The Relationship between Physical Activity and Bone during Adolescence Differs according to Sex and Biological Maturity

A cross-sectional study of the relationship between recreational sporting activity and calcaneal bone density in adolescents and young adults

OBJECTIVE

Childhood and adolescence are critical periods of bone development. Sporting activity is thought to impact peak bone mass acquisition, but most studies have used dual-energy X-ray absorptiometry (DXA) to assess bone health and reported associations between bone mass and elite sporting activity. The objective of this study was instead to assess the relationship between recreational sporting activity (RSA) and another bone assessment, calcaneal quantitative ultrasound (cQUS), in adolescents and young adults.

METHODS

We related recreational sporting activity, assessed through a lifestyle questionnaire, to heel ultrasound bone parameters in a cohort of New Zealand students aged 16-35 years. Complete datasets with data on all relevant confounders (body mass index (BMI), pubertal timing, smoking status, and alcohol consumption) were available for 452 participants. cQUS was performed using a Lunar Achilles EX II machine to obtain bone parameters, broadband ultrasound attenuation (BUA), and speed of sound (SOS); stiffness index (SI) was derived from these measures. All descriptive statistics and statistical analyses were carried out using SPSS Statistics for Macintosh, Version 23.0 (IBM Corp., Armonk, NY, USA). Results are presented as p-values and 95% CI.

RESULTS

Reported lifetime sport participation declined after an individual's mid-teens. Bone cQUS parameters (SI and BUA and T-score) were all positively associated with BMI, and current physical activity (SI, SOS, BUA, T-score, and Z-score) with SI and SOS measures most strongly associated with current high impact and past recreational sporting activity (all p < 0.05).

CONCLUSION

Calcaneal heel ultrasound bone parameters were associated with physical activity, with SI and SOS rather than BUA more strongly related to current and past recreational sporting activity in young New Zealand adults.

Risk Factors, Diagnosis and Management of Bone Stress Injuries in Adolescent Athletes: A Narrative Review

Physical activity is known to be beneficial for bone; however, some athletes who train intensely are at risk of bone stress injury (BSI). Incidence in adolescent athlete populations is between 3.9 and 19% with recurrence rates as high as 21%. Participation in physical training can be highly skeletally demanding, particularly during periods of rapid growth in adolescence, and when competition and training demands are heaviest. Sports involving running and jumping are associated with a higher incidence of BSI and some athletes appear to be more susceptible than others. Maintaining a very lean physique in aesthetic sports (gymnastics, figure skating and ballet) or a prolonged negative energy balance in extreme endurance events (long distance running and triathlon) may compound the risk of BSI with repetitive mechanical loading of bone, due to the additional negative effects of hormonal disturbances. The following review presents a summary of the epidemiology of BSI in the adolescent athlete, risk factors for BSI (physical and behavioural characteristics, energy balance and hormone disruption, growth velocity, sport-specific risk, training load, etc.), prevention and management strategies.

Physical and Lifestyle Factors Influencing Bone Density in Jockeys: A Comprehensive Update of the Bone Density Status of Irish Jockeys

Compromised bone density in jockeys has previously been identified as an important health and safety concern in horseracing. Despite this, no update on the bone density status in Irish jockeys has been provided in the past decade. The study aimed to conduct a comprehensive update of the current bone density status in professional Irish jockeys and identify possible contributory physical and lifestyle factors. Eighty-five professional male jockeys (flat n = 39; national hunt (NH) n = 46) completed a dual-energy X-ray absorptiometry (DXA) scan for the assessment of body composition and bone mineral density (BMD) at the lumbar spine (LS), femoral neck (FN) and hip, 24-hour food recall, bone-specific physical activity questionnaire (BPAQ) and lifestyle questionnaire on weight making practices and injury history. Z-scores were interpreted to assess current bone density status. Correlation analysis was used to identify physical and lifestyle factors associated with bone mineral apparent density (BMAD). Results revealed a high prevalence of low BMD (Z-score < - 1.0) at the LS (44%), FN (15%) and hip (29%) in Irish jockeys. Analysis of jockeys physical characteristics found a positive relationship with the LS but not FN BMAD. Riding experience and timing of weight cut in NH and the practice of cutting weight in flat jockeys negatively influenced BMAD sites, while supplement use in flat jockeys displayed a positive effect on LS BMAD. Findings indicate the need for targeted individualised support strategies. Further investigation is required into jockey-specific intervention strategies that promote the development of optimal bone health in professional jockeys.

