Skip to main content
NCBI home page
British Journal of Sports Medicine logoLink to British Journal of Sports Medicine
. 1999 Dec;33(6):378–386. doi: 10.1136/bjsm.33.6.378

Is there a role for exercise in the prevention of osteoporotic fractures?

O M Rutherford
PMCID: PMC1756218  PMID: 10597845

Abstract

OBJECTIVES: To examine whether there is a role for exercise in improving bone mineral density (BMD), particularly in postmenopausal women. The effects of different types of exercise are examined together with their effects at selected skeletal sites. The role of activity in reducing falls and hip fractures will also be considered as well as the potentially negative effects of excessive exercise. METHODS: A literature search over the past 20 years was conducted and landmark papers selected. RESULTS: Certain types of exercise have been found to exert moderate benefits on BMD of the wrist, spine, and hip. Most studies do not detect a difference between the effects of endurance activities and strength training for BMD of the spine. It has been more difficult to isolate the optimal type of activity for effecting an osteogenic response at the hip, but recent evidence suggests that high impact work such as stepping and jumping may be effective at this site. The combination of hormone replacement therapy and exercise would appear to be more effective than either intervention on its own. Certain types of exercises have additional benefits, such as muscle strengthening, which could reduce the incidence of falls. Excessive exercise can lead to menstrual disturbances in female athletes and this in turn can cause bone loss, particularly from the spine. CONCLUSIONS: Exercise across the life span should be encouraged in order to maximise peak bone mass, reduce age related bone loss, and maintain muscle strength and balance. Although the effects of exercise on BMD later in life are small, epidemiological evidence suggests that being active can nearly halve the incidence of hip fractures in the older population. This effect is most probably multifactorial through the positive effects on bone, muscle strength, balance, and joint flexibility. Younger women should be aware of the dangers to the skeleton of menstrual disorders. 




Full Text

The Full Text of this article is available as a PDF (141.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ayalon J., Simkin A., Leichter I., Raifmann S. Dynamic bone loading exercises for postmenopausal women: effect on the density of the distal radius. Arch Phys Med Rehabil. 1987 May;68(5 Pt 1):280–283. [PubMed] [Google Scholar]
  2. Bassey E. J., Ramsdale S. J. Increase in femoral bone density in young women following high-impact exercise. Osteoporos Int. 1994 Mar;4(2):72–75. doi: 10.1007/BF01623226. [DOI] [PubMed] [Google Scholar]
  3. Bassey E. J., Ramsdale S. J. Weight-bearing exercise and ground reaction forces: a 12-month randomized controlled trial of effects on bone mineral density in healthy postmenopausal women. Bone. 1995 Apr;16(4):469–476. doi: 10.1016/8756-3282(95)90193-0. [DOI] [PubMed] [Google Scholar]
  4. Bassey E. J., Rothwell M. C., Littlewood J. J., Pye D. W. Pre- and postmenopausal women have different bone mineral density responses to the same high-impact exercise. J Bone Miner Res. 1998 Dec;13(12):1805–1813. doi: 10.1359/jbmr.1998.13.12.1805. [DOI] [PubMed] [Google Scholar]
  5. Bennell K. L., Malcolm S. A., Wark J. D., Brukner P. D. Skeletal effects of menstrual disturbances in athletes. Scand J Med Sci Sports. 1997 Oct;7(5):261–273. doi: 10.1111/j.1600-0838.1997.tb00151.x. [DOI] [PubMed] [Google Scholar]
  6. Beverly M. C., Rider T. A., Evans M. J., Smith R. Local bone mineral response to brief exercise that stresses the skeleton. BMJ. 1989 Jul 22;299(6693):233–235. doi: 10.1136/bmj.299.6693.233. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Calvo M. S., Eyre D. R., Gundberg C. M. Molecular basis and clinical application of biological markers of bone turnover. Endocr Rev. 1996 Aug;17(4):333–368. doi: 10.1210/edrv-17-4-333. [DOI] [PubMed] [Google Scholar]
