Effect of exercise on bone mineral density and quality of life among postmenopausal women with osteoporosis without fracture: A systematic review

Impact of menopause hormone therapy, exercise, and their combination on bone mineral density and mental wellbeing in menopausal women: a scoping review

Background

Osteoporosis, a condition marked by low bone mineral density (BMD) and structural deterioration, affects more women than men over 50 globally. In women, declining estrogen during the menopause accelerates bone resorption, heightening fracture risk. An association between osteoporosis and depression, frailty fractures and poor quality of life has been identified. Both menopause hormone therapy (MHT) and exercise are shown to improve BMD, with MHT reducing bone resorption and exercise promoting bone formation. This review examines the effectiveness of MHT, exercise, and their combination in managing menopausal osteoporosis.

Method

A multifactor scoping review was conducted to address osteoporosis and MHT, osteoporosis and exercise, and osteoporosis and MHT and exercise combined.

Results

Initial searches identified 15,158 studies, narrowed to 20 meeting the inclusion criteria. MHT and exercise are effective in preserving BMD in menopausal women. Combined estrogen and progesterone MHT is more effective than estrogen-only, with studies suggesting that MHT prescribed at low doses for longer durations more effectively preserves BMD. Resistance training (RT) completed 2-3 days per week at a moderate-to-high intensity combined with impact activity completed at a minimum of 3 days per week is optimal for improving BMD in menopausal women, while low-impact exercises provide supplemental benefits. Combining MHT with exercise enhances BMD more than either alone.

Conclusion

This review highlights that combining MHT and structured exercise is most effective for enhancing BMD in menopausal women. Given certain safety considerations surrounding MHT in some women, exercise remains a cornerstone for the prevention and management of osteoporosis as well as for promoting overall wellness.

Jingui Shenqi Wan alleviates bone loss induced by primary osteoporosis by inhibiting osteoblast pyroptosis

OBJECTIVE

The primary objective of this study was to elucidate the underlying pharmacological mechanisms by which Jingui Shenqi Wan (JGSQW) alleviates postmenopausal osteoporosis (PMOP). Through a systematic investigation, we sought to identify the specific molecular pathways through which JGSQW modulates the progression of PMOP, thereby providing a scientific basis for its clinical application.

METHODS

We established an ovariectomized (OVX) mouse model to simulate estrogen deficiency-induced PMOP. Initially, micro-CT imaging and Alcian blue hematoxylin/orange G (ABH/OG) staining were employed to assess the effects of JGSQW on bone microarchitecture and bone mass preservation. Immunohistochemistry (IHC) was then utilized to evaluate the expression of osteogenic markers, including Osterix (OSX), Runx2, and Osteopontin (OPN). Additionally, Tartrate - Resistant Acid Phosphatase (TRAP) staining was performed to visualize and quantify osteoclasts. We further investigated the potential role of JGSQW in modulating the pyroptosis pathway.

RESULTS

JGSQW effectively alleviates the destruction of bone microstructure and the loss of bone mass caused by estrogen deficiency, an effect that appears to be mediated by promoting osteogenesis. Additionally, JGSQW significantly downregulates the expression of GSDMD in osteoblasts and mitigates the abnormal release of inflammatory factors, thereby maintaining the normal functional activities of osteoblasts.

CONCLUSION

JGSQW may effectively mitigate the progression of estrogen deficiency-induced PMOP by inhibiting the dysregulated activation of osteoblast pyroptosis.

Effect of exercise intervention on health-related quality of life in middle-aged and older people with osteoporosis: a systematic review and meta-analysis

Background

Osteoporosis is a common condition affecting middle-aged and older people, posing a serious threat to their health-related quality of life (HRQOL). In recent years, multiple studies have investigated the impact of exercise interventions on HRQOL in middle-aged and older individuals with osteoporosis, but the conclusions have been inconsistent. The aim of this study was to determine the true significance of exercise interventions on HRQOL in middle-aged and older individuals with osteoporosis and to identify optimal exercise prescriptions.

Methods

Six databases were searched for RCTs on the impact of exercise interventions on HRQOL in middle-aged and older individuals with osteoporosis. The methodological quality of the study was evaluated with Cochrane risk assessment tool. The effect size pooling, heterogeneity testing, and publication bias were analyzed using Review Manager 5.4 software.

Result

A total of 14 RCTs involving 1,214 participants were included, published between 2007 and 2022. The pooled results demonstrated that exercise interventions significantly improved general HRQOL (SMD = 0.79, 95% CI [0.34-1.24], p = 0.0006). In terms of physical HRQOL, significant improvements were observed in bodily pain (SMD = 0.51, 95% CI [0.24-0.78], p= 0.0002), physical function (SMD = 0.56, 95% CI [0.21-0.91], p = 0.002), role physical (SMD = 0.39, 95% CI [0.14-0.64], p = 0.003), and general health (SMD = 0.68, 95% CI [0.25-1.11], p = 0.002). Regarding mental HRQOL, significant improvements were found in vitality (SMD = 0.58, 95% CI [0.15-1.01], p = 0.008), social function (SMD = 0.37, 95% CI [0.17-0.58], p = 0.0004), and mental health (SMD = 0.50, 95% CI [0.25-0.74], p < 0.0001). Subgroup analysis results indicated that resistance training (SMD = 1.01, 95% CI [0.50-1.52], p = 0.0001), intervention frequency of at least three times per week (SMD = 0.80, 95% CI [0.22-1.38], p = 0.007), and intervention duration of 13-24 weeks (SMD = 0.85, 95% CI [0.37-1.33], p = 0.0005) had large and significant effects on general HRQOL improvements.

