Long-term recreational gymnastics provides a clear benefit in age-related functional decline and bone loss. A prospective 6-year study

Does long-term recreational gymnastics prevent injurious falls in older women? A prospective 20-year follow-up

Background

Exercise interventions focusing on balance and strength training have been shown to be effective for falls prevention. The aim of this 20-year register-based follow-up was to examine whether long-term participation in recreational female gymnastics is associated with a lower risk of medically-attended injurious falls.

Methods

Health care register data of 187 women (103 recreational gymnasts and 84 sedentary controls) from the original cohort of 243 women were assessed. The mean age (sd) at baseline was 62.8 (5.4) years and the mean follow-up time was 19.4 (2.7) years (range from 5.6 to 21.0 years).

Injurious falls were scrutinized from medical records. An injurious fall was defined as an event in which falling was mentioned as a reason for making contact with health-care professionals. Negative binomial regression was used to estimate incidence rate ratios (IRR) for injurious falls, and Cox-regression models for calculating hazard ratios (HR) for injured fallers with the control group as reference.

Results

Recreational gymnasts had about 30% less injurious falls compared to controls, the mean IRR (95% CI) being 0.71 (0.51 to 0.96). The HR for injured fallers was 0.73 (0.52 to 1.02) favoring the recreational gymnasts. There were no statistically significant between-group differences for fractures.

Conclusions

Long-term recreational gymnastics appears to reduce the risk of injurious falls in old age.

Effects of physical activity on bone mineral density in older adults: Korea National Health and Nutrition Examination Survey, 2008-2011

We compared the relationship between physical activity (PA) and bone mineral density (BMD) in men and women aged over 50 years. Only moderate-to-vigorous PA was positively associated with hip BMD in men. There was no association between PA and BMD at any site in women.

INTRODUCTION

Physical activity (PA) is widely recommended for osteoporosis. However, epidemiological data regarding the intensity or volume of PA required for bone health are lacking. We aimed to investigate and compare the relationship between PA and bone mineral density (BMD) in men and women.

METHODS

This population-based cross-sectional study used data from the 4th and 5th Korea National Health and Nutrition Examination Surveys and included 2767 men and 2753 women aged > 50 years. The intensity, frequency, and duration of PA were assessed using a questionnaire, and the participants were divided into the no activity, walking-only, moderate PA, and vigorous PA groups. BMD was measured at the lumbar spine (LS), femur neck (FN), and total hip (TH) using dual-energy X-ray absorptiometry.

RESULTS

Adjusted-BMDs of the hip were higher in men and women in the moderate and vigorous PA groups than those in men and women in the walking-only and no activity groups, while frequency and duration of PA were not associated with BMD at any site. The odds ratios for osteoporosis were the lowest at the FN and TH in men in the vigorous PA group (0.354, 95% confidence interval (CI) 0.139-0.901, P < 0.002, and 0.072, 95% CI 0.007-0.766, P < 0.003, respectively), while it was not significant in women.

CONCLUSION

Only moderate-to-vigorous PA was positively associated with the hip BMD in men. There was no association between PA and BMD at any site in women. It is necessary to assess the PA intensity for bone health based on the site and sex.

Bone Mass and Strength and Fall-Related Fractures in Older Age

INTRODUCTION

Low bone mineral density is a risk factor for fractures. The aim of this follow-up study was to assess the association of various bone properties with fall-related fractures.

MATERIALS AND METHODS

187 healthy women aged 55 to 83 years at baseline who were either physically active or inactive were followed for 20 years. They were divided into two groups by whether or not they sustained fall-related fractures: fracture group (F) and nonfracture group (NF). At baseline, several bone properties were measured with DXA and pQCT, and their physical performance was also assessed.

RESULTS

During the follow-up, 120 women had no fall-related fractures, while 67 (38%) sustained at least one fall with fracture. NF group had about 4 to 11% greater BMD at the femoral neck and distal radius; the mean differences (95% CI) were 4.5 (0.3 to 8.6) % and 11.1 (6.3 to 16.1) %, respectively. NF group also had stronger bone structure at the tibia, the mean difference in BMC at the distal tibia was 6.0 (2.2 to 9.7) %, and at the tibial shaft 3.6 (0.4 to 6.8) %. However, there was no mean difference in physical performance.

CONCLUSIONS

Low bone properties contribute to the risk of fracture if a person falls. Therefore, in the prevention of fragility fractures, it is essential to focus on improving bone mass, density, and strength during the lifetime. Reduction of falls by improving physical performance, balance, mobility, and muscle power is equally important.

