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Twelve-month resistance and impact exercise program or risedronate provides a relative benefit to hip bone structure in postmenopausal women: results from a randomized controlled trial

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Abstract

Summary

Bone strength estimates are important for fracture prevention. This study compared bone strength changes in postmenopausal women with low bone mass who were assigned to 12 months of exercise, a bone medication, or control. Exercise and bone medications benefited structure at the hip. Structure should be considered in fracture prevention research.

Purpose

Exercise and bisphosphonates reduce fracture risk, but their impact on estimates of bone strength remains uncertain. This study compared changes in tibial bone strength using peripheral quantitative computed tomography (pQCT) and hip structure analysis (HSA) outcomes from dual-energy X-ray absorptiometry (DXA) scans in postmenopausal women with low bone mass assigned to 12 months of exercise, risedronate, or control.

Methods

In this RCT, 276 postmenopausal women within 6 years of menopause were randomly assigned to three groups: exercise (92), risedronate (91), or control (93). Exercise included weighted jogging and progressive resistance exercises; risedronate treatment was 150 mg monthly; all groups received calcium and vitamin D. pQCT and DXA images were obtained at baseline and 6 and 12 months and compared between groups over time.

Results

Participants had a mean (± SD) age of 54.5 (± 3.2) years with an average of 36.7 (± 40.7) months postmenopause. No significant differences were found between groups for the change in pQCT outcomes (volumetric bone mineral density, area, and strength estimates). At 12 months, mean percent differences (95% CI) in HSA measures between exercise and controls were as follows: intertrochanteric, cross-sectional area 2.25% (0.28, 4.12) (p = .03), cross-sectional moment of inertia (CSMI) 5.67% (1.47, 9.87) (p < .01), and section modulus (SM) 4.38% (1.02, 7.74) (p = .01), and narrow neck, average cortical thickness 2.37% (−0.08, 4.83) (p = .031). Mean percent differences (95% CI) in HSA measures between risedronate and control were as follows: intertrochanteric, CSMI 4.28% (−0.24, 8.81) (p = .03) and SM 3.35% (−0.21, 6.91) (p = .03), and shaft, subperiosteal width 0.82% (0.05, 1.58) (p = .047), CSMI 2.53% (0.88, 4.18) (p = .004), and SM 1.57% (0.34, 2.8) (p = .008). Exercise maintained neck-shaft angle compared to both control 1.27% (0.13, 2.41) (p = .04) and risedronate 1.31% (0.23, 2.39) (p = .03). All other differences for changes in HSA outcomes over time were not significantly different between the exercise and risedronate groups.

Conclusion

Exercise and bisphosphonates may influence structural and strength estimates at the hip, but not at peripheral sites (tibia). Neither exercise nor bisphosphonates were found to be superior in improving estimates of hip bone strength.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors acknowledge the excellent work and contributions of the study team including Dr. Melissa Manzer, Kara Smith, Mel Meisinger, Cherie Kimble, and Nebraska Medicine Department of Radiology Staff. Language learning models (LLMs) were used to assess grammar and readability.

Funding

Research reported in this publication was supported by the National Institute of Nursing Research of the National Institutes of Health under award number R01NR015029.

Author information

Authors and Affiliations

  1. College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA

    R. Blay & L. Bilek

  2. College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA

    K. Kupzyk & N. Waltman

  3. Creighton Osteoporosis Research Center, Omaha, NE, USA

    J. Lappe

  4. College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA

    L.E. Flores & L. Mack

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  1. R. Blay
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Correspondence to L. Bilek.

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Blay, R., Flores, L., Kupzyk, K. et al. Twelve-month resistance and impact exercise program or risedronate provides a relative benefit to hip bone structure in postmenopausal women: results from a randomized controlled trial. Osteoporos Int 35, 877–891 (2024). https://doi.org/10.1007/s00198-023-07008-x

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