loveridge N, Power J, Garrahan N, Meggitt BF, Reeve J (1999) Regional differences in cortical porosity in the fractured femoral neck. Bone 24:57–64PubMedCrossRef Bell KL, Loveridge N, Power J, Garrahan N, Meggitt BF, Reeve J (1999) Regional differences in cortical porosity in the fractured femoral neck. Bone 24:57–64PubMedCrossRef
8.
go back to reference Bell KL, Loveridge N, Power J, Garrahan N, Stanton M, Lunt M, Meggitt BF, Reeve J (1999) Structure of the femoral neck in hip fracture: cortical bone loss in the inferoanterior to superoposterior axis. J Bone Miner Res 14:111–119PubMedCrossRef Bell KL, Loveridge N, Power J, Garrahan N, Stanton M, Lunt M, Meggitt BF, Reeve J (1999) Structure of the femoral neck in hip fracture: cortical bone loss in the inferoanterior to superoposterior axis. J Bone Miner Res 14:111–119PubMedCrossRef
9.
go back to reference Crabtree N, Loveridge N, Parker M, Rushton N, Power J, Bell KL, Beck TJ, Reeve J (2001) Intracapsular hip fracture and the region specific loss of cortical bone: analysis by peripheral quantitative computed tomography. J Bone Miner Res 16:1318–1328PubMedCrossRef Crabtree N, Loveridge N, Parker M, Rushton N, Power J, Bell KL, Beck TJ, Reeve J (2001) Intracapsular hip fracture and the region specific loss of cortical bone: analysis by peripheral quantitative computed tomography. J Bone Miner Res 16:1318–1328PubMedCrossRef
10.
go back to reference Mayhew P, Kaptoge S, Loveridge N, Power J, Kroger HP, Parker M, Reeve J (2004) Discrimination between cases of hip fracture and controls is improved by hip structural analysis compared to areal bone mineral density. An ex vivo study of the femoral neck. Bone 34:352–361PubMedCrossRef Mayhew P, Kaptoge S, Loveridge N, Power J, Kroger HP, Parker M, Reeve J (2004) Discrimination between cases of hip fracture and controls is improved by hip structural analysis compared to areal bone mineral density. An ex vivo study of the femoral neck. Bone 34:352–361PubMedCrossRef
11.
go back to reference Kannus P, Sievänen H, Palvanen M, Järvinen T, Parkkari J (2005) Prevention of falls and consequent injuries in elderly people. Lancet 366:1885–1893PubMedCrossRef Kannus P, Sievänen H, Palvanen M, Järvinen T, Parkkari J (2005) Prevention of falls and consequent injuries in elderly people. Lancet 366:1885–1893PubMedCrossRef
12.
go back to reference Sievänen H, Kannus P (2007) Physical activity reduces the risk of fragility fracture. PLoS Med 4:e222PubMedCrossRef Sievänen H, Kannus P (2007) Physical activity reduces the risk of fragility fracture. PLoS Med 4:e222PubMedCrossRef
13.
go back to reference Järvinen TL, Sievänen H, Khan KM, Heinonen A, Kannus P (2008) Shifting the focus in fracture prevention from osteoporosis to falls. BMJ 336:124–126PubMedCrossRef Järvinen TL, Sievänen H, Khan KM, Heinonen A, Kannus P (2008) Shifting the focus in fracture prevention from osteoporosis to falls. BMJ 336:124–126PubMedCrossRef
14.
go back to reference Nikander R, Sievänen H, Heinonen A, Karstila T, Kannus P (2008) Load-specific differences in the structure of femoral neck and tibia between world-class moguls skiers and slalom skiers. Scand J Med Sci Sports 8:145–153 Nikander R, Sievänen H, Heinonen A, Karstila T, Kannus P (2008) Load-specific differences in the structure of femoral neck and tibia between world-class moguls skiers and slalom skiers. Scand J Med Sci Sports 8:145–153
15.
go back to reference Nikander R, Sievanen H, Heinonen A, Kannus P (2005) Femoral neck structure in adult female athletes subjected to different loading modalities. J Bone Miner Res 20:520–528PubMedCrossRef Nikander R, Sievanen H, Heinonen A, Kannus P (2005) Femoral neck structure in adult female athletes subjected to different loading modalities. J Bone Miner Res 20:520–528PubMedCrossRef
16.
go back to reference Heinonen A, Sievanen H, Kyrolainen H, Perttunen J, Kannus P (2001) Mineral mass, size, and estimated mechanical strength of triple jumpers’ lower limb. Bone 29:279–285PubMedCrossRef Heinonen A, Sievanen H, Kyrolainen H, Perttunen J, Kannus P (2001) Mineral mass, size, and estimated mechanical strength of triple jumpers’ lower limb. Bone 29:279–285PubMedCrossRef
17.