Low Muscle Strength and Mass Is Associated With the Accelerated Decline of Bone Microarchitecture at the Distal Radius in Older Men: the Prospective STRAMBO Study

Low muscle mass and strength are associated with poor bone microarchitecture. We studied the association of muscle mass and strength with changes in bone microarchitecture of distal radius in 821 older men during an 8-year prospective follow-up. Bone microarchitecture was assessed by high resolution peripheral quantitative computed tomography (XtremeCT-1, Scanco) at baseline, then after 4 and 8 years. Relative appendicular lean mass of the upper limbs (RALM-u.l.) was calculated as DXA-measured lean mass of upper limbs divided by (height)² . Relative grip strength was calculated as grip strength divided by height. Decrease in bone mineral content (BMC), total volumetric bone mineral density (Tt.vBMD), cortical thickness (Ct.Th), cortical area (Ct.Ar) and cortical vBMD (Ct.vBMD) accelerated with age. Trabecular area (Tb.Ar) expansion and trabecular bone deterioration accelerated with age. Men in the first RALM-u.l. quartile had more rapid loss of BMC, Tt.vBMD, Ct.Th, Ct.vBMD and Ct.Ar vs. the highest quartile. They had more rapid increase in Tb.Ar. Men in the lowest quartile of grip strength had greater decrease in BMC, Tt.vBMD, Ct.Th, Ct.vBMD, Ct.Ar, and greater increase in Tb.Ar vs. the highest quartile. In the models including ALM-u.l. and grip strength (not corrected for height), both muscle-related variables were associated with more rapid bone microarchitectural deterioration (slightly more so for grip strength). Trabecular vBMD (Tb.vBMD) and Central.Tb.vBMD increased in men having higher muscle mass and strength. Trends in trabecular number and thickness did not differ across the groups in all the analyses. Thus, in men, aging-related deterioration of bone microarchitecture was most rapid after the age of 80. Low grip strength (and slightly more weakly low RALM-u.l.) is associated with the more rapid decrease in Tt.vBMD and cortical variables, and with greater Tb.Ar expansion. In conclusion, dynapenia and sarcopenia contribute to the deterioration of bone microarchitecture in older men. © 2018 American Society for Bone and Mineral Research.

Differences in fitness level between women aged 60 and over participating in three different supervised exercise programs and a sedentary group

The aim of this study was to compare fitness levels in women aged 60 and over participating in a supervised exercise program (involving tai chi, recreational gymnastics, and/or aquatic fitness) with those in a sedentary group. An observational, descriptive, cross-sectional study was performed on a total of 171 women aged from 60 to 92 who attended public community clubs for older adults. The instruments used included the Senior Fitness Test, the Tinetti Balance Assessment Tool, the Katz Index, and the Lawton & Brody Activities of Daily Living Scale. Significant differences in fitness levels were observed when we compared the exercise groups with the sedentary group. Women with better fitness levels had a lower risk of suffering falls and greater autonomy in performing activities of daily living and instrumental activities of daily living. Agility and gait control were found to be independently associated with exercise groups.

An Increase in Forearm Cortical Bone Size After Menopause May Influence the Estimated Bone Mineral Loss--A 28-Year Prospective Observational Study

Areal bone mineral density (aBMD) is the most common estimate of bone mass, incorporated in the World Health Organization definition of osteoporosis. However, aBMD depends on not only the amount of mineral but also the bone size. The estimated postmenopausal decline in aBMD could because of this be influenced by changes in bone size.We measured bone mineral content (BMC; mg), aBMD (mg/cm2), and bone width (mm) by single-photon absorptiometry at the cortical site of the forearm in a population-based sample of 105 Caucasian women. We conducted 12 measurements during a 28-yr period from mean 5 yr (range: 2-9) before menopause to mean 24 yr (range: 18-28) after menopause. We calculated individual slopes for changes in the periods before menopause, 0-<8, 8-<16, and 16-28 yr after menopause. Data are presented as means with 95% confidence intervals. The annual BMC changes in the 4 periods were -1.4% (-0.1, -2.6), -1.1% (-0.9, -1.4), -1.2% (-0.9, -1.6), and -1.1% (-0.8, -1.4) and the annual increase in bone width 0.4% (-1.2, 1.9), 0.7% (0.5, 0.9), 0.1% (-0.2, 0.4), and 0.1% (-0.2, 0.4). BMC loss was similar in all periods, whereas the increase in bone width was higher in the first postmenopausal period than in the second (p=0.003) and the third (p=0.01) postmenopausal periods. Menopause is followed by a transient increase in forearm bone size that will influence the by aBMD estimated cortical loss in bone minerals.

