Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Osteoporosis International
Published in: Osteoporosis International 4/2012

01-04-2012 | Original Article

Exercise and fractures in postmenopausal women: 12-year results of the Erlangen Fitness and Osteoporosis Prevention Study (EFOPS)

Authors: W. Kemmler, S. von Stengel, M. Bebenek, K. Engelke, C. Hentschke, W. A. Kalender

Published in: Osteoporosis International | Issue 4/2012

Login to get access

Abstract

Summary

This trial is the first exercise study that focuses on fracture incidence as a primary study endpoint. Although we marginally failed to determine significant effects on “overall” fracture risk (p = .074) or rate ratio (p = .095), our findings further increased the evidence that exercise relevantly prevents fractures in the elderly.

Introduction

The purpose of this study is to determine the effect of strictly supervised long-term exercise training on “overall” fracture incidence and bone mineral density (BMD) in postmenopausal osteopenic women.

Methods

Eighty-five early postmenopausal (1–8 years), osteopenic women living in the area of Erlangen–Nuremberg, Germany without any medication or diseases affecting bone metabolism were assessed after 12 years of supervised exercise (EG) or unvarying lifestyle (control, CG).
Exercisers were encouraged to perform two group sessions/week and two home training sessions/week. Calcium and vitamin D supplementation was provided for both groups. “Overall” fractures were determined by questionnaires and structured interviews. The BMD was assessed at lumbar spine and proximal femur by dual-energy X-ray absorptiometry.

Results

“Overall” fracture risk ratio in the EG was 0.32 (95% confidence interval (CI), 0.08 to 1.05; p = .074), and the rate ratio for “overall” fractures was 0.38 (95% CI, 0.11 to 1.15; p = .095). BMD changes at lumbar spine (EG, −0.8%; 95% CI, 0.8% to −2.7% vs. CG, −4.0%; 95% CI, −2.4% to −5.7%; p = .011) and femoral neck (EG, −3.7%; 95% CI, −2.4% to −5.0% vs. CG, −6.7%; 95% CI, −5.3% to −8.2%; p = .003) significantly differed between both groups.