  8. Campbell A. J., Robertson M. C., Gardner M. M., Norton R. N., Tilyard M. W., Buchner D. M. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ. 1997 Oct 25;315(7115):1065–1069. doi: 10.1136/bmj.315.7115.1065. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Carbon R. J. Exercise, amenorrhoea and the skeleton. Br Med Bull. 1992 Jul;48(3):546–560. doi: 10.1093/oxfordjournals.bmb.a072562. [DOI] [PubMed] [Google Scholar]
  10. Cavanaugh D. J., Cann C. E. Brisk walking does not stop bone loss in postmenopausal women. Bone. 1988;9(4):201–204. doi: 10.1016/8756-3282(88)90031-2. [DOI] [PubMed] [Google Scholar]
  11. Chow R., Harrison J. E., Notarius C. Effect of two randomised exercise programmes on bone mass of healthy postmenopausal women. Br Med J (Clin Res Ed) 1987 Dec 5;295(6611):1441–1444. doi: 10.1136/bmj.295.6611.1441. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Cicinelli E., Ignarro L. J., Lograno M., Matteo G., Falco N., Schonauer L. M. Acute effects of transdermal estradiol administration on plasma levels of nitric oxide in postmenopausal women. Fertil Steril. 1997 Jan;67(1):63–66. doi: 10.1016/s0015-0282(97)81857-2. [DOI] [PubMed] [Google Scholar]
  13. Dalsky G. P., Stocke K. S., Ehsani A. A., Slatopolsky E., Lee W. C., Birge S. J., Jr Weight-bearing exercise training and lumbar bone mineral content in postmenopausal women. Ann Intern Med. 1988 Jun;108(6):824–828. doi: 10.7326/0003-4819-108-6-824. [DOI] [PubMed] [Google Scholar]
  14. Drinkwater B. L. 1994 C. H. McCloy Research Lecture: does physical activity play a role in preventing osteoporosis? Res Q Exerc Sport. 1994 Sep;65(3):197–206. doi: 10.1080/02701367.1994.10607620. [DOI] [PubMed] [Google Scholar]
  15. Drinkwater B. L., Nilson K., Chesnut C. H., 3rd, Bremner W. J., Shainholtz S., Southworth M. B. Bone mineral content of amenorrheic and eumenorrheic athletes. N Engl J Med. 1984 Aug 2;311(5):277–281. doi: 10.1056/NEJM198408023110501. [DOI] [PubMed] [Google Scholar]
  16. Duncan P. W., Studenski S., Chandler J., Prescott B. Functional reach: predictive validity in a sample of elderly male veterans. J Gerontol. 1992 May;47(3):M93–M98. doi: 10.1093/geronj/47.3.m93. [DOI] [PubMed] [Google Scholar]
  17. Ernst E. Exercise for female osteoporosis. A systematic review of randomised clinical trials. Sports Med. 1998 Jun;25(6):359–368. doi: 10.2165/00007256-199825060-00002. [DOI] [PubMed] [Google Scholar]
  18. Fehling P. C., Alekel L., Clasey J., Rector A., Stillman R. J. A comparison of bone mineral densities among female athletes in impact loading and active loading sports. Bone. 1995 Sep;17(3):205–210. doi: 10.1016/8756-3282(95)00171-9. [DOI] [PubMed] [Google Scholar]
  19. Forwood M. R., Burr D. B. Physical activity and bone mass: exercises in futility? Bone Miner. 1993 May;21(2):89–112. doi: 10.1016/s0169-6009(08)80012-8. [DOI] [PubMed] [Google Scholar]
  20. Gutin B., Kasper M. J. Can vigorous exercise play a role in osteoporosis prevention? A review. Osteoporos Int. 1992 Mar;2(2):55–69. doi: 10.1007/BF01623838. [DOI] [PubMed] [Google Scholar]
  21. Hatori M., Hasegawa A., Adachi H., Shinozaki A., Hayashi R., Okano H., Mizunuma H., Murata K. The effects of walking at the anaerobic threshold level on vertebral bone loss in postmenopausal women. Calcif Tissue Int. 1993 Jun;52(6):411–414. doi: 10.1007/BF00571327. [DOI] [PubMed] [Google Scholar]
  22. Heinonen A., Kannus P., Sievänen H., Oja P., Pasanen M., Rinne M., Uusi-Rasi K., Vuori I. Randomised controlled trial of effect of high-impact exercise on selected risk factors for osteoporotic fractures. Lancet. 1996 Nov 16;348(9038):1343–1347. doi: 10.1016/S0140-6736(96)04214-6. [DOI] [PubMed] [Google Scholar]
  23. Heinonen A., Oja P., Kannus P., Sievänen H., Mänttäri A., Vuori I. Bone mineral density of female athletes in different sports. Bone Miner. 1993 Oct;23(1):1–14. doi: 10.1016/s0169-6009(08)80086-4. [DOI] [PubMed] [Google Scholar]