Long-Term Exercise and Bone Mineral Density Changes in Postmenopausal Women--Are There Periods of Reduced Effectiveness?

There is increasing evidence that physical exercise can prevent fractures in postmenopausal women. However, even with careful adaptation of the exercise program to subjects' changing bone, health, and fitness status, effectivity may still decrease over the time. This could be specifically the case where the limitations of higher age collide with the specification of the exercise program. Thus, the aim of this study was to monitor bone mineral density (BMD) changes over a 16-year period of supervised exercise. Our hypothesis was that BMD differences at lumbar spine (LS) and femoral neck (FN) between exercisers (EG) and nontraining controls (CG) increased throughout the intervention with significant differences for each of the four 4-year observation periods. Sixty-seven (EG, n = 39 versus CG, n = 28) initially early-postmenopausal osteopenic women of the Erlangen Fitness and Osteoporosis Prevention Study (EFOPS) with complete BMD data sets for baseline (1998) and 4-, 8-, 12-, and 16-year follow-up were included in the analysis. The exercise protocol initially focused on a high-intensity strategy that addressed bone but increasingly shifted to a more comprehensive intervention. LS-BMD differences between the EG and CG continuously increased (year 4: 2.4% (95%- Confidence Interval 1.0% to 3.8%), year 8: 3.1% (1.6% to 4.7%), year 12: 3.9% (1.9% to 5.8), year 16: 4.5% (2.5% to 6.6%). Correspondingly, rising differences for FN-BMD (0.9% (-0.2% to 2.1%) versus 1.9% (0.4% to 3.3%) versus 2.0% (0.5% to 3.8%) versus 3.0% (1.0% to 5.0%)) were observed. However, in contrast to our hypothesis, group differences within the four 4-year periods were not consistently significant (LS, p = 0.001 to 0.097; FN, p = 0.026 to 0.673); further, BMD kinetics among the groups varied between LS and FN. Of particular importance, significant differences (p ≤ 0.030) for both regions were still found in the final period. We conclude that exercise-even when adapted for subjects' decreasing bone, health, and fitness status-is consistently effective in favorably affecting BMD in (initially) early-postmenopausal osteopenic women without any leveling-off effect after 16 years of exercise.

Active commuting reduces the risk of wrist fractures in middle-aged women-the UFO study

SUMMARY

Middle-aged women with active commuting had significantly lower risk for wrist fracture than women commuting by car/bus.

INTRODUCTION

Our purpose was to investigate whether a physically active lifestyle in middle-aged women was associated with a reduced risk of later sustaining a low-trauma wrist fracture.

METHODS

The Umeå Fracture and Osteoporosis (UFO) study is a population-based nested case-control study investigating associations between lifestyle and fragility fractures. From a cohort of ~35,000 subjects, we identified 376 female wrist fracture cases who had reported data regarding their commuting habits, occupational, and leisure physical activity, before they sustained their fracture. Each fracture case was compared with at least one control drawn from the same cohort and matched for age and week of reporting data, yielding a total of 778 subjects. Mean age at baseline was 54.3 ± 5.8 years, and mean age at fracture was 60.3 ± 5.8 years.

RESULTS

Conditional logistic regression analysis with adjustments for height, body mass index, smoking, and menopausal status showed that subjects with active commuting (especially walking) were at significantly lower risk of sustaining a wrist fracture (OR 0.48; 95 % CI 0.27-0.88) compared with those who commuted by car or bus. Leisure time activities such as dancing and snow shoveling were also associated with a lower fracture risk, whereas occupational activity, training, and leisure walking or cycling were unrelated to fracture risk.

CONCLUSION

This study suggests that active commuting is associated with a lower wrist fracture risk, in middle-aged women.

