Short-term and long-term site-specific effects of tennis playing on trabecular and cortical bone at the distal radius

Pathways linking sports participation to bone density and geometry among adolescents: ABCD growth study

This study investigated variables linked to sports participation and its impacts on bone density and geometry among adolescents. This study shows that lean soft tissue was the main link between sports participation and bone density and geometry among adolescents of both sexes. Higher ground reaction force in sports impacts bone positively, while higher body fatness and bone resorption rate negatively, all these variables seem to assume complementary roles in this phenomenon, especially among boys.

INTRODUCTION

Sports participation boosts bone formation in early life, but the pathways are still unclear.

OBJECTIVE

To investigate which variables linked to sports participation are most consistently related to bone density and geometry among adolescents.

METHODS

A total of 86 adolescents (28 girls) aged from 11 to 17 years were classified as Control (12 adolescents) and Sport (74 adolescents). The outcomes were bone density and geometry from lower limbs measured using the bone densitometry technique. Variables linked to participation were intensity, ground reaction force, strength, lean soft tissue, and parameter of bone formation. Covariates were sex, somatic maturation, and body fatness.

RESULTS

Among boys, lean soft tissue (r = 0.861) remained the main determinant of bone density along with sport ground reaction force (r = 0.211). For bone geometry, lean soft tissue remained the main determinant, while blood concentration of bone resorption markers (r = - 0.262) and body fatness (r = - 0.205) were inversely related to it. For girls, the only determinant of bone density and geometry was lean soft tissue (ranging from r = 0.461 to r = 0.759). All models explained bone density and geometry better among boys (from 73.4 to 80.9%) than girls (from 47.6 to 62.6%).

CONCLUSION

Lean soft tissue is the main link of sports participation with bone density and geometry among adolescents of both sexes. Higher ground reaction force in sports impacts bone positively, while higher body fatness and bone resorption rate negatively, all these variables seem to assume complementary roles in this phenomenon, especially among boys.

Impact loading exercise induced osteogenesis from childhood to early adulthood in tennis players aged 8-30 years

Osteogenesis with impact-loading exercise is often assessed by the extra bone growth induced in the loaded arm of tennis players. We used PRISMA to explore % bone mineral content (BMC) and area (BA) asymmetry in players 8-30 years according to weekly training hours, age, sex, maturity, and bone segment. Proper statistics for 70 groups were extracted by two reviewers from 18 eligible studies of low risk of bias (< 35, STROBE) and good quality (> 70%). The quality of the review was high (AMSTAR, 81%). Using "random effects" we tested moderation-specific meta-comparisons and meta-regressions. The loaded bones % hypertrophy was higher in BMC (19%) than BA (10%), and, with BMC and BA merged, in boys (17%) than girls (13%), in humerus (19%) than radius-ulna (14%), and in pubertal (19%) players. Weekly training hours were more important (43%) than sex (17%), puberty (14%) and bone (15%) in BMC, and puberty (48%) was more important than weekly training hours (19%), sex (12%), and radius-ulna (5%) in BA. The loaded bones % hypertrophy correlated with weekly training hours highly (> 0.60) in all maturity groups for BMC and BA, and moderately (0.41) in early adults for BA; it also correlated with age (≥ 0.60) in children and peripubertal players, but not (0.037) with starting age. Impact loading exercise favors mineralization twice than bone expansion, while puberty favors bone expansion about three times more than mineralization. The bone gains are higher for boys than girls, and for peripubertal than older players. The bone growth implications are discussed considering limitations and future research.

Dynamics of postnatal bone development and epiphyseal synostosis in the caprine autopod

Bones develop to structurally balance strength and mobility. Bone developmental dynamics are influenced by whether an animal is ambulatory at birth (i.e., precocial). Precocial species, such as goats, develop advanced skeletal maturity in utero, making them useful models for studying the dynamics of bone formation under mechanical load. Here, we used microcomputed tomography and histology to characterize postnatal bone development in the autopod of the caprine lower forelimb. The caprine autopod features two toes, fused by metacarpal synostosis (i.e., bone fusion) prior to birth. Our analysis focused on the phalanges 1 (P1) and metacarpals of the goat autopod from birth through adulthood (3.5 years). P1 cortical bone densified rapidly after birth (half-life using one-phase exponential decay model (τ1/2 = 1.6 ± 0.4 months), but the P1 cortical thickness increased continually through adulthood (τ1/2 = 7.2 ± 2.7 mo). Upon normalization by body mass, the normalized polar moment of inertia of P1 cortical bone was constant over time, suggestive of structural load adaptation. P1 trabecular bone increased in trabecular number (τ1/2 = 6.7 ± 2.8 mo) and thickness (τ1/2 = 6.6 ± 2.0 mo) until skeletal maturity, while metacarpal trabeculae grew primarily through trabecular thickening (τ1/2 = 7.9 ± 2.2 mo). Unlike prenatal fusion of the metacarpal diaphysis, synostosis of the epiphyses occurred postnatally, prior to growth plate closure, through a unique fibrocartilaginous endochondral ossification. These findings implicate ambulatory loading in postnatal bone development of precocial goats and identify a novel postnatal synostosis event in the caprine metacarpal epiphysis.

Inter-arm bone mass and size asymmetries in children tennis players are maturity status specific: a 9-month study on the effects of training time across pubertal change and somatic growth

PURPOSE

Bone growth with exercise is best assessed by tennis-induced inter-arm asymmetries. Yet, the effects of training and maturation across puberty were unclear. This study explored arm bone growth across 9 months of training in 46 tennis players 7-14 years (25 boys, 21 girls).

METHODS

Bone mineral content (BMC) and bone area (BA) were measured from DXA scans. Pubertal status was assessed by Tanner stage (TS) and somatic growth by maturity offset (MO). Children were grouped as pre- (TS I-I), early (TS I-II), and mid/late pubertal (TS II-III).

RESULTS

Training time (TT) change in the three groups was 160-170, 190-230, and 200-220 h, respectively. Bone asymmetries were large in all groups (d > 0.8, P < 0.001): 5-18 g (9-21%) and 9-17 g (17-23%) in girls and boys, respectively, for BMC, and 5-15 cm2 (6-13%) and 9-15 cm2 (12-15%) in girls and boys (10-13%), respectively, for BA. BMC and BA change asymmetry peaked at pre-puberty in girls (56%, 46%) and at early puberty in boys (57%, 43%). Asymmetry gains varied with baseline asymmetry (41%) and change in TT (38%) and TS (17%) in BMC, and with baseline asymmetry (58%) and change in MO (17%) and TS (12%) in BA.

CONCLUSION

All bone asymmetries were substantial. Tennis-induced bone gains were higher at pre- to early puberty in girls and at early to mid/late puberty in boys. Training enhanced mostly bone mass and maturity status enhanced mostly bone size; sex was not bone-change modeling impactful. Implications are discussed considering certain limitations.