go back to reference Bolotin HH, Sievanen H, Grashuis JL, Kuiper JW, Jarvinen TL (2001) Inaccuracies inherent in patient-specific dual-energy X-ray absorptiometry bone mineral density measurements: comprehensive phantom-based evaluation. J Bone Miner Res 6:417–426CrossRef Bolotin HH, Sievanen H, Grashuis JL, Kuiper JW, Jarvinen TL (2001) Inaccuracies inherent in patient-specific dual-energy X-ray absorptiometry bone mineral density measurements: comprehensive phantom-based evaluation. J Bone Miner Res 6:417–426CrossRef
18.
go back to reference Beck TJ (2007) Extending DXA beyond bone mineral density: understanding hip structural analysis. Curr Osteoporos Rep 5:49–55PubMedCrossRef Beck TJ (2007) Extending DXA beyond bone mineral density: understanding hip structural analysis. Curr Osteoporos Rep 5:49–55PubMedCrossRef
19.
go back to reference McKay HA, Sievanen H, Petit MA, MacKelvie K, Forkheim KA, Whittall KP, Forster BB, MacDonald H (2004) Application of magnetic resonance imaging to evaluation of femoral neck structure in growing girls. J Clin Densitom 7:161–168PubMedCrossRef McKay HA, Sievanen H, Petit MA, MacKelvie K, Forkheim KA, Whittall KP, Forster BB, MacDonald H (2004) Application of magnetic resonance imaging to evaluation of femoral neck structure in growing girls. J Clin Densitom 7:161–168PubMedCrossRef
20.
go back to reference Gomberg BR, Saha PK, Wehrli FW (2005) Method for cortical bone structural analysis from magnetic resonance images. Acad Radiol 12:1320–1332PubMedCrossRef Gomberg BR, Saha PK, Wehrli FW (2005) Method for cortical bone structural analysis from magnetic resonance images. Acad Radiol 12:1320–1332PubMedCrossRef
21.
go back to reference Sievanen H, Karstila T, Apuli P, Kannus P (2007) Magnetic resonance imaging of the femoral neck cortex. Acta Radiol 48:308–314PubMedCrossRef Sievanen H, Karstila T, Apuli P, Kannus P (2007) Magnetic resonance imaging of the femoral neck cortex. Acta Radiol 48:308–314PubMedCrossRef
22.
go back to reference Nikander R, Sievänen H, Heinonen A, Kannus P (2006) Loading modalities and bone structures at nonweight-bearing upper extremity and weight-bearing lower extremity—a pQCT study of adult female athletes. Bone 39:886–894PubMedCrossRef Nikander R, Sievänen H, Heinonen A, Kannus P (2006) Loading modalities and bone structures at nonweight-bearing upper extremity and weight-bearing lower extremity—a pQCT study of adult female athletes. Bone 39:886–894PubMedCrossRef
23.
go back to reference Heinonen A, Sievanen H, Viitasalo J, Pasanen M, Oja P, Vuori I (1994) Reproducibility of computer measurement of maximal isometric strength and electromyography in sedentary middle-aged women. Eur J Appl Physiol 68:310–314CrossRef Heinonen A, Sievanen H, Viitasalo J, Pasanen M, Oja P, Vuori I (1994) Reproducibility of computer measurement of maximal isometric strength and electromyography in sedentary middle-aged women. Eur J Appl Physiol 68:310–314CrossRef
24.
go back to reference Torvinen S, Sievanen H, Jarvinen TA, Pasanen M, Kontulainen S, Kannus P (2002) Effect of 4-min vertical whole body vibration on muscle performance and body balance: a randomized cross-over study. Int J Sports Med 23:374–379PubMedCrossRef Torvinen S, Sievanen H, Jarvinen TA, Pasanen M, Kontulainen S, Kannus P (2002) Effect of 4-min vertical whole body vibration on muscle performance and body balance: a randomized cross-over study. Int J Sports Med 23:374–379PubMedCrossRef
25.
go back to reference Sievänen H, Koskue V, Rauhio A, Kannus P, Heinonen A, Vuori I (1998) Peripheral quantitative computed tomography in human long bones: evaluation of in vitro and in vivo precision. J Bone Miner Res 13:871–882PubMedCrossRef Sievänen H, Koskue V, Rauhio A, Kannus P, Heinonen A, Vuori I (1998) Peripheral quantitative computed tomography in human long bones: evaluation of in vitro and in vivo precision. J Bone Miner Res 13:871–882PubMedCrossRef
26.