Physical activity reduces bone loss in the distal forearm in post-menopausal women--a 25-year prospective study

Intervention studies have shown that high-intensity training programs with duration of 1-3 years can influence bone mass in post-menopausal women. We wanted to investigate whether moderate physical activity could be associated with reduced post-menopausal bone loss also in the long-term perspective. We evaluated changes in bone mass and bone structure by repeated single-photon absorptiometry measurements of the distal forearm in 91 moderately physically active and 21 inactive women, categorized according to information from questionnaires, from menopause and on average 25 years onwards. Data were calculated with analysis of variance and analysis of covariance tests and presented as means with 95% confidence interval. There were no group differences in bone mass or bone structure at menopause. The mean annual loss in bone mineral content was 1.2% (1.1, 1.3) in the physically active and 1.6% (1.3, 1.8) in the inactive women (after adjustment for menopausal age P = 0.02) and the mean decline in a strength index based on bone mass and bone structure was 0.7% (0.6, 0.8) in the physically active and 1.2% (0.8, 1.5) in the inactive women (P = 0.004). There were no group differences in the changes in bone structure. Physical activity is also in a long-term perspective associated with reduced post-menopausal bone loss.

[Impact of physical activity and exercise on bone health in the life course : a review]

Physical activity and exercise are important determinants for metabolic and cardiovascular health. They also play an important role for bone health in childhood, adolescence, and adulthood. This review summarizes results from observational and intervention studies which evaluated the association between physical activity/exercise and bone health in different life course stages. In childhood and adolescence, physical activity and exercise induce improved bone accrual. In adulthood, mainly in postmenopausal women, long-term exercise programs reduce age-related bone loss. Especially weight-bearing activities seem to have an important osteogenic effect. Children and adolescent show a higher bone accrual until 5 years after cessation of an exercise program compared to their peers, who do not participate in an exercise program. In contrast, adults who quit exercising have a higher decrease in bone stiffness compared to adults who never exercised. This effect was particularly seen in postmenopausal women. Continuous physical activity and exercise over the life course and the implementation of exercise programs in schools and community-based intervention programs can help prevent or even reduce osteoporosis and osteoporosis-related fractures. Due to the lack of prospective longitudinal studies, the supposed long-term sustainable protective effect of physical activity and exercise in childhood and adolescent on bone health in later adulthood is not well established.

Exercise and fractures in postmenopausal women: 12-year results of the Erlangen Fitness and Osteoporosis Prevention Study (EFOPS)

This trial is the first exercise study that focuses on fracture incidence as a primary study endpoint. Although we marginally failed to determine significant effects on "overall" fracture risk (p = .074) or rate ratio (p = .095), our findings further increased the evidence that exercise relevantly prevents fractures in the elderly.

INTRODUCTION

The purpose of this study is to determine the effect of strictly supervised long-term exercise training on "overall" fracture incidence and bone mineral density (BMD) in postmenopausal osteopenic women.

METHODS

Eighty-five early postmenopausal (1-8 years), osteopenic women living in the area of Erlangen-Nuremberg, Germany without any medication or diseases affecting bone metabolism were assessed after 12 years of supervised exercise (EG) or unvarying lifestyle (control, CG). Exercisers were encouraged to perform two group sessions/week and two home training sessions/week. Calcium and vitamin D supplementation was provided for both groups. "Overall" fractures were determined by questionnaires and structured interviews. The BMD was assessed at lumbar spine and proximal femur by dual-energy X-ray absorptiometry.

RESULTS

"Overall" fracture risk ratio in the EG was 0.32 (95% confidence interval (CI), 0.08 to 1.05; p = .074), and the rate ratio for "overall" fractures was 0.38 (95% CI, 0.11 to 1.15; p = .095). BMD changes at lumbar spine (EG, -0.8%; 95% CI, 0.8% to -2.7% vs. CG, -4.0%; 95% CI, -2.4% to -5.7%; p = .011) and femoral neck (EG, -3.7%; 95% CI, -2.4% to -5.0% vs. CG, -6.7%; 95% CI, -5.3% to -8.2%; p = .003) significantly differed between both groups.

CONCLUSION

Although we marginally failed to determine significant effects on overall fracture risk or rate ratio, our study increased the body of evidence for the fracture prevention efficiency of exercise programs, with special regard on bone strength (as assessed by bone mineral density measurement). Future studies should focus on subjects more prone to fractures to generate enough statistical power to clearly determine this issue.