Adolescents running in conventional running shoes have lower vertical instantaneous loading rates but greater asymmetry than running barefoot or in partial-minimal shoes

Footwear may moderate the transiently heightened asymmetry in lower limb loading associated with peak growth in adolescence during running. This repeated-measures study compared the magnitude and symmetry of peak vertical ground reaction force and instantaneous loading rates (VILRs) in adolescents during barefoot and shod running. Ten adolescents (age, 10.6 ± 1.7 years) ran at self-selected speed (1.7 ± 0.3 m/s) on an instrumented treadmill under three counter-balanced conditions; barefoot and shod with partial-minimal and conventional running shoes. All participants were within one year of their estimated peak height velocity based on sex-specific regression equations. Foot-strike patterns, peak vertical ground reaction force and VILRs were recorded during 20 seconds of steady-state running. Symmetry of ground reaction forces was assessed using the symmetry index. Repeated-measures ANOVAs were used to compare conditions (α=.05). Adolescents used a rearfoot foot-strike pattern during barefoot and shod running. Use of conventional shoes resulted in a lower VILR (P < .05, dz = 0.9), but higher VILR asymmetry (P < .05) than running barefoot (dz = 1.5) or in partial-minimal shoes (dz = 1.6). Conventional running shoes result in a lower VILR than running unshod or in partial-minimal shoes but may have the unintended consequence of increasing VILR asymmetry. The findings may have implications for performance, musculoskeletal development and injury in adolescents.

Lumbar spine bone mineral adaptation: cricket fast bowlers versus controls

Elite adult male fast bowlers have high lumbar spine bone mineral, particularly on the contralateral side to their bowling arm. It is thought that bone possesses its greatest ability to adapt to loading during adolescence, but it is unknown at what age the greatest changes in lumbar bone mineral and asymmetry develops in fast bowlers.

Objectives

This study aims to evaluate the adaptation of the lumbar vertebrae in fast bowlers compared to controls and how this is associated with age.

Methods

91 male fast bowlers and 84 male controls aged 14-24 years had between one and three annual anterior-posterior lumbar spine dual-energy-X-ray absorptiometry scans. Total (L1-L4) and regional ipsilateral and contralateral L3 and L4 (respective to bowling arm) bone mineral density and content (BMD/C) were derived. Multilevel models examined the differences in lumbar bone mineral trajectories between fast bowlers and controls.

Results

At L1-L4 BMC and BMD, and contralateral BMD sites, fast bowlers demonstrated a greater negative quadratic pattern to their accrual trajectories than controls. Fast bowlers had greater increases in BMC in L1-L4 between 14 and 24 years of 55% compared with controls (41%). Within vertebra, asymmetry was evident in all fast bowlers and increased by up to 13% in favour of the contralateral side.

Conclusions

Lumbar vertebral adaptation to fast bowling substantially increased with age, particularly on the contralateral side. The greatest accrual was during late adolescence and early adulthood, which may correspond with the increasing physiological demands of adult professional sport.

Effects of backhand stroke styles on bone mineral content and density in postmenopausal recreational tennis players: a cross-sectional pilot investigation

Background

One-handed backhand (OB) and two-handed backhand (TB) styles are commonly used in tennis, but only TB generates loadings on the non-dominant arm and a greater extension torque on the rear leg, leading to a greater axial torque involving rotation of the hip and trunk. The current study investigated whether those effects can further affect bone area (BA), bone mineral content (BMC) and density (BMD) in postmenopausal recreational tennis players.

Methods

BA, BMC and BMD of the lumbar spine, hip and distal radius were assessed using dual-energy X-ray absorptiometry in TB, OB, and swimmers’ group as a control (SG) (all participants self-reported for at least 5 years of exercise history, n = 14 per group). Muscular strength was assessed with a hand dynamometer. Among these three groups, the BA, BMC and BMD of distal radius and muscle strength were assessed using one-way ANOVA, and those of the lumbar region and the hip joint were tested by one-way ANCOVA.

Results

TB showed higher BMC and BMD for both lumbar spine and femoral neck than SG (all, p < 0.05). Both OB and TB showed greater BMD inter-trochanter than SG (both, p < 0.05). OB demonstrated greater inter-arm differences in the distal radius, which involved 1/3 distal for BMC and mid-distal radius for BMD compared to the TB and SG (all, p < 0.05). In addition, greater inter-arm asymmetry of grip strength was found in OB compared to TB and SG (both, p < 0.05).

Conclusion

For postmenopausal women, performing two-handed backhand strokes, leads to higher BMC and BMD in the non-dominant arm, the lumbar region, and hips, indicating potential benefit to maintain bone health and strength. Whether this result leads to reducing the risk of osteoporosis needs to be investigated in further research.

Relationship between muscular fitness and bone health in young baseball players

The physical actions developed by baseball players can increase muscular fitness, and consequently improve bone health. The objective was to relate some indicators of muscular fitness to bone health in young baseball players. A descriptive cross-sectional study was carried out in 102 children and adolescent baseball players of the Brazilian National Team. The age range ranged from 9.0 to 15.0 years, the average chronological age was 12.2±2.2 years and the maturity status was 14.8±0.5 APHV (age at peak height velocity). Anthropometry, body composition [% fat, fat mass (FM) and fat-free mass (FFM)], physical tests [horizontal jump (HJ) and medicine ball throw (MBT)] bone health was estimated by anthropometry [bone mineral density (BMD) and bone mineral content (BMC)]. There was positive and significant correlation between bone health with FFM (r2= 89%) and with muscle strength tests (HJ and MBT) (R2= 55 to 75%). Young baseball players classified with low bone health level, reflected decreased values of FFM, HJ and MBT, in relation to young players classified with moderate and high bone health level (p<0.05). It was shown that good bone health is a consequence of a greater presence of muscular fitness, as a result of increased physical activity. These results suggest that emphasis should be placed on those young people who present a greater risk of having low BMD and BMC.

Bone asymmetries in the limbs of children tennis players: testing the combined effects of age, sex, training time, and maturity status

This study estimated upper and lower limb bone mineral content (BMC) and bone area (BA) in 48 children tennis players (24 boys, 24 girls) aged 7-13 years. The sample comprised four age groups (8.2 ± 0.44, 9.5 ± 0.13, 10.5 ± 0.33, 12.2 ± 0.58). BMC and BA were measured via DXA, and sexual maturity by the Tanner scale, then used as a binary: prepubertal vs peripubertal. Total training time (TTT) included all playing years. Arms were asymmetric and legs symmetric. Boys were more asymmetric than girls in BMC (18% vs 13%) and BA (11% vs 8%). Pre-pubertal children were less asymmetric than peri-pubertal in BMC (14% vs 18%) and in BA (9.4% vs 10%). Bone growth changed with age and TTT markedly better in the dominant arm. The linear combination of TTT, sex, and maturity binary extracted 59% of BMC asymmetry and only 21% of BA asymmetry. For both bone parameters the sex effect was significant only for the pre-pubertal children. Training time constitutes the best predictor of bone asymmetry compared to age, sex, and maturity; when adequate, playing arm bone hypertrophy may be detectable at the age of 7-8 years. These results have health and performance implications.