Conclusion

Exercise interventions improved HRQOL in middle-aged and older individuals with osteoporosis. Resistance training has shown greater benefits than mixed exercises. The optimal frequency is at least three per week, yielding the greatest improvement. Exercise interventions lasting 13-24 weeks had the most pronounced effect compared to other durations.

Registration

PROSPERO (No. CRD42023438771).

Adaptation, Validation, and Feasibility Evaluation of Mindful Standing Yoga Combined with Baduanjin for Older Patients with Primary Osteoporosis

OBJECTIVE

This study aimed to adapt, validate, and evaluate the feasibility of a mindful exercise program (Mindful Standing Yoga combined with Baduanjin) for older patients with primary osteoporosis.

METHODS

The study was conducted in 3 stages. Stage 1 involved a qualitative focus group discussion with 6 experts to gather perspectives on modifying the exercise program. Stage 2 used a Delphi approach with another 6 experts to validate the program. In Stage 3, a feasibility study was conducted with 20 eligible patients (out of 23 initially enrolled) at a traditional Chinese medicine hospital, using a single-group pre- and posttest design. The strenuousness of the adapted exercise was assessed through heart rate (HR) and rating of perceived exertion (RPE). Its effects were measured using the Global Pain Scale (GPS), the Five Facets Mindfulness Questionnaire-Short Form (FFMQ-SF), the Tampa Kinesiophobia-11 Scale, and the Timed Up and Go test. Patient satisfaction and feedback were also collected.

RESULTS

The modified program, consisting of 9 movements and taking 30 min to complete, was validated by experts as suitable, safe, and effective for practice. HR and RPE measurements confirmed it as a low-intensity exercise and not strenuous for the study population. The program significantly improved back pain and mindfulness in the feasibility study, with most participants expressing satisfaction with the protocol.

CONCLUSION

Experts and participants affirmed that the program was appropriate and satisfactory for older patients with primary osteoporosis, particularly those with back pain. Further high-quality randomized controlled trials are needed to validate its effectiveness.

Correlation between 25-hydroxyvitamin D level of lactating mothers and bone mineral density of infants and analysis of risk factors

Background

Aim was to demonstrate the influencing factors of infant bone mineral density (BMD) and its correlation with serum 25-hydroxyvitamin D (25-(OH)D) in nursing mothers.

Methods

200 children aged 0 č 1 years were rolled into normal group (n=120) and abnormal group (n=80) regarding the results of ultrasound BMD examination. The sunshine duration of infants with different BMD and 25(OH)D, calcium and phosphorus levels of nursing mothers were analyzed, and univariate and multivariate analyses of BMD were implemented.

Results

The results revealed that the sunshine duration and serum 25-(OH)D level of nursing mothers in abnormal group were inferior to those in normal group (P<0.05). Additionally, a notable positive correlation existed between sunshine duration, serum 25-(OH)D level of nursing mothers and BMD (r = 0.911 and 0.503, P<0.05). According to Logistic regression analysis, outdoor activity time 0 č 1 h/d, premature infants, and breastfeeding alone were independent risk factors (RFs) for abnormal BMD in infants, and vitamin D(VD) and calcium supplementation were independent protective factors (P<0.05).

Conclusions

VD and calcium intake, adequate sunshine duration, mixed feeding, and increasing serum 25-(OH)D can reduce the occurrence of abnormal BMD in infants.

Efficacy of Mindfulness Exercises for Primary Osteoporosis Pain and Balance: A Systematic Review and Network Meta-Analysis

Mindfulness exercise has shown great benefits for patients with osteoporosis. However, there are various types of mindfulness exercises and no studies have compared their efficacy. The aim of this study was to compare the efficacy of mindfulness exercises on pain and balance in patients with primary osteoporosis. Articles published in 10 English and three Chinese language databases from January 1, 2003, to December 31, 2022, were systematically searched. Twenty-two studies (N = 1,603) of five types of mindfulness exercises (Pilates, Ba Duan Jin, Wu Qin Xi, Tai Chi, and Yi Jin Jing) were eligible for this meta-analysis. Evidence from this review indicated that all five of the mindfulness exercises included in this study effectively reduced pain and improved balance for patients with primary osteoporosis. Pilates had the highest value of surface under the cumulative ranking as the best intervention. Future studies could consider developing a standard guideline for mindfulness exercise to be incorporated into osteoporosis rehabilitation.

Effects of tibolone combined with zoledronic acid on bone density, bone metabolism, and pain in postmenopausal patients with osteoporosis

OBJECTIVE

To explore the efficacy and safety of tibolone combined with zoledronic acid in the treatment of postmenopausal osteoporosis (PMO).

METHODS

We conducted a retrospective analysis of 121 PMO patients from March 2019 to July 2021. Patients were divided into two groups based on treatment regimen: an observation group (n=62) receiving zoledronic acid combined with tibolone and a control group (n=59) receiving tibolone monotherapy. We evaluated and compared therapeutic efficacy, bone mineral density, bone metabolism markers (osteocalcin, serum C-terminal telopeptide of type I collagen, and bone alkaline phosphatase), pain, knee joint function, incidence of fragility fractures, and adverse reactions. Logistic regression analysis was used to evaluate risk factors affecting treatment efficacy.

RESULTS

The observation group showed a significantly higher therapeutic effect (96.77%) compared to the control group (83.05%), and a lower incidence of fragility fractures (P=0.012). Before treatment, there were no significant differences in bone mineral density, bone metabolism markers, pain status, or knee function between the two groups (all P>0.05). However, after treatment, evaluations showed marked improvements in these parameters in both groups, with more significant enhancements observed in the observation group (all P<0.001). The incidence of adverse reactions did not significantly differ between the groups (20.97% vs 13.56%, P=0.282). Logistic regression analysis identified the use of tibolone combined with zoledronic acid as a protective factor for effective treatment.