go back to reference Kontulainen S, Sievanen H, Kannus P, Pasanen M, Vuori I (2002) Effect of long-term impact-loading on mass, size, and estimated strength of humerus and radius of female racquet-sports players: a peripheral quantitative computed tomography study between young and old starters and controls. J Bone Miner Res 17:2281–2289PubMedCrossRef Kontulainen S, Sievanen H, Kannus P, Pasanen M, Vuori I (2002) Effect of long-term impact-loading on mass, size, and estimated strength of humerus and radius of female racquet-sports players: a peripheral quantitative computed tomography study between young and old starters and controls. J Bone Miner Res 17:2281–2289PubMedCrossRef
27.
go back to reference Heinonen A, Sievanen H, Kannus P, Oja P, Vuori I (2002) Site-specific skeletal response to long-term weight training seems to be attributable to principal loading modality: a pQCT study of female weightlifters. Calcif Tissue Int 70:469–474PubMedCrossRef Heinonen A, Sievanen H, Kannus P, Oja P, Vuori I (2002) Site-specific skeletal response to long-term weight training seems to be attributable to principal loading modality: a pQCT study of female weightlifters. Calcif Tissue Int 70:469–474PubMedCrossRef
28.
go back to reference Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H, Vuori I, Järvinen M (1999) Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int 65:183–187PubMedCrossRef Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H, Vuori I, Järvinen M (1999) Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int 65:183–187PubMedCrossRef
29.
go back to reference Feskanich D, Willett W, Colditz G (2002) Walking and leisure-time activity and risk of hip fracture in postmenopausal women. JAMA 288:2300–2306PubMedCrossRef Feskanich D, Willett W, Colditz G (2002) Walking and leisure-time activity and risk of hip fracture in postmenopausal women. JAMA 288:2300–2306PubMedCrossRef
30.
go back to reference Michaelsson K, Olofsson H, Jensevik K, Larsson S, Mallmin H, Berglund L, Vessby M, Melhus H (2007) Leisure physical activity and the risk of fracture in men. PLoS Med 4:e199PubMedCrossRef Michaelsson K, Olofsson H, Jensevik K, Larsson S, Mallmin H, Berglund L, Vessby M, Melhus H (2007) Leisure physical activity and the risk of fracture in men. PLoS Med 4:e199PubMedCrossRef
31.
go back to reference Nordström A, Karlsson C, Nyquist F, Olsson T, Nordström P, Karlsson M (2005) Bone loss and fracture risk after reduced physical activity. J Bone Miner Res 20:202–207PubMedCrossRef Nordström A, Karlsson C, Nyquist F, Olsson T, Nordström P, Karlsson M (2005) Bone loss and fracture risk after reduced physical activity. J Bone Miner Res 20:202–207PubMedCrossRef
32.
go back to reference Lotz JC, Cheal EJ, Hayes WC (1995) Stress distributions within the proximal femur during gait and falls: implications for osteoporotic fracture. Osteoporos Int 5:252–261PubMedCrossRef Lotz JC, Cheal EJ, Hayes WC (1995) Stress distributions within the proximal femur during gait and falls: implications for osteoporotic fracture. Osteoporos Int 5:252–261PubMedCrossRef
33.
go back to reference Hayes WC, Myers ER, Robinovich SN, van der Kroonenberg A, Courtney AC, McMahon TA (1996) Etiology and prevention of age-related hip-fractures. Bone 18:77S–86SPubMedCrossRef Hayes WC, Myers ER, Robinovich SN, van der Kroonenberg A, Courtney AC, McMahon TA (1996) Etiology and prevention of age-related hip-fractures. Bone 18:77S–86SPubMedCrossRef
34.
go back to reference Vainionpaa A, Korpelainen R, Vihriala E, Rinta-Paavola A, Leppaluoto J, Jamsa T (2006) Intensity of exercise is associated with bone density change in premenopausal women. Osteoporos Int 17:455–463PubMedCrossRef Vainionpaa A, Korpelainen R, Vihriala E, Rinta-Paavola A, Leppaluoto J, Jamsa T (2006) Intensity of exercise is associated with bone density change in premenopausal women. Osteoporos Int 17:455–463PubMedCrossRef
35.
go back to reference van den Bogert AJ, Read L, Nigg BM (1999) An analysis of hip joint loading during walking, running, and skiing. Med Sci Sports Exerc 31:131–142PubMedCrossRef van den Bogert AJ, Read L, Nigg BM (1999) An analysis of hip joint loading during walking, running, and skiing. Med Sci Sports Exerc 31:131–142PubMedCrossRef
36.