Impact of changes in fat mass and lean soft tissue on bone mineral density accrual in adolescents engaged in different sports: ABCD Growth Study

Body composition can have a significant impact on bone mineral density (BMD) in pediatric patients and may cause bone disease. This study demonstrated that lean soft tissue (LST) seems to have a greater impact on BMD gain in the lower limbs of adolescents.

PURPOSE

To analyze the impact of changes in lean soft tissue (LST) and fat mass on areal bone mineral density (BMD) accrual in the lower limbs among adolescents engaged in sports with different weight-bearing levels.

METHODS

Longitudinal (12 months: measurements at two time points). Adolescents of both sexes (n = 191; 62 girls [32.5%] and 129 boys [67.5%]) were divided into three groups: control group (n = 65), swimming group (n = 25), and weight-bearing sports group (n = 100). Absolute changes in LST (kg) and fat mass (kg) were the independent variables, while BMD accrual (left and right legs) was the dependent variable. Linear regression was used to assess the relationship between dependent and independent variables in a multivariate model adjusted by sex, body weight, somatic maturation, serum osteocalcin, and baseline values of BMD of the lower limbs.

RESULTS

For the left leg, LST was positively related to areal BMD accrual in the control (β = 0.021 [95%CI: 0.001 to 0.042]) and weight-bearing sport groups (β = 0.051 [95%CI: 0.037 to 0.065]), but not among swimmers (β = 0.029 [95%CI: - 0.004 to 0.062]). For the right leg, LST was positively related to areal BMD accrual in the swimming group (β = 0.065 [95%CI: 0.031 to 0.100]) and weight-bearing sport groups (β = 0.048 [95%CI: 0.034 to 0.062]), but not in the control group (β = 0.014 [95%CI: - 0.002 to 0.030]). Fat mass was not significantly related to areal BMD in either leg.

CONCLUSIONS

Changes in LST were the most relevant determinant of BMD accrual in the lower limbs, mainly among adolescents engaged in sports.

Utility of Distal Forearm DXA as a Screening Tool for Primary Osteoporotic Fragility Fractures of the Distal Radius: A Case-Control Study

BACKGROUND

Osteoporotic fragility fractures frequently occur at the distal part of the radius. This suggests that initial osteoporosis evaluation at this site may inform screening and treatment to prevent additional fractures. The purpose of this study was to investigate the utility of distal forearm dual x-ray absorptiometry (DXA) as a screening tool to assess the risk of fragility fractures at the distal part of the radius.

METHODS

This retrospective, case-control study included postmenopausal women who had sustained a distal radial fracture (fracture group, n = 110) and postmenopausal women with no history of fracture (control group, n = 95). DXA measurements at the spine, hip, and distal part of the forearm (ultra-distal, mid-distal, and one-third distal sections) were compared between the groups on the basis of bone mineral density (BMD), T-score, and the proportion of patients with a T-score of ≤-2.5 standard deviations (SD). We also investigated the regional differences on the basis of T-score among the skeletal sites. Furthermore, the reliability of distal forearm DXA measurements was validated by assessing the statistical correlation (r) with volumetric BMD by computed tomography (CT).

RESULTS

Compared with the control group, the fracture group showed significantly lower BMD and T-scores and higher proportions of patients with a T-score of ≤-2.5 SD at the ultra-distal, mid-distal, and one-third distal forearm; however, the spine and hip measurements did not differ significantly between the 2 groups. With respect to regional differences, in the fracture group, T-scores were significantly lower and the proportions of patients with a T-score of ≤-2.5 SD were significantly higher for the 3 distal forearm sites compared with the spine and hip. DXA measurements at all 3 of the distal forearm regions exhibited high correlation with volumetric BMD by CT (r = 0.83 to 0.92).

CONCLUSIONS

Some postmenopausal women were found to exhibit bone loss preferentially at the distal part of the radius, which may render them vulnerable to fragility fractures. Forearm DXA for the assessment of local bone loss may demonstrate benefit in screening for those at risk for distal radial fractures and facilitate the early identification of patients who require intervention for osteoporosis.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Lumbar bone mineral asymmetry in elite cricket fast bowlers

PURPOSE

Bone responds to mechanical loading by increasing bone mineral density (BMD) and/or bone area to enhance bone strength at the site of the greatest strain. Such localised adaptation has not been demonstrated at the spine. The aim of this study is to determine if BMD and/or bone mineral content (BMC) differs between dominant (ipsilateral to bowling/throwing arm) and non-dominant sides of the vertebrae in cricket fast bowlers, and whether this asymmetry differs according to stress fracture or disc injury history. A further aim was to determine if regional BMD and BMC in the lumbar spine differ between fast bowlers, other cricketers, rugby players and non-active controls, to highlight the site-specific response of lumbar vertebra to unilateral activity.

METHODS

23 fast bowlers, 14 other cricketers, 22 rugby players and 20 controls underwent an antero-posterior (AP) and lateral DXA scans of their lumbar spine to assess BMD, BMC and area. A custom analysis measured BMD and BMC of the dominant and non-dominant sides (lateral 33%) of the AP lumbar spine. BMD and BMC were compared between groups, injury status, vertebrae and sides using ANOVA.

RESULTS

Analysis of medical records showed that 6 fast bowlers had a history of lumbar stress fracture. Significantly greater BMD and BMC was found in the L4 non-dominant vertebra compared with the dominant vertebra in fast bowlers. BMD and BMC differed significantly according to vertebra, side and group, with fast bowlers having significantly greater BMD and BMC at the L3 and L4 non-dominant vertebra compared with other groups (L3: 13.3%-45.3%, L4: 15.7%-44.0%) compared with other groups. Fast bowlers who never suffered lumbar stress fracture had 3.6% and 1.7% greater BMD in the dominant and non-dominant sides of lumbar vertebrae respectively compared with those who did suffer lumbar stress fracture, but evidence of this was weaker (P = 0.08).

CONCLUSION

The lumbar spine responds to a unique unilateral high loading activity through site-specific increased bone mass at the site of most strain. Fast bowlers had increased lumbar BMD, particularly on the non-dominant side of L4, although this adaptation was less marked in those with history of lumbar stress fracture. Site-specific low bone mineral density within the lumbar side may be implicated in the aetiology of lumbar stress fracture.