Conclusion

Although we marginally failed to determine significant effects on overall fracture risk or rate ratio, our study increased the body of evidence for the fracture prevention efficiency of exercise programs, with special regard on bone strength (as assessed by bone mineral density measurement). Future studies should focus on subjects more prone to fractures to generate enough statistical power to clearly determine this issue.
Literature
1.
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22:465–475CrossRefPubMed
2.
Ray NF, Chan JK, Thamer M, Melton LJ III (1997) Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 12:24–35CrossRefPubMed
3.
Salkeld G (2000) Quality of life related to fear of falling and hip fracture in older women: a time trade off study. BMJ 320:341–346CrossRefPubMed
4.
De Laet CE, Pols HA (2000) Fractures in the elderly: epidemiology and demography. Baillieres Best Pract Res Clin Endocrinol Metab 14:171–179CrossRefPubMed
5.
Gregg EW, Pereira MA, Caspersen CJ (2000) Physical activity, falls, and fractures among older adults: a review of the epidemiologic evidence. J Am Geriatr Soc 48:883–893PubMed
6.
Karlsson MK, Nordqvist A, Karlsson C (2008) Physical activity, muscle function, falls and fractures. Food Nutr Res 52:1–7
7.
Moayyeri A (2008) The association between physical activity and osteoporotic fractures: a review of the evidence and implications for future research. Ann Epidemiol 18:827–835CrossRefPubMed
8.
Gregg EW, Cauley JA, Seeley DG, Ensrud KE, Bauer DC (1998) Physical activity and osteoporotic fracture risk in older women. Study of Osteoporotic Fractures Research Group. Ann Intern Med 129:81–88PubMed
9.
Silman AJ, O'Neill TW, Cooper C, Kanis J, Felsenberg D (1997) Influence of physical activity on vertebral deformity in men and women: results from the European Vertebral Osteoporosis Study. J Bone Miner Res 12:813–819CrossRefPubMed
10.
Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH (2009) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2:CD007146PubMed
11.
Kemmler W, Engelke K, Lauber D, Weineck J, Hensen J, Kalender WA (2003) The Erlangen Fitness Osteoporosis Prevention Study (EFOPS)—a controlled exercise trial in early postmenopausal women with low bone density: first year results. Arch Phys Med Rehabil 84:673–683PubMed
12.
Kemmler W, Lauber D, Weineck J, Hensen J, Kalender W, Engelke K (2004) Benefits of 2 years of intense exercise on bone density, physical fitness, and blood lipids in early postmenopausal osteopenic women: results of the Erlangen Fitness Osteoporosis Prevention Study (EFOPS). Arch Intern Med 164:1084–1091CrossRefPubMed
13.
von Stengel S, Kemmler W, Kalender WA, Engelke K, Lauber D (2007) Differential effects of strength versus power training on bone mineral density in postmenopausal women: a 2-year longitudinal study. Br J Sports Med 41:649–655CrossRef
14.
Kemmler W, Lauber D, Von Stengel S, Engelke K (2005) Developing maximum strength in older adults—a series of studies. In: Gießing J, Fröhlich M, Preuss P (eds) Current results of strength training research. Cuvillier Verlag, Göttingen, pp 114–133
15.
Fahrenberg J, Myrtek M, Wilk D, Kreutel K (1986) Multimodal assessment of life satisfaction: a study of patients with cardiovascular diseases. Psychother Psychosom Med Psychol 36:347–354PubMed
16.
Kemmler W, Weineck J, Kalender WA, Engelke K (2004) The effect of habitual physical activity, non-athletic exercise, muscle strength, and VO2max on bone parameters is rather low in early osteopenic postmenopausal women. J Muskuloskel Neuron Interact 4:325–334
17.
Salamone LM, Dallal GE, Zantos D, Makrauer F, Dawson-Hughes B (1994) Contributions of vitamin D intake and seasonal sunlight exposure to plasma 25-hydroxyvitamin D concentration in elderly women. Am J Clin Nutr 59:80–86PubMed
18.
Bebenek M, Kemmler W, von Stengel S, Engelke K, Kalender W (2010) Effect of exercise and cimicifuga racemosa (CR BNO 1055) on postmenopausal risk factors and complaints—the randomized controlled TRACE Study. Menopause 17:791–800PubMed
19.
Karinkanta S, Piirtola M, Sievanen H, Uusi-Rasi K, Kannus P (2010) Physical therapy approaches to reduce fall and fracture risk among older adults. Nat Rev Endocrinol 6(7):396–407CrossRefPubMed
20.
Cohen J (1988) Statistical power analysis for the behavioral sciences. Lawrence Earlbaum Associate, Hillsdale
21.
Ashburn A, Fazakarley L, Ballinger C, Pickering R, McLellan LD, Fitton C (2007) A randomised controlled trial of a home based exercise programme to reduce the risk of falling among people with Parkinson's disease. J Neurol Neurosurg Psychiatry 78:678–684CrossRefPubMed
22.
Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM (1999) Falls prevention over 2 years: a randomized controlled trial in women 80 years and older. Age Ageing 28:513–518CrossRefPubMed
23.
Campbell AJ, Robertson MC, Gardner MM, Norton RN, Tilyard MW, Buchner DM (1997) Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. Bmj 315:1065–1069CrossRefPubMed
24.
Kemmler W, von Stengel S, Engelke K, Haberle L, Kalender WA (2010) Exercise effects on bone mineral density, falls, coronary risk factors, and health care costs in older women: the randomized controlled senior fitness and prevention (SEFIP) study. Arch Intern Med 170:179–185CrossRefPubMed