go back to reference Daly RM, Rich PA, Klein R, Bass S (1999) Effects of high-impact exercise on ultrasonic and biochemical indices of skeletal status: a prospective study in young male gymnasts. J Bone Miner Res 14:1222–1230PubMedCrossRef Daly RM, Rich PA, Klein R, Bass S (1999) Effects of high-impact exercise on ultrasonic and biochemical indices of skeletal status: a prospective study in young male gymnasts. J Bone Miner Res 14:1222–1230PubMedCrossRef
37.
go back to reference Heinonen A, Kannus P, Sievänen H, Oja P, Pasanen M, Rinne M, Uusi–Rasi K, Vuori I (1996) Randomised controlled trial of effect of high-impact exercise on selected risk factors for osteoporotic fractures. Lancet 348:1343–1347PubMedCrossRef Heinonen A, Kannus P, Sievänen H, Oja P, Pasanen M, Rinne M, Uusi–Rasi K, Vuori I (1996) Randomised controlled trial of effect of high-impact exercise on selected risk factors for osteoporotic fractures. Lancet 348:1343–1347PubMedCrossRef
38.
go back to reference Uusi-Rasi K, Kannus P, Cheng S, Sievänen H, Pasanen M, Heinonen A, Nenonen A, Halleen J, Fuerst T, Genant H, Vuori I (2003) Effect of alendronate and exercise on bone and physical performance of postmenopausal women: a randomized controlled trial. Bone 33:132–143PubMedCrossRef Uusi-Rasi K, Kannus P, Cheng S, Sievänen H, Pasanen M, Heinonen A, Nenonen A, Halleen J, Fuerst T, Genant H, Vuori I (2003) Effect of alendronate and exercise on bone and physical performance of postmenopausal women: a randomized controlled trial. Bone 33:132–143PubMedCrossRef
39.
go back to reference Bergström I, Landgren BM, Brinck J, Freyschuss B (2008) Physical training preserves bone mineral density in postmenopausal women with forearm fractures and low bone mineral density. Osteopor Int 19:177–188CrossRef Bergström I, Landgren BM, Brinck J, Freyschuss B (2008) Physical training preserves bone mineral density in postmenopausal women with forearm fractures and low bone mineral density. Osteopor Int 19:177–188CrossRef
40.
go back to reference Karinkanta S, Heinonen A, Sievänen HA, Uusi-Rasi K, Pasanen M, Ojala K, Fogelholm M, Kannus P (2007) Multi-component exercise regimen to prevent functional decline and bone fragility in home-dwelling elderly women: randomized, controlled trial. Osteoporos Int 18:453–462PubMedCrossRef Karinkanta S, Heinonen A, Sievänen HA, Uusi-Rasi K, Pasanen M, Ojala K, Fogelholm M, Kannus P (2007) Multi-component exercise regimen to prevent functional decline and bone fragility in home-dwelling elderly women: randomized, controlled trial. Osteoporos Int 18:453–462PubMedCrossRef
41.
go back to reference Liu-Ambrose TY, Khan KM, Eng JJ, Heinonen A, McKay HA (2004) Both resistance and agility training increase cortical bone density in 75- to 85-year-old women with low bone mass: a 6-month randomized controlled trial. J Clin Dens 7:390–398CrossRef Liu-Ambrose TY, Khan KM, Eng JJ, Heinonen A, McKay HA (2004) Both resistance and agility training increase cortical bone density in 75- to 85-year-old women with low bone mass: a 6-month randomized controlled trial. J Clin Dens 7:390–398CrossRef
42.
go back to reference Korpelainen R, Keinänen-Kiukaanniemi S, Heikkinen J, Väänänen K, Korpelainen J (2006) Effect of impact exercise on bone mineral density in elderly women with low BMD: a population-based randomized controlled 30-month intervention. Osteoporos Int 17:109–118PubMedCrossRef Korpelainen R, Keinänen-Kiukaanniemi S, Heikkinen J, Väänänen K, Korpelainen J (2006) Effect of impact exercise on bone mineral density in elderly women with low BMD: a population-based randomized controlled 30-month intervention. Osteoporos Int 17:109–118PubMedCrossRef
Metadata
Title
Targeted exercises against hip fragility
Authors
R. Nikander
P. Kannus
P. Dastidar
M. Hannula
L. Harrison
T. Cervinka
N. G. Narra
R. Aktour
T. Arola
H. Eskola
S. Soimakallio
A. Heinonen
J. Hyttinen
H. Sievänen
Publication date
01-08-2009
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 8/2009
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-008-0785-x

Other articles of this Issue 8/2009

Osteoporosis International 8/2009 Go to the issue