Effects of Maturation on Physical Fitness Adaptations to Plyometric Drop Jump Training in Male Youth Soccer Players

Vera-Assaoka, T, Ramirez-Campillo, R, Alvarez, C, Garcia-Pinillos, F, Moran, J, Gentil, P, and Behm, D. Effects of maturation on physical fitness adaptations to plyometric drop jump training in male youth soccer players. J Strength Cond Res 34(10): 2760-2768, 2020-The objective of this study was to compare the effects of maturation on physical fitness adaptations to a twice weekly, 7-week plyometric drop jump training program. Seventy-six young male soccer players (aged 10-16 years) participated in this randomized controlled trial. Before and after the intervention, a physical fitness test battery was applied (countermovement jump; drop jump from 20 to 40 cm; 5 multiple bounds test; 20-m sprint time; change of direction speed; 2.4-km running time-trial; 5 repetition maximum [RM] squat; and maximal kicking distance). Participants were randomly divided into an active soccer-control group (CG) with Tanner stage maturation of 1-3 (CG-early; n = 16) or Tanner stage 4-5 (CG-late; n = 22), and to plyometric drop jump training groups with Tanner stage 1-3 (plyometric jump training [PJT]-early; n = 16) or 4-5 (PJT-late; n = 22). The analysis of variance and effect size (ES) measures revealed that when compared with their age-matched controls, the PJT-early (ES = 0.39-1.58) and PJT-late (ES = 0.21-0.65) groups showed greater improvements (p < 0.05) in sprint time, 2.4-km running time-trial, change of direction speed, 5RM squat, jumping, and kicking distance. The PJT-early exceeded the PJT-late group with greater (p < 0.05) improvements in drop jump from 20 cm (ES = 1.58 vs. 0.51) and 40 cm (ES = 0.71 vs. 0.4) and kicking distance (ES = 0.95 vs. 0.65). Therefore, a 7-week plyometric drop jump training program was effective in improving physical fitness traits in both younger and older male youth soccer players, with greater jumping and kicking adaptations in the less-mature athletes.

Characterisation of peripheral bone mineral density in youth at risk of secondary osteoporosis - a preliminary insight

OBJECTIVES

To describe peripheral long bone material and structural differences in youth at risk of secondary osteoporosis across disease-specific profiles.

METHODS

Upper- and lower limbs of children and adolescents were scanned at 4% distal and 66% mid-shaft sites using peripheral Quantitative Computed Tomography sub-categorised as (1) increased risk of secondary osteoporosis (neuromuscular disorders; chronic diseases; endocrine diseases; inborn errors of metabolism; iatrogenic conditions), (2) low motor competence and (3) non-affected controls.

RESULTS

Children with disease-specific profiles showed a range of bone deficits compared to the control group with these predominantly indicated for neuromuscular disorders, chronic diseases and low motor competence. Deficits between upper arm and lower leg long bone parameters were different for disease-specific profiles compared to the control group. Endocortical radius, muscle area, and mid-cortical ring density were not significantly different for any disease-specific profile compared to the control group for any bone sites.

CONCLUSIONS

Neuromuscular disorders, chronic diseases and low motor competence have a strong correlation to bone health for appendicular bone parameters in youth, suggesting a critical mechanical loading influence which may differ specific to disease profile. As mechanical loading effects are observed in regional bone analyses, targeted exercise interventions to improve bone strength should be implemented to examine if this is effective in reducing the risk of secondary osteoporosis in youth.