CONCLUSIONS

Tibolone combined with zoledronic acid significantly increases bone mineral density, improves bone metabolism, and reduces pain in PMO patients, with a safety profile comparable to that of monotherapy. This regimen should be considered for clinical use in treating PMO.

Bone Mineral Density in Field Hockey Players: A Systematic Review

The aim of this study was to carry out a systematic review to compare and analyse the bone mineral density of field hockey players of both sexes and of different ages, with other sports and with a sedentary population. The search process was carried out using the PubMed, SPORTDiscus, Web of Science and Scopus databases. The search ended on 18 March 2024. We selected articles in which a comparison was made of bone mineral density of the whole body, lumbar spine, femoral neck, arms and legs, among field hockey players, and/or with other sports and/or with a sedentary population. The systematic review followed the guidelines described in the 2020 PRISMA statement. The initial search identified 220 articles. After applying the inclusion and exclusion criteria, the search was narrowed down to seven articles in total. It was observed that the field hockey group had better bone mineral density values than sedentary population and the low-impact sports population. Basketball players had better whole body and leg bone mineral density values than field hockey players. Causality could not be established due to the cross-sectional nature of the included studies. The better bone mineral density values in field hockey players compared to the sedentary population may be because people who participate in impact sports have a better bone mineral density. The differences in bone mineral density between field hockey and low-impact sports could be related to a lower impact during their practice in these disciplines.

Effects of kinect-based virtual reality training on bone mineral density and fracture risk in postmenopausal women with osteopenia: a randomized controlled trial

Osteopenia is a condition characterized by low bone mineral density (BMD) that increases fracture risk, particularly among postmenopausal women (PMW). This study aimed to determine the effects of Kinect-based VRT on BMD and fracture risk in PMW with osteopenia. The study was a prospective, two-arm, parallel-design, randomized controlled trial. The study enrolled 52 participants, 26 randomly assigned to each group. In the experimental group, Kinect-based VRT was provided thrice weekly for 24 weeks for 45 min/session. Both groups were instructed to engage in a daily 30-min walk outdoors. The fracture risk assessment tool (FRAX) was used to calculate fracture risk, and dual-energy X-ray absorptiometry was used to measure lumbar spine and femur neck BMD. Both variables were assessed at baseline and 24 weeks afterwards. After 24 weeks of Kinect-based VRT, the experimental group showed significant BMD increases in the right and left femoral necks and lumbar spine (p value < 0.001). In the control group, the BMD at the right and left femoral necks showed fewer significant changes (p value < 0.022 and 0.004, respectively). In the control group, lumbar spine BMD did not change (p = 0.57). The experimental group showed significantly lower FRAX scores for hip fracture prediction (HFP) and hip prediction of major osteoporotic (HPMO) at both femoral necks (p value < 0.001) than the control group (p = 0.05 and p = 0.01, respectively), but no significant change at the left femoral neck for HFP (p = 0.66) or HPMO (p = 0.26). These findings indicate that a Kinect-based VRT intervention resulted in significantly increased BMD and a reduced fracture risk, as predicted by HFP and HPMO measurements. These improvements were more pronounced in the experimental group than in the control group. Thus, Kinect-based VRT may be utilized as an effective intervention to improve BMD and reduce fracture risk in postmenopausal women with osteopenia.

Quality of life in postmenopausal women with osteoporosis and osteopenia: associations with bone microarchitecture and nutritional status

PURPOSE

Primary aim of the study was to investigate the status of different health-related quality of life (HRQoL) domains in postmenopausal women with osteoporosis and osteopenia, and to explore possible associations with bone microarchitecture and nutritional status.

METHODS

This was a single-center cross-sectional study that included 232 postmenopausal women, from which they were divided into three groups-osteoporosis (OP, N = 63), osteopenia (OPIA, N = 123), and control group (N = 46). Detailed medical history data and anthropometric measurements were taken from all women. Bone structure parameters were taken with DXA device, with additional analysis of bone microarchitecture status with Trabecular Bone Score (TBS). Nutritional status was assessed with Mini Nutritional Assessment (MNA) questionnaire, and HRQoL with Medical Outcomes Study Short Form-36 (SF-36) questionnaire.

RESULTS

Nutrition evaluation analysis have shown that patients in OP group had significantly lower values of MNA score compared to the OPIA group and control group (P = 0.005). Furthermore, a significant positive correlation was found between all of the SF-36 domains and MNA scores, while significant positive correlation was found between TBS values and Physical functioning (P < 0.001), Bodily pain (P = 0.027), Social functioning (P = 0.029), and Vitality domains (P = 0.041) in total investigated population. Further analyses were performed only in OP and OPIA groups, and TBS score showed significant positive correlation with Physical functioning (r = 0.248, P < 0.001) and Bodily pain domains as well (r = 0.180, P = 0.014), while MNA score positively correlated with each of the SF-36 domains. Multiple regression models have shown that MNA score retained significant association with each SF-36 domains, and TBS value with Physical functioning (P = 0.003), Social functioning (P = 0.012), and Vitality domains (P = 0.014).

CONCLUSION

This study highlights the associations that TBS has with some domains of HRQoL in postmenopausal women with osteoporosis and osteopenia. Moreover, nutritional status could play a role in the complex interplay between TBS and HRQoL.

Correlation of serum anti-Mullerian hormone and Inhibin-B levels with osteoporosis of menopausal woman in Chinese Daur ethnic group

PURPOSE

To investigate the diagnostic value of anti-Mullerian hormone (AMH) and Inhibin B (InhB) in menopausal women with osteoporosis from the Chinese Daur ethnic group.

