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Male Osteoporosis and Strength Training

Male Osteoporosis and Strength Training

            Male osteoporosis is underdiagnosed and undertreated but there is increased attention to this public health problem. In a recently published Endocrine Society Clinical Practice Guideline, increased testing is recommended for males over the age of 70 years and for males 50-69 years old who have risk factors [1]. Treatment recommendations included sufficient calcium, vitamin D and weight bearing exercise. The evidence of the benefits of exercise on bone mineral density on males with osteoporosis is growing but remains far from conclusive.

            The research on strength training for males in relationship to bone is diverse because of the variety of strength training exercises. They range between progressive resistive exercise with weights or machines to low load, high repetition resistance and to vibration exercise.

            Although some research indicates that resistance exercise does not increase bone mineral density (BMD), but these studies may not have had sufficient intensity [2, 3, 4]. A lifetime of weightlifting and impact activities, such as boxing, demonstrates beneficial effects on BMD [5]. In a review article Cheung and Giangregorio, summarize their findings that older persons engaging in strength training activity and high force dynamic exercise can enhance their BMD [6]. “Males with the greatest muscle power had the greatest bone strength”. Several small studies found beneficial effects of high impact or resistance training on the BMD in some, but not all, sites that were tested [7, 8, 9]. Daly et al studied high intensity resistance training for 12 months in older overweight adults with Type 2 diabetes ages 60-80 years and reported the resistance training group maintained their BMD and bone mineral content whereas the non-exercising group lost BMD [10]. Braith et al measured BMD for the total body, femoral neck, and lumbar vertebrae in 16 male heart transplant recipients. They found resistance exercise for 6 months offset the BMD loss which was found 2 months after transplantation [11]. The control group did not recover any of the losses.  Chilibeck et al studied 29 older men age 71 who performed resistance training for 12 weeks [12]. They found creatine supplementation enhanced BMD. Yarasheski and colleagues used daily growth hormone along with resistance training for 16 weeks 4 times a week in healthy males, aged 67 years [13]. They found BMD of the proximal femur significantly increased but BMD was not increased at the spine or the femoral neck. Kukuljan et al studied 180 men between the ages of 50 and 79 years of age [14]. They exercised 3 times weekly with progressive resistive exercise and weight bearing impact activities. After 18 months, there was a 1.9% gain in areal BMD at the femoral neck and lumbar spine trabecular bone mineral density also showed a 2.2% increase. Maddalozzo and Snow reported that high intensity standing free weight exercise program conducted approximately 75 minutes for 3 times weekly for 24 weeks significantly increased the BMD in the spine of men, mean age 54.6 years. Moderate intensity exercise training produced no bone effect.

Colletti et al studied 12 young men between 19 and 40 years, who had engaged in resistance training for at least one year and found significant increases in BMD of the lumbar spine, greater trochanter, and the femoral neck but not at the mid-radius [16].   The Canadian Multicentre Osteoporosis Study included 2,855 community dwelling males who were at least 25 years of age and older [17]. They used a self-reported physical activity questionnaire at the start of the study and 5 years later. They quantified physical activity based on metabolic equivalent (MET) and included work history as well as sporting and leisure time activity. Physical activity was associated with a small increase in total hip BMD. Higher physical activity was defined as greater than 2,455 MET min/day. Kelley, Kelley and VuTran conducted a meta-analysis to investigate the association of exercise and BMD in males. They concluded that site specific exercise may improve or maintain BMD at the femur, lumbar spine, and os calcis in older men, although they stated that the variety of exercises will not allow them to form any firm conclusions. A positive relationship between physical activity and BMD has been reported for boys ages 15 and 16 years of age as well as active men, ages 21-42 years who demonstrated a 9% higher BMD at the hip when compared to persons who are less active [19].            

In conclusion, there is clear evidence that resistance training and high impact activities can enhance BMD [7, 8, 9, 12, 14]. There are benefits to starting this early in life [16, 19] yet benefits can also be found in older adults [6, 11, 17].

                       

 

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