Differences in the relation between bone mineral content and lean body mass according to gender and reproductive status by age ranges

The present study aims: (1) to explore the influence of lean mass (LM) on bone mineral content (BMC), (2) to investigate the pubertal influences on the BMC-LM relation, and (3) to perform Z-score charts of BMC-LM relation, stratified by gender and reproductive status categorized by age ranges. A cross-sectional analysis was conducted using 4001 healthy subjects between 7 and 90 years participating in the Health Workers Cohort Study. Of these, 720 participants were ≤ 19 years, 2417 were women ≥ 20 years, and 864 were men ≥ 20 years. Using Dual X-ray absorptiometry (DXA), we measured BMC and LM. Participants' pubertal development was assessed according to Tanner's stage scale. To describe BMC-LM relation, simple correlation coefficients were computed. To produce best-fit equations, an ANOVA test was conducted. Z-score graphs for the BMC-LM relation were obtained. In general, the BMC-LM correlations were linear and highly significant. For boys, curves were virtually parallel, with similar intercepts and a progressive displacement of values toward the upper-right region of the graph, for each Tanner subgroup. For girls, curves for Tanner 1-2 and 4-5 stages were parallel; but, in girls Tanner 4-5, the intercepts were significantly higher by about +300-400 g of BMC (P < 0.001). For postmenopausal women, the curve was parallel to that for the premenopausal but showed a lower intercept (P < 0.001). We provide DXA reference data on a well-characterized cohort of 4001 healthy subjects. These reference curves provide a reference value for the assessment and monitoring of bone health in all age groups included in the present study.

Please Don't Move-Evaluating Motion Artifact From Peripheral Quantitative Computed Tomography Scans Using Textural Features

Most imaging methods, including peripheral quantitative computed tomography (pQCT), are susceptible to motion artifacts particularly in fidgety pediatric populations. Methods currently used to address motion artifact include manual screening (visual inspection) and objective assessments of the scans. However, previously reported objective methods either cannot be applied on the reconstructed image or have not been tested for distal bone sites. Therefore, the purpose of the present study was to develop and validate motion artifact classifiers to quantify motion artifact in pQCT scans. Whether textural features could provide adequate motion artifact classification performance in 2 adolescent datasets with pQCT scans from tibial and radial diaphyses and epiphyses was tested. The first dataset was split into training (66% of sample) and validation (33% of sample) datasets. Visual classification was used as the ground truth. Moderate to substantial classification performance (J48 classifier, kappa coefficients from 0.57 to 0.80) was observed in the validation dataset with the novel texture-based classifier. In applying the same classifier to the second cross-sectional dataset, a slight-to-fair (κ = 0.01-0.39) classification performance was observed. Overall, this novel textural analysis-based classifier provided a moderate-to-substantial classification of motion artifact when the classifier was specifically trained for the measurement device and population. Classification based on textural features may be used to prescreen obviously acceptable and unacceptable scans, with a subsequent human-operated visual classification of any remaining scans.

Long bone robustness during growth: A cross-sectional pQCT examination of children and young adults aged 5-29years

Skeletal robustness (cross-section size relative to length) is associated with stress fractures in adults, and appears to explain the high incidence of distal radius fractures in adolescents. However, little is known about the ontogeny of long bone robustness during the first three decades of life. Therefore, we explored the ontogeny of tibial, fibular, ulnar and radial robustness in a cross-sectional sample of 5 to 29year-old volunteers of both sexes. Peripheral quantitative computed tomography (pQCT) was used to evaluate cross-sections of the leg (4%, 14%, 38% and 66%), and forearm (4%, and 66%) in N=432 individuals. Robustness was evaluated as the total bone area divided by bone length. Differences between age-groups, sexes, and age-group×sex interactions were evaluated with ANOVA with Tukey's post hocs where appropriate. Most bone sites exhibited more robust bones in men than women (P<0.001 to 0.02), and in older age-groups than younger (P<0.001). Sex×age-group interaction was observed at the 66% and 38% tibia sites with robustness increasing more with age in men than in women (P=0.006 to 0.042). Post-hoc analyses indicated no sex differences prior to 13years-of-age, and notable exceptions to increasing robustness with age at the 4% radial and 66% tibial sites, which exhibited reduced robustness in age groups close to peak height velocity. In conclusion, the present results suggest that very little sexual dimorphism in long bone robustness exists prior to puberty, and that divergence occurs primarily after cessation of longitudinal growth. A period of relative diaphyseal slenderness was identified at age-groups coinciding with the adolescent growth spurt, which may be related to the relatively high incidence of frank and stress fracture in adolescents.