METHODS

A total of 175 menopausal women were selected and divided into the osteoporosis group (N = 90) and the control group (N = 85). BMD was measured by dual-energy X-ray absorptiometry, and laboratory indicators of osteoporosis, for example, serum osteocalcin (OC), β-collagen special sequence (β-CTX), and procollagen type I amino-terminal propeptide (PINP), bone alkaline phosphatase (BALP), AMH, and InhB were measured by commercial kits. The relationship between osteoporosis and AMH or InhB was analyzed. The predictive values of AMH and InhB were reflected by the ROC curve and logistic regression.

RESULTS

The level of BMD was decreased and the levels of OC, β-CTX, PINP, and BALP of the menopausal osteoporosis group were increased. The concentration of AMH and InhB in the menopausal osteoporosis group was decreased and they had connections with each other. AMH and InhB could be used as independent indicators for the occurrence of osteoporosis in menopausal women and their combination had a higher diagnostic value.

CONCLUSION

AMH and InhB measurements in menopausal women had a certain clinical significance in the detection of osteoporosis. The occurrence of osteoporosis was related to BMD, OC, β-CTX, BALP, AMH, and InhB.

What is the evidence for the effect of physical exercise on bone health in menopausal women? An umbrella systematic review

This study aimed to analyze the effects of physical exercise (PE) on bone health in menopausal women through an umbrella review and to assess the quality of systematic reviews (SRs) and meta-analyses (MAs) included. The review was registered in PROSPERO (CRD42020208130) and the Rayyan application was used. The methodological quality of the included studies was evaluated by A MeaSurement Tool to Assess Systematic Reviews (AMSTAR), and Grading of Recommendations Assessment, Development and Evaluation (GRADE) was applied to assess the level of evidence of the results. The results showed that low-intensity jumping exercises with longer sessions proved to be efficient in the hip segment. Swimming requires further investigation, as it showed high heterogeneity. Aerobic and resistance exercises showed inconsistent results, requiring further studies with these modalities of PE. Concurrent training showed improvements in the lumbar spine, femoral neck, Ward's triangle and trochanter. Finally, combined resistance exercises are effective in preserving bone mineral density (BMD) of the femoral neck and lumbar spine in postmenopausal women. In conclusion, jumping exercises were efficient in the hip, while aerobic and resistance exercises are still inconsistent. Concurrent training showed improvements in BMD of the lumbar spine, femoral neck, Ward's triangle and trochanter. Finally, combined resistance protocols are effective in preserving BMD of the femoral neck and lumbar spine in postmenopausal women.

Effect of Aerobic/Strength Training on RANKL Gene DNA Methylation Levels

BACKGROUND

The osteoclastogenesis RANKL gene plays a key role in bone remodeling. The hypomethylation of its promoter region may cause osteoporosis. The present study aimed to elucidate the influence of physical activity on DNA methylation changes of RANKL promoter cytosine-phosphate-guanine (CpG)-rich region in active and sedentary adults and to assess the effect of aerobic and strength training on RANKL DNA methylation changes among Tunisian-North African adults.

METHODS

A total of 104 participants including 52 adults (58% males and 42% females) and 52 adults (31% males and 69% females) were recruited for the observational and interventional part of the study, respectively. The intervention consisted of 12 weeks of aerobic training (30 min/session) followed by 10 minutes of strengthening exercises. All participants completed the International Physical Activity Questionnaire and provided blood samples for quantitative methylation-specific polymerase chain reaction (PCR) analysis.

RESULTS

The study revealed a significant difference (P = 6 × 10-10) in the methylation level of the RANKL promoter region between active and sedentary adults, with a 6.68-fold increase observed in the active group. After the intervention, both the trained (P = 41 × 10-5) and untrained (P = .002) groups displayed high methylation levels in the RANKL promoter region. In addition, the trained group exhibited significant improvements in heart rate (P = 2.2 × 10-16), blood pressure (P = 39 × 10-3), maximal oxygen uptake (P = 1.5 × 10-7), and fat mass (P = 7 × 10-4).

CONCLUSION

Exploring epigenetic modifications in the RANKL promoter region may contribute to a more comprehensive understanding of the complexity of osteoporosis. This suggests that aerobic/strength training could potentially improve the bone system, reducing its vulnerability to osteoporosis by increasing RANKL DNA methylation.

Effect of Lifestyle Modification Intervention Programme on Bone Mineral Density among Postmenopausal Women with Osteoporosis

Objectives

Osteoporosis is one of the major public health problems worldwide among postmenopausal osteoporotic women. Lifestyle modification interventions along with pharmacotherapy help to revert bone loss and prevent complications.

Methods

A randomised controlled trial was conducted at Kasturba Hospital, Manipal from January 2019 to December 2021 among postmenopausal women with osteoporosis. The postmenopausal women who attended the osteoporosis clinic and were within the age group of 45-65 years, could speak and understand English or Kannada and whose bone mineral density (BMD) score was between -1 and -3 were included in the study. The total sample size of the study was 120 with 60 in each of the experimental and control groups. After obtaining informed consent, a stratified block randomisation method was used to allocate the participants to intervention and control groups. The BMD was monitored by the portable ultrasound densitometer by a technician at the outpatient departments. The baseline information was collected by a structured demographic questionnaire. Intervention group participants received a lifestyle modification intervention program (LMIP) whereas the control group received standard regular care from the physician. Follow-up was done at three and six months.

Results

The results revealed that the increase in the BMD median score among the experimental group was from -2.2 (-2.5- -1.8) to -1.5 (-1.8- -0.65) whereas in the control group, it was from -2.3 (-2.6- -1.9) to -2.0 (-2.4- -1.5). The results of the Mann Whitey U test showed a statistical significance between the intervention and control groups in the post-test after six months (U = 505.5; P <0.05). Wilcoxon signed rank test showed a significant change in both the intervention and control groups from pre-test to post-test I (3 months) and post-test II (6 months; P <0.001).