Sports participation and muscle mass affect sex-related differences in bone mineral density between male and female adolescents: A longitudinal study

BACKGROUND

Sports participation plays an important role in bone gain during childhood and adolescence. The aim here was to identify sex-related determinants of bone mineral density (BMD) differences between male and female adolescents, with emphasis on the role of sports participation.

DESIGN AND SETTING

Longitudinal study conducted in a public university in Presidente Prudente, Brazil.

METHODS

The sample comprised 48 adolescents aged 11-17 years, of both sexes, who were matched according to sex, age and sports participation. BMD was the main outcome, while muscle mass, sports participation, calendar age and biological maturation were treated as covariates. Participants were followed up after nine months.

RESULTS

At baseline, BMD values were similar between the sexes. However, adjustment for covariates showed that BMD was higher among girls at all sites, with a contribution from lean soft tissue (LST) in the model (partial eta-squared, ES-r = 0.619 in upper limbs; 0.643 in lower limbs; 0.699 in spine; and 0.599 in whole body). Sports participation only explained the upper-limb variance (ES-r = 0.99). At the follow-up, the results resembled the baseline except in the lower limbs (P = 0.109), in which BMD was similar between the groups. BMD gain over time was similar between girls and boys in all segments, and baseline LST affected upper-limb and whole-body BMD accrual (ES-r = 0.396 and 0.107, respectively).

CONCLUSION

Whole-body and specific-site BMD differed between baseline and follow-up. However,BMD accrual was similar between the sexes, given that muscle mass constituted the most relevant determinant of the difference between them.

Tsc1 Regulates the Balance Between Osteoblast and Adipocyte Differentiation Through Autophagy/Notch1/β-Catenin Cascade

A reduction in trabecular bone mass is often associated with an increase in marrow fat in osteoporotic bones. The molecular mechanisms underlying this inverse correlation are incompletely understood. Here, we report that mice lacking tuberous sclerosis 1 (Tsc1) in Osterix-expressing cells had a significant decrease in trabecular bone mass characterized by decreased osteoblastogenesis, increased osteoclastogenesis, and increased bone marrow adiposity in vivo. In vitro study showed that Tsc1-deficient bone marrow stromal cells (BMSCs) had decreased proliferation, decreased osteogenic differentiation, and increased adipogenic differentiation in association with the downregulation of Wnt/β-catenin signaling. Mechanistically, TSC1 deficiency led to autophagy suppression and consequent Notch1 protein increase, which mediated the GSK3β-independent β-catenin degradation. Together, our results indicate that Tsc1 controls the balance between osteoblast and adipocyte differentiation of BMSCs. © 2018 American Society for Bone and Mineral Research.

Study of human radius construction systematics: evaluation by DXA in dry bone

This study has been undertaken in order to describe the bone mass distribution of the dry human radius via dual x-ray absorptiometry (DXA) with a Norland XR-800 densitometer machine. A sample of 39 dry radius bones was used. Two projections were made: antero-posterior and lateral, and five regions of interest were selected. The bone densities and the bone mineral contents of the various regions of the radius in the two projections were compared using Student's t tests for paired samples, with statistically significant differences being found in all of the values, except in the proximal extremity (P Ext). The area of greatest bone mineral content (BMC) was the medial diaphysis (M Diaph), followed by the distal extremity (D Ext), with the lowest value being found in the proximal extremity (P Ext). As for bone mineral density (BMD), a great symmetry is observed if we take the mean point of the longitudinal axis as a reference, with it being distributed from highest to lowest from the central part to the extremities. A correlation study of the BMD and BMC values between the segments themselves and with the total, in both positions, provides us with a high correlation (p ≤ 0.01), with the highest correlation value being found for the proximal diaphysis (P Diaph) region, indicating the heterogeneous nature of the distribution of the radius bone mass. Bone densitometry via DXA is useful in order to establish an overview of the structural construction of the human radius.

Adults Engaged in Sports in Early Life Have Higher Bone Mass Than Their Inactive Peers

Purpose: To analyze the relationship between engagement in sports in early life and bone variables among adults of both sexes. Methods: The sample was composed of 225 men and women. Demographic data were collected, and dual-energy X-ray absorptiometry was used to assess bone mineral density, bone mineral content, and lean soft tissue. Sports participation in early life was assessed by an interview including childhood and adolescence. Consumption of tobacco and alcohol was also assessed by interview and the habitual physical activity level by a pedometer. Results: Inactive men had bone mineral content around 11% lower than active men in childhood or adolescence, whereas for women, this difference represented around 14%. Active men had 74% less fat mass than inactive men in early life, and the difference was 67% for women. Early sports participation explained the differences in whole-body bone mineral content (16.8%, P-value = .005) and bone mineral density (8.8%, P-value = .015), as well as bone mineral density in lower limbs (18.9%, P-value = .001) among women. Conclusion: Adults engaged in sports in early life have higher bone mass than their inactive peers, especially women.

Impact of Martial Arts (Judo, Karate, and Kung Fu) on Bone Mineral Density Gains in Adolescents of Both Genders: 9-Month Follow-Up

PURPOSE

To compare bone mineral density (BMD) gains in adolescents of both genders stratified according to different martial art styles in a 9-month follow-up study.

METHODS

The longitudinal study consisted of 29 adolescents of both genders and age between 11 and 17 years stratified into a control group (not engaged in any sport) and 50 fighters (kung fu/karate, n = 29; judo, n = 21). All 79 subjects underwent anthropometric measures (weight, height, leg length, and height set) and dual-energy X-ray absorptiometry (BMD, in g/cm²) at 2 moments, baseline and 9 months later. Maturity offset (age at peak height velocity), lean soft tissue, chronological age, and resistance training were treated as covariates.

RESULTS

Male judoists presented higher gains in BMD-spine [0.098 g/cm² (95% confidence interval, 0.068-0.128)] than control group [0.040 g/cm² (95% confidence interval, 0.011-0.069)] (post hoc test with P = .030). There was no effect of martial art on BMD gains among girls. Independently of gender, in all multivariate models, lean soft tissue constituted the most relevant covariate.

CONCLUSIONS

Judo practice in adolescents affected the bone accrual significantly after 9-month follow-up compared with controls, mainly in boys.

Characterization of bone diagenesis by histology in forensic contexts: a human taphonomic study

The diagenesis of a bone in the postmortem period causes an identifiable deterioration in histology. This degradation is characterized by a collagenous alteration, which can be observed very early. In order to develop a method for determining a postmortem interval for medico-legal use, two ribs collected from six human bodies were studied prospectively over 2 years. Each bone was studied after staining with Sirius red to demonstrate the degradation of collagen as a function of time. This study demonstrated a time-based bone alteration characterized by the architectural degradation of the lamellar bone, without any microbial influence in this postmortem period. The staining was carried out by using Sirius red and correlated this alteration with a collagenic degradation by chemical hydrolysis owing to the affinity of this dye to the amino acids lysine, hydroxylysine, and arginine. Our work asserts that human bone samples that were studied in a controlled environment and analyzed for 24 months underwent a diagenetic trajectory whose main element was collagen hydrolysis.