Effects of bone-specific physical activity, gender and maturity on tibial cross-sectional bone material distribution: a cross-sectional pQCT comparison of children and young adults aged 5-29 years

Growth is the opportune time to modify bone accrual. While bone adaptation is known to be dependent on local loading and consequent deformations (strain) of bone, little is known about the effects of sex, and bone-specific physical activity on location-specific cross-sectional bone geometry during growth. To provide more insight we examined bone traits at different locations around tibial cross sections, and along the tibia between individuals who vary in terms of physical activity exposure, sex, and pubertal status. Data from 304 individuals aged 5-29 years (172 males, 132 females) were examined. Peripheral quantitative computed tomography (pQCT) was applied at 4%, 14%, 38%, and 66% of tibial length. Maturity was established by estimating age at peak height velocity (APHV). Loading history was quantified with the bone-specific physical activity questionnaire (BPAQ). Comparisons, adjusted for height, weight and age were made between sex, maturity, and BPAQ tertile groups. Few to no differences were observed between sexes or BPAQ tertiles prior to APHV, whereas marked sexual dimorphism and differences between BPAQ tertiles were observed after APHV. Cross-sectional location-specific differences between BPAQ tertiles were not evident prior to APHV, whereas clear location-specificity was observed after APHV. In conclusion, the skeletal benefits of physical activity are location-specific in the tibia. The present results indicate that the peri- or post-pubertal period is likely a more favourable window of opportunity for enhancing cross-sectional bone geometry than pre-puberty. Increased loading during the peri-pubertal period may enhance the bone of both sexes.

Effects of in-season low-volume high-intensity plyometric training on explosive actions and endurance of young soccer players

Integrating specific training methods to improve explosive actions and endurance in youth soccer is an essential part of players' development. This study investigated the efficiency of short-term vertical plyometric training program within soccer practice to improve both explosive actions and endurance in young soccer players. Seventy-six players were recruited and assigned either to a training group (TG; n = 38; 13.2 ± 1.8 years) or a control group (CG; n = 38; 13.2 ± 1.8 years) group. All players trained twice per week, but the TG followed a 7-week plyometric program implemented within soccer practice, whereas the CG followed regular practice. Twenty-meter sprint time (20-m), Illinois agility test time, countermovement jump (CMJ) height, 20- (RSI20) and 40- (RSI40) cm drop jump reactive strength index, multiple 5 bounds distance (MB5), maximal kicking test for distance (MKD), and 2.4-km time trial were measured before and after the 7-week period. Plyometric training induced significant (p ≤ 0.05) and small to moderate standardized effect (SE) improvement in the CMJ (4.3%; SE = 0.20), RSI20 (22%; SE = 0.57), RSI40 (16%; SE = 0.37), MB5 (4.1%; SE = 0.28), Illinois agility test time (-3.5%, SE = -0.26), MKD (14%; SE = 0.53), 2.4-km time trial (-1.9%; SE = -0.27) performances but had a trivial and nonsignificant effect on 20-m sprint time (-0.4%; SE = -0.03). No significant improvements were found in the CG. An integrated vertical plyometric program within the regular soccer practice can substitute soccer drills to improve most explosive actions and endurance, but horizontal exercises should also be included to enhance sprinting performance.

Exercise to improve pediatric bone and fat: a systematic review and meta-analysis

PURPOSE

This study aimed to determine the effects of school-based, bone-focused exercise interventions on bone, fat, and lean mass in children by systematically reviewing and meta-analyzing the literature.

METHODS

Potentially relevant articles were identified by searching electronic databases. Abstracts were included if they described the effects of an in-school exercise intervention for children 5-17 yr old compared with controls and presented baseline and follow-up results for bone, fat, and lean measures. Identified studies were systematically reviewed for methodological quality. Meta-analyses were performed for whole body, lumbar spine, and femoral neck bone mineral content (BMC), fat, and lean mass.

RESULTS

Sixteen eligible trials were identified including eight randomized controlled trials, three clinical controlled trials, and five nonrandomized, nonmatched studies. The quality analysis revealed two studies had low, nine had medium, and five had a high risk of bias. Meta-analyses revealed a small positive effect of bone-targeted exercise on whole body BMC (standardized mean difference [SMD] = 0.483, 95% CI = 0.132-0.833), femoral neck BMC (SMD = 0.292, 95% CI = -0.022 to 0.607), lumbar spine BMC (SMD = 0.384, 95% CI = 0.193-0.575), fat mass (SMD = -0.248, 95% CI = -0.406 to -0.089), and lean mass (SMD = 0.159, 95% CI = -0.076 to 0.394).

CONCLUSIONS

Beneficial effects of school-based, bone-targeted exercise were observed for bone and fat, but not for lean mass. Excluding trials with high risk of bias strengthened that effect. Considerable study heterogeneity may have obscured effects on lean mass. The effects observed for bone and fat support the pursuit of brief, jumping-focused interventions to reduce fat as well as enhance musculoskeletal tissue in school age children.

The effects of interset rest on adaptation to 7 weeks of explosive training in young soccer players

The aim of the study was to compare the effects of plyometric training using 30, 60, or 120 s of rest between sets on explosive adaptations in young soccer players. Four groups of athletes (age 10.4 ± 2.3 y; soccer experience 3.3 ± 1.5 y) were randomly formed: control (CG; n = 15), plyometric training with 30 s (G30; n = 13), 60 s (G60; n = 14), and 120 s (G120; n = 12) of rest between training sets. Before and after intervention players were measured in jump ability, 20-m sprint time, change of direction speed (CODS), and kicking performance. The training program was applied during 7 weeks, 2 sessions per week, for a total of 840 jumps. After intervention the G30, G60 and G120 groups showed a significant (p = 0.0001 - 0.04) and small to moderate effect size (ES) improvement in the countermovement jump (ES = 0.49; 0.58; 0.55), 20 cm drop jump reactive strength index (ES = 0.81; 0.89; 0.86), CODS (ES = -1.03; -0.87; -1.04), and kicking performance (ES = 0.39; 0.49; 0.43), with no differences between treatments. The study shows that 30, 60, and 120 s of rest between sets ensure similar significant and small to moderate ES improvement in jump, CODS, and kicking performance during high-intensity short-term explosive training in young male soccer players. Key pointsReplacing some soccer drills by low volume high-intensity plyometric training would be beneficial in jumping, change of direction speed, and kicking ability in young soccer players.A rest period of 30, 60 or 120 seconds between low-volume high-intensity plyometric sets would induce significant and similar explosive adaptations during a short-term training period in young soccer players.Data from this research can be helpful for soccer trainers in choosing efficient drills and characteristics of between sets recovery programs to enhance performances in young male soccer players.

Associations between a priori-defined dietary patterns and longitudinal changes in bone mineral density in adolescents

OBJECTIVE

To quantify short- and long-term associations between dietary patterns defined a priori and bone mineral density (BMD) during adolescence.

DESIGN

Dietary patterns were defined at 13 years old using a Mediterranean diet (MD) quality index, the Dietary Approaches to Stop Hypertension (DASH) diet index and the Oslo Health Study (OHS) dietary index. Linear regression coefficients were used to estimate associations between dietary patterns and forearm BMD at 13 and 17 years, measured by dual-energy X-ray absorptiometry.