Conclusion

The lifestyle modification intervention was found to be effective in improving the bone health status of postmenopausal women. Hence it is very important to integrate it into regular therapy.

Use of Systemic Steroids, Hormone Replacement Therapy, or Oral Contraceptives Is Associated with Decreased Implant Survival in Women

BACKGROUND

Systemic steroids, such as prednisone, hormonal replacement therapies, or oral contraceptives, are commonly prescribed to women who might also be receiving dental implant therapy. However, the effect of these medications on dental implant survival is unknown.

METHODS

The medical and dental records of individuals with dental implants (N = 1480 implants) who visited a postgraduate periodontics clinic between 2000 and 2017 were initially considered. Those younger than 21 years old, pregnant, or male were excluded according to the study's exclusion criteria. The presence of systemic diseases and conditions was assessed. Implant failure rates among female patients using systemic steroids, hormone replacement therapy, or oral contraceptives were compared with failure rates among patients not taking those medications.

RESULTS

The implant failure rate for the 65 implants in patients taking steroid medications was 7.69%; the failure rate for the 712 implants in patients not taking steroids was 1.54% (p < 0.001). After adjusting for smoking and the presence of diabetes, that relationship persisted, with an 8.47% implant failure rate for the 59 implants in patients taking steroids (vs. 1.54% failure for the 585 implants in patients not taking steroids; p < 0.001). Regression analyses demonstrated that the odds of implant failure versus success were 5.31 times greater in patients taking systemic steroids, hormone replacement therapy, or oral contraceptives (p < 0.05). No statistically significant differences in patient plaque control were found between the experimental and control groups.

CONCLUSIONS

Among women, the use of systemic steroids is associated with a five-fold increase in the rate of dental implant failure, regardless of the presence of smoking or diabetes.

The relationship between sarcopenia-related measurements and osteoporosis: The SARCOP study

As muscle and bone are closely-related, we have explored the association between sarcopenia-related measurements and bone mineral density (BMD) (and osteoporosis) in postmenopausal women. Grip strength, anterior thigh muscle thickness and chair stand test were found to be related with BMD. Additionally, grip strength < 22 kg increased the odds ratio of osteoporosis 1.6 times.

INTRODUCTION

As muscle and bone are two closely related tissues, we aimed to investigate the association between sarcopenia-related measurements (i.e., sonographic anterior thigh muscle thickness, grip strength, chair stand test (CST), gait speed) and clinical factors, lumbar/femoral BMD, and the presence of osteoporosis (OP) in postmenopausal women.

METHODS

Community dwelling postmenopausal women from two physical and rehabilitation medicine outpatient clinics were consecutively included in this cross-sectional study. Demographic data, age, weight, height, education/exercise status, smoking, and comorbidities were registered. BMD measurements were performed from lumbar vertebrae (L1-4) and femoral neck using dual energy X-ray absorptiometry (DXA). A T-score of ≤ -2.5 SD in the lumbar vertebrae (L1-L4) and/or femoral neck was accepted as OP. Anterior thigh muscle thickness (MT) at the midthigh level was measured sonographically using a linear probe. Grip strength was measured from the dominant side. Physical performance was assessed by CST and gait speed.

RESULTS

Among 546 postmenopausal women, 222 (40.7%) had OP. Among sarcopenia-related parameters, grip strength and anterior thigh MT were positively associated with lumbar vertebral BMD. CST performance was positively associated with femoral neck BMD. After adjusting for confounding factors, low grip strength (< 22 kg) increased 1.6 times the risk of OP.

CONCLUSION

Loss of muscle mass/function (i.e., sarcopenia) can coexist with loss of trabecular and cortical bone. To this end, grip strength and anterior thigh MT seem to be associated with the lumbar vertebral BMD, while CST is associated with the femoral neck BMD. Lastly, low grip strength might have an association with postmenopausal OP.

Effects of a 12-Week Pilates Program on Functional Physical Fitness and Basal Metabolic Rate in Community-Dwelling Middle-Aged Women: A Quasi-Experimental Study

Background: The aging society worldwide carries public and inevitable issues. Aging is accompanied by multiple diseases, and the health impacts challenge healthcare and social systems. In addition to medical treatment, exercise has been recognized as an effective strategy not only for disease prevention and alleviation, but also for multiple health benefits on health promotion. The purpose of this study was to investigate the effects of a suitable Pilates exercise intervention program on health maintenance and benefits in community-dwelling middle-aged women with a quasi-experimental design. Methods: We recruited healthy middle-aged community-dwelling women who had not regularly exercised in the previous three months. The participants were assigned to the experimental (n = 22) and control (n = 23) groups based on a quasi-experimental design. The experimental group participated in a mat-based Pilates exercise class twice a week (1 h/session) throughout the 12-week intervention, whereas there was no intervention for the control group. Body composition, basal metabolic rate, and functional physical fitness—comprising cardiovascular capacity, flexibility, muscular strength of upper limbs, muscular strength of lower limbs, core strength, agility, static balance, and dynamic balance—were assessed as primary outcomes in both groups before and after the intervention. Results: There were no significant differences in any of the dependent variables between the two groups before the exercise intervention. After the 12-week intervention, body composition, including body mass index, body fat (−1.5 to 3%), and basal metabolic rate (+10.6%), and functional fitness, including flexibility (+3.5%), core strength (+31.5%), lower-limb strength (+13.5%), agility (+7.3%), and balance (+4.2%), improved significantly in the experimental group relative to the control group (p < 0.05). Moreover, the improvement in physical fitness in lower-limb strength, agility, and balance for fall prevention also demonstrated higher clinical significance than the control. Conclusions: This 12-week mat-based Pilates exercise program significantly improved body composition, basal metabolic rate, and functional physical fitness in community-dwelling middle-aged women. The beneficial effects of Pilates exercise programs may thus promote improved health in the middle-aged female population, with practical implications for communities.