In vivo Visualisation and Quantification of Bone Resorption and Bone Formation from Time-Lapse Imaging

PURPOSE OF REVIEW

Mechanoregulation of bone cells was proposed over a century ago, but only now can we visualise and quantify bone resorption and bone formation and its mechanoregulation. In this review, we show how the newest advances in imaging and computational methods paved the way for this breakthrough.

RECENT FINDINGS

Non-invasive in vivo assessment of bone resorption and bone formation was demonstrated by time-lapse micro-computed tomography in animals, and by high-resolution peripheral quantitative computed tomography in humans. Coupled with micro-finite element analysis, the relationships between sites of bone resorption and bone formation and low and high tissue loading, respectively, were shown. Time-lapse in vivo imaging and computational methods enabled visualising and quantifying bone resorption and bone formation as well as its mechanoregulation. Future research includes visualising and quantifying mechanoregulation of bone resorption and bone formation from molecular to organ scales, and translating the findings into medicine using personalised bone health prognosis.

Bone tissue, blood lipids and inflammatory profiles in adolescent male athletes from sports contrasting in mechanical load

Exploring the effect of non-impact and impact sports is particular relevant to understand the interaction between skeletal muscle and bone health during growth. The current study aimed to compare total and regional bone and soft-tissue composition, in parallel to measurements of blood lipid and inflammatory profiles between adolescent athletes and non-athletes. Anthropometry, biological maturity, dual energy X-ray absorptiometry (DXA) scans, training load and lipid and inflammatory profiles were assessed in a cross-sectional sample of 53 male adolescents (20 non-athletes, 15 swimmers and 18 basketball players) aged 12–19 years. Multiple comparisons between groups were performed using analysis of variance, covariance and magnitude effects (ES-r and Cohen’s d). The comparisons of controls with other groups were very large for high-sensitivity C-reactive protein (d range: 2.17–2.92). The differences between sports disciplines, regarding tissue outputs obtained from DXA scan were moderate for all variables except fat tissue (d = 0.4). It was possible to determine small differences (ES-r = 0.17) between controls and swimmers for bone area at the lower limbs (13.0%). In parallel, between swimmers and basketball players, the gradient of the differences was small (ES-r range: 0.15–0.23) for bone mineral content (24.6%), bone area (11.3%) and bone mineral density (11.1%) at the lower limbs, favoring the basketball players. These observations highlight that youth male athletes presented better blood and soft tissues profiles with respect to controls. Furthermore, sport-specific differences emerged for the lower limbs, with basketball players presenting higher bone mineral content, area and density than swimmers.

Somatic maturation and the relationship between bone mineral variables and types of sports among adolescents: cross-sectional study

CONTEXT AND OBJECTIVE:

Peak height velocity (PHV) is an important maturational event during adolescence that affects skeleton size. The objective here was to compare bone variables in adolescents who practiced different types of sports, and to identify whether differences in bone variables attributed to sports practice were dependent on somatic maturation status.

DESIGN AND SETTING:

Cross-sectional study, São Paulo State University (UNESP).

METHODS:

The study was composed of 93 adolescents (12 to 16.5 years old), divided into three groups: no-sport group (n = 42), soccer/basketball group (n = 26) and swimming group (n = 25). Bone mineral density and content were measured using dual-energy x-ray absorptiometry and somatic maturation was estimated through using peak height velocity. Data on training load were provided by the coaches.

RESULTS:

Adolescents whose PHV occurred at an older age presented higher bone mineral density in their upper limbs (P = 0.018). After adjustments for confounders, such as somatic maturation, the swimmers presented lower values for bone mineral density in their lower limbs, spine and whole body. Only the bone mineral density in the upper limbs was similar between the groups. There was a negative relationship between whole-body bone mineral content and the weekly training hours (β: -1563.967; 95% confidence interval, CI: -2916.484 to -211.450).

CONCLUSION:

The differences in bone variables attributed to sport practice occurred independently of maturation, while high training load in situations of hypogravity seemed to be related to lower bone mass in swimmers.

Basketball Affects Bone Mineral Density Accrual in Boys More Than Swimming and Other Impact Sports: 9-mo Follow-Up

The objective of this study was to analyze the effect of different sports on bone mineral density (BMD) accrual among male adolescents during a 9-mo follow-up. The sample was composed of 82 boys (control [n = 13], basketball [n = 14], karate [n = 9], soccer [n = 18], judo [n = 12], and swimming [n = 16]) who were followed up for 9 mo (from October 2013 to August 2014). BMD (gram per square centimeter) was assessed at baseline and follow-up using a dual-energy X-ray absorptiometry scanner, whereas somatic maturation was estimated through the use of the peak height velocity. Vitamin D consumption was assessed by questionnaire. After 9 mo of follow-up, all groups (including the control group) presented significant BMD accrual (overall sample: 4.5% in the whole body). On the other hand, the basketball group presented higher BMD accrual in the upper limbs (17.6%) than the control group (7.2%). A similar difference was observed in whole-body BMD (control group: 4.1% vs basketball group: 7.1%). The basketball group had significantly higher BMD gains than the control group and other sports groups.

[Practice of martial arts and bone mineral density in adolescents of both sexes]

OBJECTIVE

The purpose of this study was to analyze the relationship between martial arts practice (judo, karate and kung-fu) and bone mineral density in adolescents.

METHODS

The study was composed of 138 (48 martial arts practitioners and 90 non-practitioners) adolescents of both sexes, with an average age of 12.6 years. Bone mineral density was measured using Dual-Energy X-ray Absorptiometry in arms, legs, spine, trunk, pelvis and total. Weekly training load and previous time of engagement in the sport modality were reported by the coach. Partial correlation tested the association between weekly training load and bone mineral density, controlled by sex, chronological age, previous practice and somatic maturation. Analysis of covariance was used to compare bone mineral density values according to control and martial arts groups, controlled by sex, chronological age, previous practice and somatic maturation. Significant relationships between bone mineral density and muscle mass were inserted into a multivariate model and the slopes of the models were compared using the Student t test (control versus martial art).

RESULTS

Adolescents engaged in judo practice presented higher values of bone mineral density than the control individuals (p-value=0.042; Medium Effect size [Eta-squared=0.063]), while the relationship between quantity of weekly training and bone mineral density was significant among adolescents engaged in judo (arms [r=0.308] and legs [r=0.223]) and kung-fu (arms [r=0.248] and spine [r=0.228]).

CONCLUSIONS

Different modalities of martial arts are related to higher bone mineral density in different body regions among adolescents.

Geometrical adaptation in ulna and radius of cerebral palsy patients: measures and consequences

BACKGROUND

The presence of significant forearm bone torsion might affect planning and evaluating treatment regimes in cerebral palsy patients. We aimed to evaluate the influence of longstanding wrist flexion, ulnar deviation, and forearm pronation due to spasticity on the bone geometries of radius and ulna. Furthermore, we aimed to model the hypothetical influence of these deformities on potential maximal moment balance for forearm rotation.

METHODS

Geometrical measures were determined in hemiplegic cerebral palsy patients (n=5) and healthy controls (n=5). Bilateral differences between the spastic arm and the unaffected side were compared to bilateral differences between the dominant and non-dominant side in the healthy controls. Hypothetical effects of bone torsion on potential maximal forearm rotation moment were calculated using an existing anatomical muscle model.

FINDINGS

Patients showed significantly smaller (radius: 41.6%; ulna: 32.9%) and shorter (radius: 9.1%; ulna: 8.4%) forearm bones in the non-dominant arm than in the dominant arm compared to controls (radius: 2.4%; ulna 2.5% and radius: 1.5%; ulna: 1.0% respectively). Furthermore, patients showed a significantly higher torsion angle difference (radius: 24.1°; ulna: 26.2°) in both forearm bones between arms than controls (radius: 2.0°; ulna 1.0°). The model predicted an approximate decrease of 30% of potential maximal supination moment as a consequence of bone torsion.

INTERPRETATION

Torsion in the bones of the spastic forearm is likely to influence potential maximal moment balance and thus forearm rotation function. In clinical practice, bone torsion should be considered when evaluating movement limitations especially in children with longstanding spasticity of the upper extremity.

Beneficial effects of judo training on bone mineral density of high-school boys in Korea

Bone mineralization is strongly stimulated by weight-bearing exercise during growth and development. Judo, an Olympic combat sport, is a well-known form of strenuous and weight-bearing physical activity. Therefore, the primary goal of this study was to determine the effects of Judo practice on the bone health of male high school students in Korea. The secondary goal of this study was to measure and compare the bone mineral density (BMD) of the hands of Judo players and sedentary control subjects. Thirty Judo players (JDP) and 30 sedentary high school boys (CON) voluntarily participated in the present study, and all of the sedentary control subjects were individually matched to the Judo players by body weight. BMD was determined by using dual-energy X-ray absorptiometry (Hologic, Bedford, MA, USA). The lumbar spine, femur and forearm BMD in the JDP group were significantly greater by 22.7%, 24.5%, and 18.3%, respectively, than those in the CON group. In addition, a significant difference in the CON group was observed between the dominant hand (DH) radius (0.710 ± 0.074 g/cm(2)) and the non-dominant hand (NDH) radius (0.683 ± 0.072 g/cm(2)), but this was not observed in the JDP group (DH = 0.819 ± 0.055 g/cm(2); NDH = 810 ± 0.066 g/cm(2)) (P < 0.05). Therefore, the results of this study suggest that Judo practice during the growth period significantly improves bone health in high school male students. In addition, it seems that Judo practice could eliminate the effect of increased BMD in the dominant hand.

R-Spondin 1 promotes vibration-induced bone formation in mouse models of osteoporosis

Bone tissue adapts to its functional environment by optimizing its morphology for mechanical demand. Among the mechanosensitive cells that recognize and respond to forces in the skeleton are osteocytes, osteoblasts, and mesenchymal progenitor cells (MPCs). Therefore, the ability to use mechanical signals to improve bone health through exercise and devices that deliver mechanical signals is an attractive approach to age-related bone loss; however, the extracellular or circulating mediators of such signals are largely unknown. Using SDS-PAGE separation of proteins secreted by MPCs in response to low-magnitude mechanical signals and in-gel trypsin digestion followed by HPLC and mass spectroscopy, we identified secreted proteins up-regulated by vibratory stimulation. We exploited a cell senescence-associated secretory phenotype screen and reasoned that a subset of vibration-induced proteins with diminished secretion by senescent MPCs will have the capacity to promote bone formation in vivo. We identified one such vibration-induced bone-enhancing (vibe) gene as R-spondin 1, a Wnt pathway modulator, and demonstrated that it has the capacity to promote bone formation in three mouse models of age-related bone loss. By virtue of their secretory status, some vibe proteins may be candidates for pre-clinical development as anabolic agents for the treatment of osteoporosis.

KEY MESSAGE

Mesenchymal stem cells respond to low magnitude mechanical signals (vibration). R-Spondin 1 is upregulated by mechanical signals and secreted. R-Spondin 1 promotes bone formation in three mouse models of osteoporosis.

Assessing bone health in children and adolescents

During normal childhood and adolescence, the skeleton undergoes tremendous change. Utilizing the processes of modeling and remodeling, the skeleton acquires its adult configuration and ultimately achieves peak bone mass. Optimization of peak bone mass requires the proper interaction of environmental, dietary, hormonal, and genetic influences. A variety of acute and chronic conditions, as well as genetic polymorphisms, are associated with reduced bone density, which can lead to an increased risk of fracture both in childhood and later during adulthood. Bone densitometry has an established role in the evaluation of adults with bone disorders, and the development of suitable reference ranges for children now permits the application of this technology to younger individuals. We present a brief overview of the factors that determine bone density and the emerging role of bone densitometry in the assessment of bone mass in growing children and adolescents.

Human biology at the interface of paediatrics: measuring bone mineral accretion during childhood

BACKGROUND

Professor Tanner established a paradigm for the study of growth and development that demands precise growth measurements, description of normal variability through development to adulthood, consideration of the effects of tempo and the study of factors that influence growth outcomes. The relatively new field of paediatric bone health assessment fits this paradigm and reflects the collaboration of human biologists and paediatricians in understanding the growth of the human skeleton.

REVIEW

This review describes the reasons for clinical assessment of bone density in children, the technological developments in bone health assessment in children, the development of reference curves and the effects of growth, body composition, pubertal timing, genetics and lifestyle on bone health outcomes.

Bone health and the female athlete triad in adolescent athletes

Peak bone mass (PBM) is a negative predictor of osteoporosis and lifelong fracture risk. Because osteoporosis is such a prevalent disease with life-threatening consequences, it is important to try to maximize PBM. Adolescence is a critical period for bone acquisition. This article discusses some of the differences in male and female skeletal development and modifiable factors that enhance bone accrual in this age group, particularly in athletes. Hormonal influences, effects of physical activity, and nutritional contributions are included, with a focus on the adolescent athlete. Emphasis is placed on the importance of appropriate energy availability in this age group. We also review prevention and treatment strategies for the female athlete triad (ie, the inter-relationship of decreased energy availability, menstrual irregularity, and low bone density) in adolescents and athletic women. Recommendations for maximizing bone density in both male and female adolescents are discussed.

Loading and skeletal development and maintenance

Mechanical loading is a major regulator of bone mass and geometry. The osteocytes network is considered the main sensor of loads, through the shear stress generated by strain induced fluid flow in the lacuno-canalicular system. Intracellular transduction implies several kinases and phosphorylation of the estrogen receptor. Several extra-cellular mediators, among which NO and prostaglandins are transducing the signal to the effector cells. Disuse results in osteocytes apoptosis and rapid imbalanced bone resorption, leading to severe osteoporosis. Exercising during growth increases peak bone mass, and could be beneficial with regards to osteoporosis later in life, but the gain could be lost if training is abandoned. Exercise programs in adults and seniors have barely significant effects on bone mass and geometry at least at short term. There are few data on a possible additive effect of exercise and drugs in osteoporosis treatment, but disuse could decrease drugs action. Exercise programs proposed for bone health are tedious and compliance is usually low. The most practical advice for patients is to walk a minimum of 30 to 60 minutes per day. Other exercises like swimming or cycling have less effect on bone, but could reduce fracture risk indirectly by maintaining muscle mass and force.

Metacarpal trabecular architecture variation in the chimpanzee (Pan troglodytes): Evidence for locomotion and tool-use?

Trabecular architecture was assessed by 3D micro-computed tomography from spherical volumes of interest located within the head and base of metacarpals (MC) 1, 2, and 5 from n = 19 adult common chimpanzees. Two subspecies, West African Pan troglodytes verus from the Taï Forest, Côte d'Ivoire (n = 12) and Central African P. t. troglodytes from Cameroon (n = 7), were studied. For the combined sample, the metacarpal head is distinguished by greater bone volume fraction across all metacarpals, though the MC 1 is distinctive in having thicker, more plate-like trabeculae. The architecture in the MC 2 and MC 5 can be related to strains associated with terrestrial knuckle-walking. In particular, the relatively robust MC 5 head architecture may result from functional loading incurred during braking and use of a palm-in hand posture. Examining differences between samples, we found that the Cameroon chimpanzees possess a more robust architecture across all metacarpals in the form of greater bone volume fraction, higher connectivity, and somewhat more plate-like structure. These differences are not explicable in terms of population distinctions in body size or daily travel distance, but possibly reflect a combination of more terrestrial knuckle-walking in the Cameroon sample and more diverse hand postures and precision handling required of nut-cracking in West African chimpanzees.

Bone and lean mass inter-arm asymmetries in young male tennis players depend on training frequency

Professional tennis players (TP) have marked inter-arm asymmetry in bone mass (BMC) and density (BMD). To determine if this asymmetry is influenced by training frequency and volume, we studied 24 young tennis players (mean age 10.6 years, Tanner 1-2), 17 physically active control boys (CG) and ten male professional tennis players. Young TP were divided into two groups depending on the number of training days per week (TP5: 5 days/week, n = 10; TP2: 2 days/week, n = 14). In young TP, the dominant arm (DA) compared to the non-dominant arm (NDA) had greater lean mass (TP5, 13.3 +/- 2.0% and TP2, 8.3 +/- 1.3%), BMC (TP5, 22.4 +/- 4.1% and TP2, 12.1 +/- 2.2%), bone area (TP5, 15.6 +/- 3.3% and TP2, 7.9 +/- 2.2%) and BMD (TP5, 4.6 +/- 1.5% and TP2, 3.8 +/- 0.6%). Inter-arm asymmetry in lean mass, BMC and bone area was greater in TP5 than TP2, being related to the number of weekly hours devoted to tennis (r = 0.45-52, P < 0.05). No significant differences in lumbar spine or femoral neck BMC or BMD were observed between TP5, TP2 and CG. In professional TP, the DA had 18, 32, 11 and 15% greater lean mass, BMC, bone area and BMD than the NDA. Thus, TP5 had 69% of the inter-arm asymmetry in BMC observed in professional TP and a similar inter-arm asymmetry in bone area, although this comparison may not be generalisable. Young tennis players have increased BMC, bone area and lean mass in dominant arm, which magnitude depends on the number of weekly hours devoted to tennis.

Throwing induces substantial torsional adaptation within the midshaft humerus of male baseball players

Athletes participating in unilateral dominant sports are useful models for investigating skeletal responses to mechanical loading as they provide controlled evidence in the absence of completing a randomized controlled trial. Throwing athletes may be an additional model for this purpose as they overload their dominant upper extremity enabling the contralateral side to act as an internal control and load the bones of the upper extremity purely via the generation of internal (i.e. muscular) forces without superposition of externally applied loads (i.e. impact with an external object). The aim of this study was to investigate upper extremity bone adaptation in throwing athletes and explore factors that predict this adaptation. Two cohorts were recruited-male baseball players (throwers; n=15) and matched controls (controls; n=15). Each subject was assessed for shoulder range and strength, and upper extremity bone mass, structure and estimated strength. Throwers had substantially greater skeletal differences between their dominant and nondominant upper extremities than controls, indicating that throwing induces greater adaptation than induced by habitual loading of the dominant upper extremity. Bone adaptation in throwers was localized to the humerus, with the midshaft humerus in the dominant upper extremity of throwers having enhanced bone mass, structure and estimated strength. The largest effect was for estimated strength of the midshaft humerus which had 30% greater polar moment of inertia (I(P)) in throwers and suggests adaptation to resist torsional loads. The skeletal effect of throwing at the midshaft humerus was influenced by playing position with pitchers and catchers displaying greater dominant-to-nondominant differences than fielders, and was predicted by years throwing and dominant-to-nondominant difference in upper arm lean cross-sectional area. The latter two variables explained 67% of the variance in dominant-to-nondominant differences in I(P). Collectively, these data indicate that throwing induces substantial adaptation within the midshaft humerus. Adaptation was primarily in the direction of torsion which is consistent with biomechanical and injury data suggesting throwing introduces high magnitude torsional forces. As the magnitude of adaptation in throwers was equivalent to that observed in athletes participating in other unilateral dominant sports, throwers represent an alternative model for investigating the skeletal effects of mechanical loading.

