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Bone Adaptation in Adult Women Is Related to Loading Dose: A 12-Month Randomized Controlled Trial.

ABSTRACT: Although strong evidence exists that certain activities can increase bone density and structure in people, it is unclear what specific mechanical factors govern the response. This is important because understanding the effect of mechanical signals on bone could contribute to more effective osteoporosis prevention methods and efficient clinical trial design. The degree to which strain rate and magnitude govern bone adaptation in humans has never been prospectively tested. Here, we studied the effects of a voluntary upper extremity compressive loading task in healthy adult women during a 12-month prospective period. A total of 102 women age 21 to 40 years participated in one of two experiments: (i) low (n = 21) and high (n = 24) strain magnitude; or (ii) low (n = 21) and high (n = 20) strain rate. Control (n = 16) no intervention. Strains were assigned using subject-specific finite element models. Load cycles were recorded digitally. The primary outcome was change in ultradistal radius integral bone mineral content (iBMC), assessed with QCT. Interim time points and secondary outcomes were assessed with high resolution pQCT (HRpQCT) at the distal radius. Sixty-six participants completed the intervention, and interim data were analyzed for 77 participants. Likely related to improved compliance and higher received loading dose, both the low-strain rate and high-strain rate groups had significant 12-month increases to ultradistal iBMC (change in control: -1.3 ± 2.7%, low strain rate: 2.7 ± 2.1%, high strain rate: 3.4 ± 2.2%), total iBMC, and other measures. "Loading dose" was positively related to 12-month change in ultradistal iBMC, and interim changes to total BMD, cortical thickness, and inner trabecular BMD. Participants who gained the most bone completed, on average, 128 loading bouts of (mean strain) 575 με at 1878 με/s. We conclude that signals related to strain magnitude, rate, and number of loading bouts contribute to bone adaptation in healthy adult women, but only explain a small amount of variance in bone changes. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.

SUBMITTER: Troy KL

PROVIDER: S-EPMC7363573 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Abstract Objectives Dietary consumption of prunes has favorable impacts on bone health, however, more research is necessary to improve upon study designs and refine our understandings and determine whether unfavorable fat gain occurs with long-term treatment. Objectives: Evaluate the effects of prunes (50g and 100g/day) on bone mineral density (BMD) in postmenopausal women during a 12-month dietary intervention. Secondary outcomes include effects on body composition. Methods Single center, parallel arm 12-month randomized controlled trial (RCT; NCT02822378) to test effects of 50g and 100g/day prunes vs. a Control group on BMD (dual-energy X-ray absorptiometry) (every 6 months) and body composition in postmenopausal women with a BMD T-score of < 0.0 and >−3.0 at any site. Results 235 women (age 62.1 ± 5.0 yr) were randomized into Control (n = 78), 50 g Prune (n = 79), or 100 g Prune (n = 78) groups. Compliance was 90.2 ± 1.8% and 87.1 ± 2.1% in the 50 g and 100 g Prune groups. Dropout was 22%; however, the dropout rate was 41% for the 100 g Prune group compared to other groups (10% Control; 15% 50 g Prune; (p < 0.001)). A group × time interaction for total hip BMD was observed in Control vs 50 g Prune groups (p = 0.030), but not in Control vs 100 g Prune groups (p = 0.194). Prune consumption did not affect body mass in 50 g prune (p = 0.837) or 100 g prune (p = 0.121) groups compared to Control. A group × time interaction for fat mass was observed in Control vs 100 g Prune groups (p = 0.031), but not in Control vs 50 g Prune groups (p = 0.792). Conclusions A 50 g dose of daily dose of prunes can prevent loss of total hip BMD in postmenopausal women, without increased fat mass seen with the larger dose. Given that there was high compliance and retention at the 50 g dosage over 12 months, we propose that the 50 g dose represents a valuable non-pharmacological treatment strategy that can be used to preserve hip BMD in postmenopausal women, without increasing body or fat mass. Funding Sources California Prune Board

Project description:In the United States, over 34 million American post-menopausal women have low bone mass (osteopenia) which increases their risk of osteoporosis and fractures. Calcium, vitamin D and exercise are recommended for prevention of osteoporosis, and bisphosphonates (BPs) are prescribed in women with osteoporosis. BPs may also be prescribed for women with low bone mass, but are more controversial due to the potential for adverse effects with long-term use. A bone loading exercise program (high-impact weight bearing and resistance training) promotes bone strength by preserving bone mineral density (BMD), improving bone structure, and by promoting bone formation at sites of mechanical stress.The sample for this study will be 309 women with low bone mass who are within 5 years post-menopause. Subjects are stratified by exercise history (?2 high intensity exercise sessions per week; < 2 sessions per week) and randomized to a control or one of two treatment groups: 1) calcium?+?vitamin D (CaD) alone (Control); 2) a BP plus CaD (Risedronate); or 3) a bone loading exercise program plus CaD (Exercise). After 12 months of treatment, changes in bone structure, BMD, and bone turnover will be compared in the 3 groups. Primary outcomes for the study are bone structure measures (Bone Strength Index [BSI] at the tibia and Hip Structural Analysis [HSA] scores). Secondary outcomes are BMD at the hip and spine and serum biomarkers of bone formation (alkaline phosphase, AlkphaseB) and resorption (Serum N-terminal telopeptide, NTx). Our central hypothesis is that improvements in bone strength will be greater in subjects randomized to the Exercise group compared to subjects in either Control or Risedronate groups.Our research aims to decrease the risk of osteoporotic fractures by improving bone strength in women with low bone mass (pre-osteoporotic) during their first 5 years' post-menopause, a time of rapid and significant bone loss. Results of this study could be used in developing a clinical management pathway for women with low bone mass at their peak period of bone loss that would involve lifestyle modifications such as exercises prior to medications such as BPs.Clinicaltrials.gov NCT02186600 . Initial registration: 7/7/2014.

Project description:Bone adapts to loading in several ways, including redistributing bone mass and altered geometry and microarchitecture. Because of previous methodological limitations, it is not known how the bone material strength is affected by mechanical loading in humans. The aim of this study was to investigate the effect of a 3-month unilateral high-impact exercise program on bone material properties and microarchitecture in healthy postmenopausal women. A total of 20 healthy and inactive postmenopausal women (aged 55.6?±?2.3 years [mean?±?SD]) were included and asked to perform an exercise program of daily one-legged jumps (with incremental number, from 3×10 to 4×20 jumps/d) during 3 months. All participants were asked to register their performed jumps in a structured daily diary. The participants chose one leg as the intervention leg and the other leg was used as control. The operators were blinded to the participant's choice of leg for intervention. The predefined primary outcome was change in bone material strength index (BMSi), measured at the mid tibia with a handheld reference probe indentation instrument (OsteoProbe). Bone microstructure, geometry, and density were measured with high-resolution peripheral quantitative computed tomography (XtremeCT) at the ultradistal and at 14% of the tibia bone length (distal). Differences were analyzed by related samples Wilcoxon signed rank test. The overall compliance to the jumping program was 93.6%. Relative to the control leg, BMSi of the intervention leg increased 7% or 0.89 SD (p?=?0.046), but no differences were found for any of the XtremeCT-derived bone parameters. In conclusion, a unilateral high-impact loading program increased BMSi in postmenopausal women rapidly without affecting bone microstructure, geometry, or density, indicating that intense mechanical loading has the ability to rapidly improve bone material properties before changes in bone mass or structure. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.

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Bone Adaptation in Adult Women Is Related to Loading Dose: A 12-Month Randomized Controlled Trial.

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