A comparison of different exercise intensities for improving bone mineral density in postmenopausal women with osteoporosis: A systematic review and meta-analysis

Objective

This study aimed to compare the effects of moderate- and high-intensity resistance and impact training (MiRIT and HiRIT, respectively) on changes in bone mineral density (BMD) in postmenopausal women with osteoporosis.

Methods

Randomized controlled trials that compared the intervention effects of MiRIT and HiRIT were used as selection criteria to assess study patients with osteoporosis or an osteoporotic condition. Database searches were conducted on August 25, 2022, using CENTRAL, PubMed, CINAHL Web of Science, EMBASE, and MEDLINE. A risk of bias assessment was performed using Revised Cochrane risk of bias tool for the assessment of randomized controlled trials. Point estimates and 95 % confidence intervals of change in BMD derived using dual-energy X-ray absorptiometry were collected as outcomes, and a meta-analysis was performed using the amount of change in BMD before and after the intervention. Adverse event data were also collected.

Results

The search yielded six studies (391 patients, mean age 53-65 years) that met the inclusion criteria. The intervention duration ranged from 24 weeks to 13 months. Compared with the MiRIT group, the HiRIT group showed significantly improved BMD of the lumbar spine (standardized mean difference 2.37 [0.10-4.65]). However, a high degree of heterogeneity was observed for three studies (154 patients, I2 = 98 %). Almost all studies reported minimal adverse events. The certainty of evidence was extremely low because of the risk of bias, inconsistency among studies, and imprecision in terms of sample size.

Conclusion

Postmenopausal women with osteoporosis may achieve more significantly improved lumbar spine BMD with HiRIT than with MiRIT.

Molecular mechanisms of exercise contributing to tissue regeneration

Physical activity has been known as an essential element to promote human health for centuries. Thus, exercise intervention is encouraged to battle against sedentary lifestyle. Recent rapid advances in molecular biotechnology have demonstrated that both endurance and resistance exercise training, two traditional types of exercise, trigger a series of physiological responses, unraveling the mechanisms of exercise regulating on the human body. Therefore, exercise has been expected as a candidate approach of alleviating a wide range of diseases, such as metabolic diseases, neurodegenerative disorders, tumors, and cardiovascular diseases. In particular, the capacity of exercise to promote tissue regeneration has attracted the attention of many researchers in recent decades. Since most adult human organs have a weak regenerative capacity, it is currently a key challenge in regenerative medicine to improve the efficiency of tissue regeneration. As research progresses, exercise-induced tissue regeneration seems to provide a novel approach for fighting against injury or senescence, establishing strong theoretical basis for more and more "exercise mimetics." These drugs are acting as the pharmaceutical alternatives of those individuals who cannot experience the benefits of exercise. Here, we comprehensively provide a description of the benefits of exercise on tissue regeneration in diverse organs, mainly focusing on musculoskeletal system, cardiovascular system, and nervous system. We also discuss the underlying molecular mechanisms associated with the regenerative effects of exercise and emerging therapeutic exercise mimetics for regeneration, as well as the associated opportunities and challenges. We aim to describe an integrated perspective on the current advances of distinct physiological mechanisms associated with exercise-induced tissue regeneration on various organs and facilitate the development of drugs that mimics the benefits of exercise.

Global trends and hotspots in research on osteoporosis rehabilitation: A bibliometric study and visualization analysis

Background

The field of rehabilitation medicine plays an essential role in the comprehensive management of osteoporosis and its consequences. The benefits of therapeutic exercise are increasingly being recognized in this area, which receives an increasing number of publications. this study was designed to comprehensively identify collaborative networks, parse and track research trends, spotlight present hotspots, and accurately predict frontiers and focus on the health topics related to osteoporosis rehabilitation.

Methods

This research adopted computer retrieval of osteoporosis rehabilitation-related research published in the Web of Science Core Collection (WoSCC) from inception to June 14, 2022. The bibliometric visualization and comparative analysis involving countries, institutions, journals, authors, references, and keywords were performed using the CiteSpace and VOSviewer software.

Results

A total of 3,268 articles were included, and the number of articles published each year has demonstrated a steady increase. The United States and the University of Melbourne were the highest productive country and institution, with 1,325 and 87 articles, respectively. The journal of osteoporosis international has published the greatest number of articles, with 221 publications, and the journal of bone and mineral research ranked first in the co-citation counts (cited by 11,792 times). The most productive and highly-cited authors were Heinonen A and Cummings S, with 35 publications and 680 citations.

Conclusions

At present, "physical activity," "weight bearing exercise," "muscle strength," "whole body vibration," "postmenopausal women," "older women," children, men are the noteworthy research hot topics. Future research that focus on the major modes and parameters of physical activity/exercise for osteoporosis (including whole body vibration, weight bearing exercises, resistance training), targeted multicomponent training regimens, rehabilitation therapy for postmenopausal women, older women, children and men, osteoporosis related-sarcopenia and fractures, and mesenchymal stem cells are becoming frontiers and focus on the health topics related to osteoporosis rehabilitation in the upcoming years, which are worthy of further exploration.

4D label-free quantitative proteomics analysis to screen potential drug targets of Jiangu Granules treatment for postmenopausal osteoporotic rats

Background: Postmenopausal osteoporosis (PMOP) is a disease with a high prevalence in postmenopausal women and is characterized by an imbalance in bone metabolism, reduced bone mass, and increased risk of fracture due to estrogen deficiency. Jiangu granules (JG) is a compound prescription used in traditional Chinese medicine to treat PMOP. However, its definitive mechanism in PMOP is unclear. This study used a 4D label-free quantitative proteomics method to explore the potential therapeutic mechanism of JG in an ovariectomy (OVX) rats' model. Materials and methods: A rat model of PMOP was established by removing the ovaries bilaterally. Nine 3-month-old specific-pathogen-free female SD rats. The nine rats were randomly divided into 3 groups (n = 3 in each group): the sham-operated group (J), the ovariectomy group (NC), and the JG treatment (ZY) group. Proteins extracted from the bone tissue of the lumbar spine (L3, L4) of three groups of rats were analyzed by 4D label-free quantitative proteomics, and proteins differentially expressed after JG treatment and proteins differentially expressed after de-ovulation were intersected to identify proteins associated with the mechanism of PMOP by JG treatment. Result: There were 104 up-regulated and 153 down-regulated differentially expressed proteins (DEPs) in the J group vs. NC group, 107 up-regulated and 113 down-regulated DEPs in the J group vs. ZY group, and 15 up-regulated and 32 down-regulated DEPs in the NC group vs. ZY group. Six potential target proteins for JG regulation of osteoblast differentiation in OVX rats were identified by taking intersections of differential proteins in the J group vs. NC group and NC group vs. ZY group. Conclusion: JG may exert therapeutic effects by modulating the expression levels of target proteins associated with osteoblast differentiation to enhance osteoblast differentiation in OVX rats. These results further uncovered the target proteins and specific mechanisms of JG in treating PMOP, providing an experimental basis for the clinical application of JG in treating PMOP.

Personalised Nutritional Plan and Resistance Exercise Program to Improve Health Parameters in Celiac Women

Celiac disease (CD) is a permanent immune reaction to gluten in those with a genetic predisposition. This study was designed to evaluate menopause-associated symptoms, mood, bone quality, and IgA antibody levels in women with CD, untreated and treated with a gluten-free diet (GFD), and with or without resistance exercise. The randomised controlled trial was conducted on 28 Spanish women (>40 years old). Participants were divided into the following intervention groups: personalised gluten-free nutrition plan + exercise (GFD + E); personalised gluten-free nutrition plan (GFD); celiac controls (NO-GFD); and non-celiac controls (CONTROL). The participants responded to the Menopause Rating Scale and the Profile of Mood States (POMS) questionnaires. Bone quality was measured with ultrasound and IgA with a blood test. After 12 weeks of intervention, the GFD + E group showed significant improvement in urogenital symptoms and scored higher on the ‘vigour’ subscale of the POMS. Negative associations were found between the total score on the Menopause Rating Scale and the ‘vigour’ subscale of the POMS questionnaire. Only those women who underwent a personalised GFD nutritional intervention combined with resistance exercise demonstrated significant changes after the intervention.

A Predictive Model for Abnormal Bone Density in Male Underground Coal Mine Workers

The dark and humid environment of underground coal mines had a detrimental effect on workers’ skeletal health. Optimal risk prediction models can protect the skeletal health of coal miners by identifying those at risk of abnormal bone density as early as possible. A total of 3695 male underground workers who attended occupational health physical examination in a coal mine in Hebei, China, from July to August 2018 were included in this study. The predictor variables were identified through single-factor analysis and literature review. Three prediction models, Logistic Regression, CNN and XG Boost, were developed to evaluate the prediction performance. The training set results showed that the sensitivity of Logistic Regression, XG Boost and CNN models was 74.687, 82.058, 70.620, the specificity was 80.986, 89.448, 91.866, the F1 scores was 0.618, 0.919, 0.740, the Brier scores was 0.153, 0.040, 0.156, and the Calibration-in-the-large was 0.104, 0.020, 0.076, respectively, XG Boost outperformed the other two models. Similar results were obtained for the test set and validation set. A two-by-two comparison of the area under the ROC curve (AUC) of the three models showed that the XG Boost model had the best prediction performance. The XG Boost model had a high application value and outperformed the CNN and Logistic regression models in prediction.

Regular Exercise Decreases the Risk of Osteoporosis in Postmenopausal Women

Regular exercise can regulate bone maintenance and improve bone health. However, large-scale epidemiological studies on the association between regular exercise and incident osteoporosis in menopausal women are still lacking. We aimed to examine the relationship between exercise and the risk of osteoporosis in menopausal women. In cross-sectional analysis, we enrolled 30,046 postmenopausal women with available information from the database of the Taiwan Biobank (TWB). We divided them into two groups according to their status of regular exercise, i.e., no exercise and regular exercise groups. A t-score of -2.5 or more standard deviations (SDs) below that of a young adult was defined as osteoporosis. Logistic regression after adjusting for confounding factors was used to analyze the association between regular exercise and the prevalence of osteoporosis. Furthermore, the risk of incident osteoporosis development was analyzed in a longitudinal cohort of 6,785 postmenopausal women without osteoporosis at baseline using a Kaplan-Meier analysis and a log-rank test. The mean age of subjects in the cross-sectional cohort was 59 years old. Fifty-six percent of them were exercising regularly. Osteoporosis was observed in 1,886 (14.2%) and 2,254 (13.4%) participants in the no exercise and regular exercise groups. Lower risk of osteoporosis was noted in postmenopausal women with regular exercise when compared with those without regular exercise [odds ratio (OR), 0.76; 95% confidence interval (95% CI), 0.71-0.81]. In the longitudinal cohort, incident osteoporosis was found in 430 (10.5%) women with regular exercise and 299 (11.2%) women without exercise during a mean follow-up of 45 months. Cox regression analysis revealed that the risk for incident osteoporosis was lower in postmenopausal women with regular exercise than those without exercise [hazard ratio (HR), 0.83; 95% CI, 0.71-0.97]. Our study suggests that regular exercise is associated with a reduced risk of osteoporosis in postmenopausal women and strengthens the importance of exercise for the prevention of osteoporosis.