  24. Joakimsen R. M., Magnus J. H., Fønnebø V. Physical activity and predisposition for hip fractures: a review. Osteoporos Int. 1997;7(6):503–513. doi: 10.1007/BF02652555. [DOI] [PubMed] [Google Scholar]
  25. Jones H. H., Priest J. D., Hayes W. C., Tichenor C. C., Nagel D. A. Humeral hypertrophy in response to exercise. J Bone Joint Surg Am. 1977 Mar;59(2):204–208. [PubMed] [Google Scholar]
  26. Kannus P., Haapasalo H., Sankelo M., Sievänen H., Pasanen M., Heinonen A., Oja P., Vuori I. Effect of starting age of physical activity on bone mass in the dominant arm of tennis and squash players. Ann Intern Med. 1995 Jul 1;123(1):27–31. doi: 10.7326/0003-4819-123-1-199507010-00003. [DOI] [PubMed] [Google Scholar]
  27. Kannus P., Niemi S., Palvanen M., Parkkari J. Fall-induced injuries among elderly people. Lancet. 1997 Oct 18;350(9085):1174–1174. doi: 10.1016/S0140-6736(97)26042-3. [DOI] [PubMed] [Google Scholar]
  28. Keen A. D., Drinkwater B. L. Irreversible bone loss in former amenorrheic athletes. Osteoporos Int. 1997;7(4):311–315. doi: 10.1007/BF01623770. [DOI] [PubMed] [Google Scholar]
  29. Kerr D., Morton A., Dick I., Prince R. Exercise effects on bone mass in postmenopausal women are site-specific and load-dependent. J Bone Miner Res. 1996 Feb;11(2):218–225. doi: 10.1002/jbmr.5650110211. [DOI] [PubMed] [Google Scholar]
  30. Kohrt W. M., Snead D. B., Slatopolsky E., Birge S. J., Jr Additive effects of weight-bearing exercise and estrogen on bone mineral density in older women. J Bone Miner Res. 1995 Sep;10(9):1303–1311. doi: 10.1002/jbmr.5650100906. [DOI] [PubMed] [Google Scholar]
  31. Krølner B., Toft B., Pors Nielsen S., Tøndevold E. Physical exercise as prophylaxis against involutional vertebral bone loss: a controlled trial. Clin Sci (Lond) 1983 May;64(5):541–546. doi: 10.1042/cs0640541. [DOI] [PubMed] [Google Scholar]
  32. Law M. R., Wald N. J., Meade T. W. Strategies for prevention of osteoporosis and hip fracture. BMJ. 1991 Aug 24;303(6800):453–459. doi: 10.1136/bmj.303.6800.453. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Lord S. R., McLean D., Stathers G. Physiological factors associated with injurious falls in older people living in the community. Gerontology. 1992;38(6):338–346. doi: 10.1159/000213351. [DOI] [PubMed] [Google Scholar]
  34. Lord S. R., Sambrook P. N., Gilbert C., Kelly P. J., Nguyen T., Webster I. W., Eisman J. A. Postural stability, falls and fractures in the elderly: results from the Dubbo Osteoporosis Epidemiology Study. Med J Aust. 1994 Jun 6;160(11):684-5, 688-91. [PubMed] [Google Scholar]
  35. Loucks A. B., Vaitukaitis J., Cameron J. L., Rogol A. D., Skrinar G., Warren M. P., Kendrick J., Limacher M. C. The reproductive system and exercise in women. Med Sci Sports Exerc. 1992 Jun;24(6 Suppl):S288–S293. [PubMed] [Google Scholar]
  36. Malina R. M. Menarche in athletes: a synthesis and hypothesis. Ann Hum Biol. 1983 Jan-Feb;10(1):1–24. doi: 10.1080/03014468300006141. [DOI] [PubMed] [Google Scholar]
  37. Martin D., Notelovitz M. Effects of aerobic training on bone mineral density of postmenopausal women. J Bone Miner Res. 1993 Aug;8(8):931–936. doi: 10.1002/jbmr.5650080805. [DOI] [PubMed] [Google Scholar]
  38. Nelson M. E., Fiatarone M. A., Morganti C. M., Trice I., Greenberg R. A., Evans W. J. Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. A randomized controlled trial. JAMA. 1994 Dec 28;272(24):1909–1914. doi: 10.1001/jama.1994.03520240037038. [DOI] [PubMed] [Google Scholar]
  39. Nelson M. E., Fisher E. C., Dilmanian F. A., Dallal G. E., Evans W. J. A 1-y walking program and increased dietary calcium in postmenopausal women: effects on bone. Am J Clin Nutr. 1991 May;53(5):1304–1311. doi: 10.1093/ajcn/53.5.1304. [DOI] [PubMed] [Google Scholar]
  40. Nilsson B. E., Westlin N. E. Bone density in athletes. Clin Orthop Relat Res. 1971;77:179–182. [PubMed] [Google Scholar]
