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Bone-loading exercises versus risedronate for the prevention of osteoporosis in postmenopausal women with low bone mass: a randomized controlled trial

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Abstract

Purpose

This randomized controlled trial compared changes in bone mineral density (BMD) and bone turnover in postmenopausal women with low bone mass randomized to 12 months of either risedronate, exercise, or a control group.

Methods

Two hundred seventy-six women with low bone mass, within 6 years of menopause, were included in analysis. Treatment groups were 12 months of (a) calcium and vitamin D supplements (CaD) (control), (b) risedronate + CaD (risedronate), or (c) bone-loading exercises + CaD (exercise). BMD and serum markers for bone formation (Alkphase B) and resorption (Serum Ntx) were analyzed at baseline, 6, and 12 months.

Results

Using hierarchical linear modeling, a group by time interaction was found for BMD at the spine, indicating a greater improvement in the risedronate group compared to exercise (p ≤ .010) or control groups (p ≤ .001). At 12 months, for women prescribed risedronate, changes in BMD at the spine, hip, and femoral neck from baseline were + 1.9%, + 0.9%, and + .09%; in exercise group women, + 0.2%, + 0.5%, and − 0.4%; and in control group women, − 0.7%, + 0.5%, and − 0.5%. There were also significant differences in reductions in Alkphase B (RvsE, p < .001, RvsC, p < .001) and Serum Ntx (RvsE, p = .004, RvsC, p = .007) in risedronate women compared to exercise and control groups. For risedronate, 12-month changes in Alkphase B and Serum Ntx were − 20.3% and − 19.0%; for exercise, − 6.7% and − 7.0%; and for control, − 6.3% and − 9.0%.

Conclusion

Postmenopausal women with low bone mass should obtain adequate calcium and vitamin D and participate in bone-loading exercises. Additional use of BPs will increase BMD, especially at the spine.

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Data availability

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

Abbreviations

BMD:

Bone mineral density

BPs:

Bisphosphonates

CaD:

Calcium and vitamin D supplements

CORC:

Creighton University Osteoporosis Research Center

DXA:

Dual-energy X-ray absorptiometry

ETs:

Exercise trainers

FRAX:

Fracture risk assessment

GI:

Gastrointestinal

HSA:

Hip structural assessment

Lbs.:

Pounds

LIFTMOR:

Lifting Intervention for Training Muscle and Osteoporosis Rehabilitation

NOF:

National Osteoporosis Foundation

pQCT:

Peripheral quantitative computed tomography

1RM:

One-repetition maximum

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Funding

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

Author information

Authors and Affiliations

  1. College of Nursing, University of Nebraska Medical Center, 550 N 19th, Street, Suite 350E, Lincoln, NE, 6850-0620, USA

    Nancy Waltman

  2. Center for Nursing Science, University of Nebraska Medical Center, 4101 Dewey Avenue, Omaha, NE, 68198-5330, USA

    Kevin A. Kupzyk

  3. College of Allied Health Professions, 984000 Nebraska Medical Center, Omaha, NE, 68198-4000, USA

    Laura E. Flores & Laura D. Bilek

  4. Diabetes, Endocrinology, & Metabolism, Nebraska Medicine, Omaha, NE, 68198-4130, USA

    Lynn R. Mack

  5. Creighton Osteoporosis Research Center, 601 North 30th, Omaha, NE, 68131, USA

    Joan M. Lappe

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Contributions

All authors were involved in the implementation of this R01-funded study. All authors read and approved this final manuscript. Dr. Waltman1 developed the research project, wrote the initial draft of the manuscript, and assisted in analyzing and interpreting results of the study. Dr. Kevin Kupzyk2 was a co-investigator in the study, conducted the power analysis to determine sample size for the study, assisted in data analysis for this study, and reviewed and critiqued the final writing of this manuscript. Laura Flores3 provided valuable information on bone mineral density and bone structure during the analysis of study results and reviewed and critiqued the drafts of the manuscript. Dr. Lynn Mack4 and Dr. Joan Lappe5 were co-investigators for the study and assisted in designing and implementing the study. They reviewed and critiqued the final writing of this manuscript. Dr. Laura Bilek6 was co-principal investigator for the study. In addition to development of this research project, she participated in and supervised recruitment of subjects, data collection, and data entry for the study. She reviewed and critiqued the statistical analysis and the final writing for this manuscript.

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Correspondence to Nancy Waltman.

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Waltman, N., Kupzyk, K.A., Flores, L.E. et al. Bone-loading exercises versus risedronate for the prevention of osteoporosis in postmenopausal women with low bone mass: a randomized controlled trial . Osteoporos Int 33, 475–486 (2022). https://doi.org/10.1007/s00198-021-06083-2

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