Physical Activity Is Associated with a Lower Risk of Osteoporotic Fractures in Osteoporosis: A Longitudinal Study

The purpose of our study was to examine the occurrence of osteoporotic fractures (fxs) according to the level of physical activity (PA) among osteoporosis using the Korean National Health Insurance Service (NHIS) customized database. From NHIS data from 2009 to 2017, osteoporosis was selected as requested. PA was classified into ‘high PA’ (n = 58,620), ‘moderate PA’ (n = 58,620), and ‘low PA’ (n = 58,620) and were matched in a 1:1:1 ratio by gender, age, income within the household unit, and region of residence. A stratified Cox proportional hazard model was used to calculate hazard ratios (HRs) for each type of fx comparing PA groups. The ‘low PA’ group was the reference group. For vertebral fx, the adjusted HR (95% confidence intervals (CIs)) was 0.27 (0.26–0.28) for the ‘high PA’ group and 0.43 (0.42–0.44) for the ‘moderate PA’ group. For hip fx, the adjusted HR (95% CIs) was 0.37 (0.34–0.40) for the ‘high PA’ group and 0.51 (0.47–0.55) for the ‘moderate PA’ group. For distal radius fx, the adjusted HR (95% CIs) was 0.32 (0.30–0.33) for the ‘high PA’ group and 0.46 (0.45–0.48) for the ‘moderate PA’ group. The results of this study suggest that a higher intensity of PA is associated with a lower risk of osteoporotic fxs, including vertebral fx, hip fx, and distal radius fx.

microRNA-211-5p predicts the progression of postmenopausal osteoporosis and attenuates osteogenesis by targeting dual specific phosphatase 6

Postmenopausal osteoporosis (PMOP) is known as one of the prevalent diseases among middle-aged and elderly women. This paper revolves around the alteration of miR-211-5p in PMOP patients and its function in osteogenic differentiation. Quantitative real-time polymerase chain reaction (qRT-PCR) was implemented to check the miR-211-5p level in the plasma of PMOP patients. Knockdown and overexpression experiments were done to verify the influence of miR-211-5p on human-derived mesenchymal stem cell (hMSC) osteogenic differentiation and osteogenesis. The alkaline phosphatase (ALP) assay kit was taken to test ALP activity. Alizarin red staining monitored osteogenic differentiation, while oil red O staining examined adipogenesis. Western blot confirmed the profiles of osteoclastogenesis-concerned factors (TRAP, NFAT2, c-FOS, Runx2, OCN, CTSK), dual specific phosphatase 6 (DUSP6), ERK, SMAD, and β-catenin. Dual-luciferase reporter and RNA immunoprecipitation assays were implemented to identify the association between miR-211-5p and DUSP6. Our data displayed that miR-211-5p was down-regulated in the PMOP patients’ plasma (in contrast with the healthy controls), and it was positively correlated with Vit-D and BMD levels. miR-211-5p overexpression vigorously facilitated hMSC osteogenic differentiation, while miR-211-5p inhibition contributed to the opposite situation. miR-211-5p initiated the ERK/SMAD/β-catenin pathway and repressed DUSP6’s expression. Overexpression of DUSP6 counteracted the miR-211-5p-mediated function to a great extent and inactivated ERK/SMAD/β-catenin, whereas enhancing ERK phosphorylation weakened the DUSP6 overexpression-induced function. Consequently, this research unveiled that miR-211-5p promotes osteogenic differentiation by interfering with the DUSP6-mediated ERK/SMAD/β-catenin pathway.

The Relationship between Body Composition and Bone Mineral Density of Female Workers in A Unit of Tai’an

Objective. To explore the relationship between body composition and bone mineral density (BMD) of female workers in a university of Tai’an. Methods. This study randomly selected 90 female employees in a university of Tai’an. The body composition was monitored by body composition analyzer (inbody770), and the lumbar bone mineral density was monitored by dual energy X-ray absorptiometry (BMD model). The data were analyzed by SPSS 22.0 statistical software. Results. With the increasing of body mass index (BMI), BMD of female lumbar spines 1-4 (L1-4) increased gradually. Spearman correlation analysis showed that BMI, skeletal muscle mass, upper limb muscle mass, trunk muscle mass, lower limb muscle mass, and whole-body phase angle were positively correlated with L1-4BMD. Age was negatively correlated with L1-4BMD. Linear regression analysis showed that age was a negative factor of L1-4BMD, and skeletal muscle mass was a protective factor of abnormal bone mass, especially lower limb muscle mass. Conclusions. Lower limb muscle mass is a protective factor of female BMD. Strengthening physical exercise to improve lower limb muscle mass is conducive to the prevention of female osteoporosis.

Functional roles of fish collagen peptides on bone regeneration

Fish collagen peptides (FCP) derived from the skin, bones and scales are commercially used as a functional food or dietary supplement for hypertension and diabetes. However, there is limited evidence on the effects of FCP on the osteoblast function in contrast to evidence of the effects on wound healing, diabetes and bone regeneration, which have been obtained from animal studies. In this narrative review, we expound on the availability of FCP by basic research using osteoblasts. Low-concentration FCP upregulates the expression of osteoblast proliferation, differentiation and collagen modifying enzyme-related genes. Furthermore, it could accelerate matrix mineralization. FCP may have potential utility as a biomaterial to improve collagen quality and promote mineralization through the mitogen-activated protein kinase and Smad cascades. However, there are few clinical studies on bone regeneration in human subjects. It is desirable to be applied clinically through clinical study as soon as possible, based on the results from basic research.