SETTING

Public and private schools of Porto, Portugal.

SUBJECTS

The EPITeen cohort comprising 1180 adolescents born in 1990, recruited at schools during the 2003/2004 school year and re-evaluated in 2007/2008.

RESULTS

In girls, at 13 years, mean BMD (g/cm2) in the first and third tertiles was 0·369 and 0·368 for the MD pattern, 0·368 and 0·369 for the DASH diet, and 0·370 and 0·363 for the OHS index. In boys, mean BMD (g/cm2) in the first and third tertiles was 0·338 and 0·347 for the MD pattern, 0·342 and 0·346 for the DASH diet, and 0·344 and 0·342 for the OHS index. None of these differences were significant. Mean BMD at 17 years and prospective variation were also not significantly different between tertiles of adherence to each score. However, a trend of increased BMD at 13 years with greater adherence to the MD pattern was observed in boys (adjusted coefficient = 0·248; 95% CI 0·052, 0·444).

CONCLUSIONS

The selected dietary patterns may not capture truly important dietary differences in determining BMD or diet may not be, beyond nutrient adequacy, a limiting determinant of BMD.

Cross-sectional study of the association of body composition and physical fitness with bone status in children and adolescents from 11 to 16 years old

Background

The aim of the study was to verify the association between body composition and physical fitness with bone status in children and adolescents.

Methods

A cross-sectional study was conducted with 300 healthy students (148 boys, 152 girls). Weight, height, fat and fat-free mass, and percentage of body fat (%BF) were evaluated, as were physical fitness (abdominal exercise, flexibility, and horizontal jump tests) and maximum oxygen consumption. Bone parameters (amplitude-dependent speed of sound; AD-SoS) and the Ultrasound Bone Profile Index (UBPI) were evaluated using DBM Sonic BP ultrasonography.

Results

In the study group, girls had higher bone parameter values than boys. A univariate analysis assessed in a stepwise multiple regression model was conducted. It showed that for boys, the %BF and height were significant independent variables for AD-SoS and UBPI, but the horizontal jump test only for AD-SoS (adjusted r² = 0.274; p < 0.001), and pubertal maturation only for UBPI (adjusted r² = 0.295; p < 0.001). For girls, age and %BF were identified as significant independent variables for AD-SoS and UBPI (adjusted r² = 0.093; p < 0.001) but height only for AD-SoS (adjusted r² = 0.408; p < 0.001).

Conclusions

Variables related to growth (age, height, and pubertal maturation) are independent positive predictors for the bone parameters in both boys and girls. %BF is an independent negative predictor. For boys, the horizontal jump test was an independent positive predictor for AD-SoS, indicating that physical fitness related to the neuromotor system can influence the amount of bone present.

Are bone and muscle changes from POWER PE, an 8-month in-school jumping intervention, maintained at three years?

Our aim was to determine if the musculoskeletal benefits of a twice-weekly, school-based, jumping regime in healthy adolescent boys and girls were maintained three years later. Subjects of the original POWER PE trial (n = 99) were contacted and asked to undergo retesting three years after cessation of the intervention. All original measures were completed including: sitting height, standing height, weight, calcaneal broadband ultrasound attenuation (BUA), whole body, hip and spine bone mineral content (BMC), lean tissue mass, and fat mass. Physical activity was recorded with the bone-specific physical activity questionnaire (BPAQ) and calcium intake was estimated with a calcium-focussed food questionnaire. Maturity was determined by Tanner staging and estimation of the age of peak height velocity (PHV). Twenty-nine adolescents aged 17.3±0.4 years agreed to participate. Three years after the intervention, there were no differences in subject characteristics between control and intervention groups (p>0.05). Three-year change in weight, lean mass, and fat mass were similar between groups (p>0.05). There were no significant group differences in three-year change in BUA or BMC at any site (p>0.05), although the between-group difference in femoral neck BMC at follow-up exceeded the least significant change. While significant group differences were not observed three years after cessation of the intervention, changes in bone parameters occurred in parallel for intervention and control groups such that the original benefits of the intervention observed within the treatment group were sustained.