  41. Phillips S. K., Rook K. M., Siddle N. C., Bruce S. A., Woledge R. C. Muscle weakness in women occurs at an earlier age than in men, but strength is preserved by hormone replacement therapy. Clin Sci (Lond) 1993 Jan;84(1):95–98. doi: 10.1042/cs0840095. [DOI] [PubMed] [Google Scholar]
  42. Pruitt L. A., Jackson R. D., Bartels R. L., Lehnhard H. J. Weight-training effects on bone mineral density in early postmenopausal women. J Bone Miner Res. 1992 Feb;7(2):179–185. doi: 10.1002/jbmr.5650070209. [DOI] [PubMed] [Google Scholar]
  43. Pruitt L. A., Taaffe D. R., Marcus R. Effects of a one-year high-intensity versus low-intensity resistance training program on bone mineral density in older women. J Bone Miner Res. 1995 Nov;10(11):1788–1795. doi: 10.1002/jbmr.5650101123. [DOI] [PubMed] [Google Scholar]
  44. Rosselli M., Imthurn B., Keller P. J., Jackson E. K., Dubey R. K. Circulating nitric oxide (nitrite/nitrate) levels in postmenopausal women substituted with 17 beta-estradiol and norethisterone acetate. A two-year follow-up study. Hypertension. 1995 Apr;25(4 Pt 2):848–853. doi: 10.1161/01.hyp.25.4.848. [DOI] [PubMed] [Google Scholar]
  45. Rubin C. T., Lanyon L. E. Regulation of bone formation by applied dynamic loads. J Bone Joint Surg Am. 1984 Mar;66(3):397–402. [PubMed] [Google Scholar]
  46. Rubin C. T., Lanyon L. E. Regulation of bone mass by mechanical strain magnitude. Calcif Tissue Int. 1985 Jul;37(4):411–417. doi: 10.1007/BF02553711. [DOI] [PubMed] [Google Scholar]
  47. Rutherford O. M., Jones D. A. The relationship of muscle and bone loss and activity levels with age in women. Age Ageing. 1992 Jul;21(4):286–293. doi: 10.1093/ageing/21.4.286. [DOI] [PubMed] [Google Scholar]
  48. Rutherford O. M. Spine and total body bone mineral density in amenorrheic endurance athletes. J Appl Physiol (1985) 1993 Jun;74(6):2904–2908. doi: 10.1152/jappl.1993.74.6.2904. [DOI] [PubMed] [Google Scholar]
  49. Salgado R., Lord S. R., Packer J., Ehrlich F. Factors associated with falling in elderly hospital patients. Gerontology. 1994;40(6):325–331. doi: 10.1159/000213607. [DOI] [PubMed] [Google Scholar]
  50. Skelton D. A., Phillips S. K., Bruce S. A., Naylor C. H., Woledge R. C. Hormone replacement therapy increases isometric muscle strength of adductor pollicis in post-menopausal women. Clin Sci (Lond) 1999 Apr;96(4):357–364. [PubMed] [Google Scholar]
  51. Smith R., Rutherford O. M. Spine and total body bone mineral density and serum testosterone levels in male athletes. Eur J Appl Physiol Occup Physiol. 1993;67(4):330–334. doi: 10.1007/BF00357631. [DOI] [PubMed] [Google Scholar]
  52. Stacey E., Korkia P., Hukkanen M. V., Polak J. M., Rutherford O. M. Decreased nitric oxide levels and bone turnover in amenorrheic athletes with spinal osteopenia. J Clin Endocrinol Metab. 1998 Sep;83(9):3056–3061. doi: 10.1210/jcem.83.9.5106. [DOI] [PubMed] [Google Scholar]
  53. Stager J. M., Hatler L. K. Menarche in athletes: the influence of genetics and prepubertal training. Med Sci Sports Exerc. 1988 Aug;20(4):369–373. doi: 10.1249/00005768-198808000-00007. [DOI] [PubMed] [Google Scholar]
  54. Welsh L., Rutherford O. M. Hip bone mineral density is improved by high-impact aerobic exercise in postmenopausal women and men over 50 years. Eur J Appl Physiol Occup Physiol. 1996;74(6):511–517. doi: 10.1007/BF02376766. [DOI] [PubMed] [Google Scholar]
  55. Wilson J. H., Wolman R. L. Osteoporosis and fracture complications in an amenorrhoeic athlete. Br J Rheumatol. 1994 May;33(5):480–481. doi: 10.1093/rheumatology/33.5.480. [DOI] [PubMed] [Google Scholar]
  56. Wimalawansa S. J., De Marco G., Gangula P., Yallampalli C. Nitric oxide donor alleviates ovariectomy-induced bone loss. Bone. 1996 Apr;18(4):301–304. doi: 10.1016/8756-3282(96)00005-1. [DOI] [PubMed] [Google Scholar]
  57. Wolf S. L., Barnhart H. X., Kutner N. G., McNeely E., Coogler C., Xu T. Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. J Am Geriatr Soc. 1996 May;44(5):489–497. doi: 10.1111/j.1532-5415.1996.tb01432.x. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Sports Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES