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Male Osteoporosis and Weight Bearing

Male Osteoporosis and Weight Bearing

            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 weight bearing on males with osteoporosis is growing but remains fair from conclusive.

            The research on weight bearing exercise for males in relationship to bone is diverse because of the range of weight bearing activities. There is a continuum from high impact dynamic exercises, such as running and jumping, to low impact activities, such as walking and further, to reduced weight bearing, such as biking and swimming.

            The large amount of evidence indicates that activity intensity was a key factor with greater bone mineral density (BMD) resulting in males performing more intense activities, such as strenuous sports and boxing (2, 3, 4,5). In contrast, some researchers reported no effect on BMD with exercise programs aimed at skill, coordination, strength or rehabilitation post-hip fracture. deJong et al found no change in BMD in frail elderly persons in the eighth and ninth decades of life who exercised twice weekly for 17 weeks. Similarly, Binder et al, also reported no increase in BMD in older adults who had sustained hip fractures and underwent 6 months of rehabilitation. Villareal conducted a randomized controlled trial of community dwelling men and women all over the age of 78 years of age (8). The subjects exercised 2-3 times weekly which included resistive exercises as well as endurance exercises for a total of 9 months. They found trends for significant increases in BMD at the total hip (.08) and trochanter sites (.07). increase in bone mineral density.         

            In later study, Villareal et al conducted a randomized controlled trial for one year and found that the exercise group increased total hip bone mineral density by 1.5% in the exercise group(9). The training intervention, 3 sessions per week of approximately 90 minutes duration, involved aerobic exercises, resistance training, and exercises to improve flexibility and balance. It included walking on a treadmill, stationary bicycle, and stair climbing. Blumenthal and associates exercised 101 males with the mean age of 67 years with a warm-up period followed by brisk walking, jogging, and arm ergometry for 15 minutes and 30 minutes of resisted bicycle (9). After 14 months, they found a mean increase in at the distal radius of 19%. Kukuljan et al conducted an 18 month trial with males between the ages of 50 and 79 years of age and demonstrated improved lumbar spine and femoral neck BMD following their program which consisted of aggressive resistive training along with weight bearing impact activities 3 days weekly(10). Weight bearing activities included jumping, bench stepping, jumping off benches landing with one or both feet.

Gomez-Cabello et al conducted a systematic review of the effects of training on bone mass in older adults which included males and females. They concluded that aerobic activities, such as walking, have less beneficial effect on bone mineral density than strength training and multi-component training activities. Borschmann and associates conducted a systematic review to determine the skeletal effects of physical activity in persons who had a stroke at least one year earlier. They found a number of studies that demonstrated a small effect with physical activity maintaining or improving bone density on the paretic side compared to control subjects. There is evidence exercise performed in the pre and early pubertal age, may have more benefits because of the bone remodeling and this appears to be maintained at advanced age (Karlsson and Rosengren). Leisure time activity may also have a positive linear trend in bone mineral density in adulthood (Morseth 2010).

            The benefits of bicycling are many but they do not appear to have beneficial effects on bone mineral density. Nichols and associates found the bone mineral density of the lumbar spine and the total hip was significantly lower in master cyclists compared to age-matched controls and young adult cyclists. Similarly, Sabo et al found the bone mineral density of the lumbar spine in endurance cyclists was lower than the controls.

            In conclusion, weight bearing activities for males have benefits on bone and intensity as well as duration are key training factors. Evidence suggests that starting at a young age is better than at an older age but older individuals can also benefit if the training intensity is sufficiently intense.

 

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