Ultrasound imaging of the patellar tendon attachment to the tibia during puberty: a 12-month follow-up in tennis players

This longitudinal study investigated the ultrasound appearance of the patellar tendon attachment to the tibia throughout puberty in young tennis players with and without Osgood-Schlatter disease (OSD). Twenty-eight competitive players (17 boys), aged 10.6-15.3 years, had bilateral ultrasound imaging of the patellar tendon attachment to the tibia at baseline and 1 year later. On each occasion, anthropometric measurements, pubertal status and injury history were recorded. Ultrasound appearance of the patellar tendon attachment was categorized into three stages: cartilage attachment, insertional cartilage and mature attachment. Stage 1 appearance, a large anechoic region with or without ossicles and irregularity of the apophysis that are classically associated with OSD, was found in eight players, seven of them were pain free. A majority (62%) of the patellar tendons in stage 1 at baseline progressed toward stage 2 or stage 3 1 year later. Likewise the patellar tendon attachment in most athletes with cartilage insertion showed progression to a mature enthesis over 1 year. The imaging appearance that is classically interpreted as OSD was common in asymptomatic knees. This ultrasonographic description of the patellar tendon attachment to the tibia during growth provides a reference for the assessment of bone tendon attachments in adolescents.

A comparison of cortical and trabecular bone from C57 Black 6 mice using Raman spectroscopy

Cortical and trabecular bone are both produced and maintained by the same cell types. At the microscopic scale they have a similar lamellar structure but at a macroscopic scale they are very different. Raman microscopy has been used to investigate compositional differences in the two bone types using bone from standard laboratory mice in physiological conditions. Clear differences were observed when complete spectra were compared by principal component analysis (PCA). Analysis of individual bands showed cortical bone to have compositional characteristics of older bone when compared with trabecular material, possibly due to the higher bone turnover traditionally reported in the trabecular compartment.

Mammalian hibernation as a model of disuse osteoporosis: the effects of physical inactivity on bone metabolism, structure, and strength

Reduced skeletal loading typically leads to bone loss because bone formation and bone resorption become unbalanced. Hibernation is a natural model of musculoskeletal disuse because hibernating animals greatly reduce weight-bearing activity, and therefore, they would be expected to lose bone. Some evidence suggests that small mammals like ground squirrels, bats, and hamsters do lose bone during hibernation, but the mechanism of bone loss is unclear. In contrast, hibernating bears maintain balanced bone remodeling and preserve bone structure and strength. Differences in the skeletal responses of bears and smaller mammals to hibernation may be due to differences in their hibernation patterns; smaller mammals may excrete calcium liberated from bone during periodic arousals throughout hibernation, leading to progressive bone loss over time, whereas bears may have evolved more sophisticated physiological processes to recycle calcium, prevent hypercalcemia, and maintain bone integrity. Investigating the roles of neural and hormonal control of bear bone metabolism could give valuable insight into translating the mechanisms that prevent disuse-induced bone loss in bears into novel therapies for treating osteoporosis.

Physical activity increases bone mass during growth

BACKGROUND

The incidence of fragility fractures has increased during the last half of the 1990's. One important determinant of fractures is the bone mineral content (BMC) or bone mineral density (BMD), the amount of mineralised bone. If we could increase peak bone mass (the highest value of BMC reached during life) and/or decrease the age-related bone loss, we could possibly improve the skeletal resistance to fracture.

OBJECTIVE

This review evaluates the importance of exercise as a strategy to improve peak bone mass, including some aspects of nutrition.

DESIGN

PUBLICATIONS WITHIN THE FIELD WERE SEARCHED THROUGH MEDLINE (PUBMED) USING THE SEARCH WORDS: exercise, physical activity, bone mass, bone mineral content, bone mineral density, BMC, BMD, skeletal structure and nutrition. We included studies dealing with exercise during growth and young adolescence. We preferably based our inferences on randomised controlled trials (RCT), which provide the highest level of evidence.

RESULTS

Exercise during growth increases peak bone mass. Moderate intensity exercise intervention programs are beneficial for the skeletal development during growth. Adequate nutrition must accompany the exercise to achieve the most beneficial skeletal effects by exercise.

CONCLUSION

Exercise during growth seems to enhance the building of a stronger skeleton through a higher peak bone mass and a larger bone size.

Whole bone geometry and bone quality in distal forearm fracture

Fracture of the distal radius is a sentinel for future increased risk of other "osteoporotic" fractures, in which the peak age for incidence of distal radius fracture is 5 to 10 years before that for spine and hip fractures. Mean bone mineral density (BMD) of the distal radius was lower in patients with osteoporosis compared with age- and sex-matched normal subjects. However, it has been shown that to predict the strength of the distal radius at the site where fractures occur requires more than measurement of bone mineral content (BMC) or BMD. Only moderate correlations have been found between forearm sites, which may be a result of differences in bone composition between sites. Different forearm sites may be used interchangeably for diagnostic purposes, but the prognostic value is not known. Using the distal radius as a screening tool for identifying individuals at risk of "osteoporotic" fracture shows that forearm site selection and accuracy of measurement can be important confounders in group studies.Improving resolution of computed tomography (CT) scanners has enabled quantitation of cortical bone density and cortical thickness. These measurements have enabled the mechanism of bone loss in the distal radius to be elucidated and show that, after menopause, bone loss is primarily through thinning of the cortex. CT imaging allows the precise localization of bone changes in individuals and should be of value in the assessment of the severity of osteoporosis. It also shows that this technology has the potential to determine the efficacy of therapeutic interventions. A concerted effort has been made to elucidate the interrelationships between the amount of bone and the geometry and that clinical imaging of BMC and/or cross-sectional area in the radius would provide improved prediction of an individual's risk of fracture.The technological tools are available, in the clinic, to accurately measure the 3-dimensional (3D) geometry of the distal radius and the amount of bone. In addition, the cortical and cancellous bone compartments can be analyzed separately. This capability, along with the easy accessibility of the distal radius to clinical imaging modalities, provides an excellent framework for longitudinal prospective studies to determine morphologic risk factors for osteoporotic fractures of the distal radius.

Health benefits of tennis

The aim of the study was to explore the role of tennis in the promotion of health and prevention of disease. The focus was on risk factors and diseases related to a sedentary lifestyle, including low fitness levels, obesity, hyperlipidaemia, hypertension, diabetes mellitus, cardiovascular disease, and osteoporosis. A literature search was undertaken to retrieve relevant articles. Structured computer searches of PubMed, Embase, and CINAHL were undertaken, along with hand searching of key journals and reference lists to locate relevant studies published up to March 2007. These had to be cohort studies (of either cross sectional or longitudinal design), case-control studies, or experimental studies. Twenty four studies were identified that dealt with physical fitness of tennis players, including 17 on intensity of play and 16 on maximum oxygen uptake; 17 investigated the relation between tennis and (risk factors for) cardiovascular disease; and 22 examined the effect of tennis on bone health. People who choose to play tennis appear to have significant health benefits, including improved aerobic fitness, a lower body fat percentage, a more favourable lipid profile, reduced risk for developing cardiovascular disease, and improved bone health.