Musculoskeletal phenotype through the life course: the role of nutrition

This review considers the definition of a healthy bone phenotype through the life course and the modulating effects of muscle function and nutrition. In particular, it will emphasise that optimal bone strength (and how that is regulated) is more important than simple measures of bone mass. The forces imposed on bone by muscle loading are the primary determinants of musculoskeletal health. Any factor that changes muscle loading on the bone, or the response of bone to loading results in alterations of bone strength. Advances in technology have enhanced the understanding of a healthy bone phenotype in different skeletal compartments. Multiple components of muscle strength can also be quantified. The critical evaluation of emerging technologies for assessment of bone and muscle phenotype is vital. Populations with low and moderate/high daily Ca intakes and/or different vitamin D status illustrate the importance of nutrition in determining musculoskeletal phenotype. Changes in mass and architecture maintain strength despite low Ca intake or vitamin D status. There is a complex interaction between body fat and bone which, in addition to protein intake, is emerging as a key area of research. Muscle and bone should be considered as an integrative unit; the role of body fat requires definition. There remains a lack of longitudinal evidence to understand how nutrition and lifestyle define musculoskeletal health. In conclusion, a life-course approach is required to understand the definition of healthy skeletal phenotype in different populations and at different stages of life.

Physical activity in middle-aged women and hip fracture risk: the UFO study

In a population-based case-control study, we demonstrate that middle-aged women who were active with walking or in different physical spare time activities were at lower risk of later sustaining a hip fracture compared to more sedentary women.

INTRODUCTION

In middle-aged women participating in the Umeå Fracture and Osteoporosis (UFO) study, we investigated whether physical activity is associated with a subsequent decreased risk of sustaining a hip fracture.

METHODS

The UFO study is a nested case-control study investigating associations between bone markers, lifestyle, and osteoporotic fractures. We identified 81 female hip fracture cases that had reported lifestyle data before they sustained their fracture. Each case was compared with two female controls who were identified from the same cohort and matched for age and week of reporting data, yielding a total cohort of 237 subjects. Mean age at baseline was 57.2 ± 5.0 years, and mean age at fracture was 65.4 ± 6.4 years.

RESULTS

Conditional logistic regression analysis with adjustments for height, weight, smoking, and menopausal status showed that subjects who were regularly active with walking or had a moderate or high frequency of physical spare time activities (i.e. berry/mushroom picking and snow shovelling) were at reduced risk of sustaining a hip fracture (OR 0.14; 95% CI; 0.05-0.53 for walking and OR 0.19; 95% CI; 0.08-0.46, OR 0.17, 95% CI; 0.05-0.64 for moderate and high frequency of spare time activities, respectively) compared to more sedentary women.

CONCLUSION

An active lifestyle in middle age seems to reduce the risk of future hip fracture. Possible mechanisms may include improved muscle strength, coordination, and balance resulting in a decreased risk of falling and perhaps also direct skeletal benefits.

The effects of exercise and physical activity participation on bone mass and geometry in postmenopausal women: a systematic review of pQCT studies

The cumulative risk of fracture for a postmenopausal woman over the age of 50 can reach up to 60%. Exercise has the potential to modify fracture risk in postmenopausal women through its effects on bone mass and geometry; however, these effects are not well characterized. To determine the effects of exercise on bone mass and geometry in postmenopausal women, we conducted a systematic review of the literature. We included all randomized controlled trials, cross-sectional studies, and prospective studies that used peripheral quantitative computed tomography to assess the effects of exercise on bone mass and geometry in this population. Exercise effects appear to be modest, site-specific, and preferentially influence cortical rather than trabecular components of bone. Exercise type also plays a role, with the most prominent mass and geometric changes being observed in response to high-impact loading exercise. Exercise appears to positively influence bone mass and geometry in postmenopausal women. However, further research is needed to determine the types and amounts of exercise that are necessary to optimize improvements in bone mass and geometry in postmenopausal women and determine whether or not these improvements are capable of preventing fractures.

Proximal femoral structure and the prediction of hip fracture in men: a large prospective study using QCT