25.
Korpelainen R, Keinanen-Kiukaanniemi S, Heikkinen J, Vaananen K, Korpelainen J (2006) Effects of impact exercise on bone mineral density in elderly women with low BMD: a population based randomized controlled 30-month intervention. Osteoporos Int 17:109–118CrossRefPubMed
26.
Korpelainen R, Keinanen-Kiukaanniemi S, Heikkinen J, Vaananen K, Korpelainen J (2006) Effect of exercise on extraskeletal risk factors for hip fractures in elderly women with low BMD: a population-based randomized controlled trial. J Bone Miner Res 21:772–779CrossRefPubMed
27.
Korpelainen R, Keinanen-Kiukaanniemi S, Nieminen P, Heikkinen J, Vaananen K, Korpelainen J (2010) Long-term outcomes of exercise: follow-up of a randomized trial in older women with osteopenia. Arch Intern Med 170:1548–1556CrossRefPubMed
28.
McMurdo ME, Mole PA, Paterson CR (1997) Controlled trial of weight bearing exercise in older women in relation to bone density and falls. BMJ 314:569CrossRefPubMed
29.
Robertson MC, Devlin N, Gardner MM, Campbell AJ (2001) Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: randomised controlled trial. BMJ 322:697–701CrossRefPubMed
30.
Robertson MC, Gardner MM, Devlin N, McGee R, Campbell AJ (2001) Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 2: controlled trial in multiple centres. BMJ 322:701–704CrossRefPubMed
31.
Sinaki M, Itoi E, Wahner HW, Wollan PC, Gelczer RK, Mullan BP, Collins DA, Hodgson SF (2002) Stronger back muscles reduce the incidence of vertebral fractures: a prospective 10 year follow-up of postmenopausal women. Bone 30:836–841CrossRefPubMed
32.
Gwi-Ryung S, Sung-Hyun C, YoungRan T (2010) Falls among Koreans 45 years of age and older: incidence and risk factors. J Adv Nurs 66:2014–2024
33.
Snow CM, Shaw JM, Winters KM, Witzke KA (2000) Long-term exercise using weighted vests prevents hip bone loss in postmenopausal women. J Gerontol A Biol Sci Med Sci 55:M489–M491CrossRefPubMed
34.
Uusi-Rasi K, Sievanen H, Heinonen A, Vuori I, Beck TJ, Kannus P (2006) Long-term recreational gymnastics provides a clear benefit in age-related functional decline and bone loss. A prospective 6-year study. Osteoporos Int 17:1154–1164CrossRefPubMed
35.
Beck TJ, Kohlmeier LA, Petit MA, Wu G, Leboff MS, Cauley JA, Nicholas S, Chen Z (2011) Confounders in the association between exercise and femur bone in postmenopausal women. Med Sci Sports Exerc 43(1):80–89CrossRefPubMed
36.
Wolff I, van Croonenborg JJ, Kemper HC, Kostense PJ, Twisk JW (1999) The effect of exercise training programs on bone mass: a meta-analysis of published controlled trials in pre- and postmenopausal women. Osteoporos Int 9:1–12CrossRefPubMed
37.
Kelley GA, Kelley KS, Tran ZV (2000) Exercise and bone mineral density in men: a meta-analysis. J Appl Physiol 88:1730–1736PubMed
38.
Cumming RG (2002) Intervention strategies and risk-factor modification for falls prevention. A review of recent intervention studies. Clin Geriatr Med 18:175–189CrossRefPubMed
39.
Mackenzie L, Byles J, D’Este C (2006) Validation of self-reported fall events in intervention studies. Clin Rehabil 20:331–339CrossRefPubMed
40.
Guglielmi G, Floriani I, Torri V, Li J, van Kuijk C, Genant HK, Lang TF (2005) Effect of spinal degenerative changes on volumetric bone mineral density of the central skeleton as measured by quantitative computed tomography. Acta Radiol 46:269–275CrossRefPubMed
41.
van Rijn RP, van Kuijk C (2008) Spinal quantitative computed tomography. In: Baert AL, Knauth M, Sartor K (eds) Radiology of osteoporosis. Springer, Heidelberg, pp 137–142CrossRef
42.
Kemmler W, von Stengel S (2011) Exercise and osteoporosis-related fractures: perspectives and recommendations of the sports and exercise scientist. Physician and Sportmedicine 39:142–157CrossRef
43.
Wallace BA, Cumming RG (2000) Systematic review of randomized trials of the effect of exercise on bone mass in pre- and postmenopausal women. Calcif Tissue Int 67:10–18CrossRefPubMed
Metadata
Title
Exercise and fractures in postmenopausal women: 12-year results of the Erlangen Fitness and Osteoporosis Prevention Study (EFOPS)
Authors
W. Kemmler
S. von Stengel
M. Bebenek
K. Engelke
C. Hentschke
W. A. Kalender
Publication date
01-04-2012
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 4/2012
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-011-1663-5

Other articles of this Issue 4/2012

Osteoporosis International 4/2012 Go to the issue

Original Article

Genetic influence on bone mineral density in Korean twins and families: the healthy twin study

Original Article

Bone texture analysis of human femurs using a new device (BMA™) improves failure load prediction

Original Article

Development and validation of a tool for identifying women with low bone mineral density and low-impact fractures: the São Paulo Osteoporosis Risk Index (SAPORI)

Original Article

Effects of paracetamol, non-steroidal anti-inflammatory drugs, acetylsalicylic acid, and opioids on bone mineral density and risk of fracture: results of the Danish Osteoporosis Prevention Study (DOPS)

Erratum

Erratum to: Ethnic differences in composite indices of femoral neck strength

Original Article

Osteoporosis medication prescribing in British Columbia and Ontario: impact of public drug coverage