Twice-weekly, in-school jumping improves lean mass, particularly in adolescent boys

OBJECTIVE

To determine the effect of a twice-weekly, school-based, 10-min jumping regime on muscle and fat tissue in healthy adolescent boys and girls.

METHODS

We replaced regular warm-up activities with jumping in physical education (PE) classes of early high school students for 8 months to observe the effect on muscle and fat tissue. A total of 99 adolescents (46 boys, 53 girls; 13.8 ± 0.4 years) volunteered to participate. Intervention group subjects performed 10 min of varied jumping activity, while control subjects performed a regular PE warm-up. Biometrics, Tanner staging, age of peak height velocity (PHV), vertical jump, whole body lean tissue and fat mass (dual-energy X-ray absorptiometry-derived) were measured at baseline and follow-up. Physical activity was determined by questionnaire.

RESULTS

There were no differences in any measured variable between control and intervention groups at baseline. Boys had a significantly older age of PHV than girls (p = 0.02). No group differences were detected for 8-month change in height, weight or maturity measures for the combined sample; however, at 8 months, jumpers had accrued greater lean tissue mass than controls (p = 0.002). Sex-specific analysis revealed that intervention group boys had gained more lean tissue mass than controls (p = 0.016) and experienced significant fat loss (p = 0.010) than controls, an effect that was not observed in the girls.

CONCLUSION

Regular, short-duration, jumping activity during adolescence increased lean tissue mass and boys additionally lost fat mass. Sex-specific and/or maturation-specific factors may explain the disparity in effect.

Physical activity, body mass index and bone mineral density-associations in a prospective population-based cohort of women and men: the Canadian Multicentre Osteoporosis Study (CaMos)

BACKGROUND

Physical activity (PA) is an important modifiable risk factor for both bone mineral density (BMD) and body mass index (BMI). However, BMI is itself strongly predictive of BMD. Our aim was to determine the association between PA and BMD, with consideration of BMI as a potential mediating factor.

METHODS

The Canadian Multicentre Osteoporosis Study (CaMos) is a population-based prospective cohort study of Canadian women and men. PA was determined from interviewer-administered questionnaires at baseline and Year 5 and summarized as daily energy expenditure in total metabolic equivalents of the task multiplied by minutes/day (MET*m/d). Height, weight, and total hip and lumbar spine BMD were measured at baseline and Year 5. General linear models assessed relationships between PA and BMD, both cross-sectionally (baseline PA with baseline BMD) and longitudinally (average PA and change in PA with change in BMD). BMI was considered as a mediating factor. Potential confounders included age, center, education, caffeine intake, alcohol exposure, smoking history, history of weight-cycling, age at menarche, past use of oral contraceptives, history of >3 months missed menstruation, menopausal status, and antiresorptive use, as relevant.

RESULTS

The study included 2855 men and 6442 women. PA was inversely associated with BMI at baseline, and an increase in PA between baseline and Year 5 was associated with a decrease in BMI, with 0.41 (95% CI: 0.22, 0.60) kg/m(2) loss per 1000 MET*m/d increase (in men) and 0.40 (95% CI: 0.23, 0.57) kg/m(2) loss per 1000 MET*m/d increase (in women). BMI was strongly associated with BMD, both cross-sectionally and longitudinally. However, increased PA was associated with a small increase in total hip BMD, 0.004 (95% CI: 0.000-0.008) g/cm(2) per 1000 MET*m/d (in men) and 0.003 (95% CI: 0.000-0.007) g/cm(2) per 1000 MET*m/d (in women). Average PA was associated with an increase in lumbar spine BMD in women, but not in men; it was not associated with change in total hip BMD in either sex.

CONCLUSION

Increased PA is associated with an increase in BMD and a concomitant decrease in BMI. These findings suggest that population-level interventions to increase PA would favorably impact bone and other health outcomes.