The structure of the femoral neck contributes to hip strength, but the relationship of specific structural features of the hip to hip fracture risk is unclear. The objective of this study is to determine the contribution of structural features and volumetric density of both trabecular and cortical bone in the proximal femur to the prediction of hip fracture in older men. Baseline QCT scans of the hip were obtained in 3347 men >or=65 yr of age enrolled in the Osteoporotic Fractures in Men Study (MrOS). All men were followed prospectively for an average of 5.5 yr. Areal BMD (aBMD) by DXA was also assessed. We determined the associations between QCT-derived measures of femoral neck structure, volumetric bone density, and hip fracture risk. Forty-two men sustained incident hip fractures during follow-up: an overall rate of 2.3/1000 person-years. Multivariable analyses showed that, among the QCT-derived measures, lower percent cortical volume (hazard ratio [HR] per SD decrease: 3.2; 95% CI: 2.2-4.6), smaller minimal cross-sectional area (HR: 1.6; 95% CI: 1.2-2.1), and lower trabecular BMD (HR: 1.7; 95% CI: 1.2-2.4) were independently related to increased hip fracture risk. Femoral neck areal BMD was also strongly related to hip fracture risk (HR: 4.1; 95% CI: 2.7-6.4). In multivariable models, percent cortical volume and minimum cross-sectional area remained significant predictors of hip fracture risk after adjustment for areal BMD, but overall prediction was not improved by adding QCT parameters to DXA. Specific structural features of the proximal femur were related to an increased risk of hip fracture. Whereas overall hip fracture prediction was not improved relative to aBMD, by adding QCT parameters, these results yield useful information concerning the causation of hip fracture, the evaluation of hip fracture risk, and potential targets for therapeutic intervention.

Influence of calcium intake and physical activity on proximal femur bone mass and structure among pre- and postmenopausal women. A 10-year prospective study

This 10-year follow-up evaluated the effect of physical activity and calcium intake on proximal femur bone mass (BMC) and structural indices (CSA and Z) and physical performance. A cohort of 133 premenopausal and 134 postmenopausal women with contrasting levels of physical activity (high [PA+]) and low [PA-]) and calcium intake (high [Ca+] and low [Ca-]) was measured with DXA at baseline and 5 and 10 years thereafter. Among premenopausal women, the mean (95% CI) femoral neck BMC was 3.8% (-0.1 to 7.8%) and the trochanter BMC 6.7% (2.4 to 11.3%) greater in the PA+ group than the PA- group. There was no difference between the Ca-intake groups. Among postmenopausal women, the mean femoral neck BMC was 4.2% (-0.2 to 8.8%) greater in the Ca+ group than in the Ca- group and 6.9% (2.2 to11.8%) greater in the PA+ group than in the PA- group. For trochanter BMC, the corresponding differences were 2.7% (-1.6 to 7.2%) and 5.5% (0.9 to 10.3%). The mean differences in CSA and Z were 3.8% (-0.9 to 8.7%) and 4.4% (-2.1 to 11.4%) in favor of the Ca+ group and 6.8% (1.9 to 12.0%) and 9.6% (2.5 to 17.1%) in favor of the PA+ group, respectively. Proximal femur BMC declined generally, but the initial differences between the physical activity and the calcium intake groups were maintained. High calcium intake seemed to slow the decline in trochanter BMC in premenopausal women, while high physical activity was beneficial for proximal femur, particularly among older women.

Age-related decline in trabecular and cortical density: a 5-year peripheral quantitative computed tomography follow-up study of pre- and postmenopausal women

This 5-year prospective study assessed changes in trabecular and cortical volumetric bone density at the non-weight-bearing radius and weight-bearing tibia among clinically healthy pre- and postmenopausal women. Altogether 79 premenopausal (mean age +/- SD at baseline 33 +/- 2 years) and 108 postmenopausal (68 +/- 2 years) women participated in the baseline and follow-up measurements. Trabecular density (TrD) of the distal radius and tibia and cortical density (CoD) of the radial and tibial shafts were assessed by peripheral quantitative computed tomography (pQCT). Repeated measures analysis of variance was used to analyze differences of means and mean changes between the age groups. As expected, TrD and CoD values were greater among premenopausal than postmenopausal women. Changes in radial TrD were similar in both age groups: mean (95% confidence interval) TrD of the distal radius declined by 3.0 mg/cm(3) (-0.9 to 7.0) and 5.1 mg/cm(3) (1.8-8.5) in the younger and older age groups, respectively. The respective declines in TrD of the distal tibia were 4.1 mg/cm(3) (2.1-6.0) and 2.8 mg/cm(3) (1.2-4.3). Decline in CoD was greater in the older than younger age group at both the radial and tibial shafts (P < 0.001). The mean absolute declines in radial CoD were 33.3 mg/cm(3) (27.9-38.7) and 49.4 mg/cm(3) (44.9-53.9) in younger and older women, and the declines in tibial CoD were 16.5 mg/cm(3) (12.6-20.2) and 28.1 mg/cm(3) (25.0-31.2), respectively. In conclusion, volumetric TrD in the weight-bearing tibia and non-weight-bearing radius showed similar age-related declines among pre- and postmenopausal women, while the decline in CoD was greater among postmenopausal women.