Category Archives: Osteoporosis

Improved BMD in Postmenopausal Women

PLoS One, 2016; 11(12): e0166774, PMID: 27907000 external link

Whole Body Vibration Treatments in Postmenopausal Women Can Improve Bone Mineral Density: Results of a Stimulus Focussed Meta-Analysis.

Fratini A, Bonci T, Bull AM
School of Life and Health Sciences, Aston University, Birmingham, United Kingdom.

Abstract

Whole body vibration treatment is a non-pharmacological intervention intended to stimulate muscular response and increase bone mineral density, particularly for postmenopausal women. The literature related to this topic is controversial, heterogeneous, and unclear despite the prospect of a major clinical effect.

The aim of this study was to identify and systematically review the literature to assess the effect of whole body vibration treatments on bone mineral density (BMD) in postmenopausal women with a specific focus on the experimental factors that influence the stimulus.

Nine studies fulfilled the inclusion criteria, including 527 postmenopausal women and different vibration delivery designs. Cumulative dose, amplitudes and frequency of treatments as well as subject posture during treatment vary widely among studies. Some of the studies included an associated exercise training regime. Both randomized and controlled clinical trials were included.

Whole body vibration was shown to produce significant BMD improvements on the hip and spine when compared to no intervention. Conversely, treatment associated with exercise training resulted in negligible outcomes when compared to exercise training or to placebo. Moreover, side-alternating platforms were more effective in improving BMD values than synchronous platforms and mechanical oscillations of magnitude higher than 3 g and/or frequency lower than 25 Hz were also found to be effective. Treatments with a cumulative dose over 1000 minutes in the follow-up period were correlated to positive outcomes.

Our conclusion is that whole body vibration treatments in elderly women can reduce BMD decline.However, many factors (e.g., amplitude, frequency and subject posture) affect the capacity of the vibrations to propagate to the target site; the adequate level of stimulation required to produce these effects has not yet been defined. Further biomechanical analyses to predict the propagation of the vibration waves along the body and assess the stimulation levels are required.

Osteoporosis Prevention

Increasingly, WBV studies are focusing on older adults.   Although evidence is overwhelming that physical exercise positively affects muscle strength at all ages, compliance of older persons with traditional exercise programs has generally been low, and only a small percentage of older persons exercise regularly.

MUSCLE POWER, the capacity of muscles to produce work in the environment, declines significantly over the life span. In women, the rate of decline accelerates after menopause and leads to reduction in physical functioning.  Improvement of muscle power and balance in the aging population reduces the risk of falls.

Osteoporosis is characterized by the loss of bone mass and strength and thus causes an increased fracture risk. Fracture prevention in the form of successful fall-prevention is therefore the key objective in the prevention of osteoporosis. Improvement of muscle strength and power enables the muscles to be coordinated and to react faster thus providing effective protection to prevent falls in daily life.

Side-alternating vibration exercises are an intervention for the prevention and the treatment of osteoporosis.  Used at high frequency (28 Hz) and very-low-magnitude (0.3g) vibration exercise has recently been reported to increase bone mass in experimental animals and in humans.

The high-frequency postural displacements induced by the alternating movements of the platform produce reflex muscle contractions aimed at stabilizing posture.  Thus, vibration can be viewed as a special form of muscle training that may particularly affect muscle power.  The force applied to bone during muscle contraction has a pivotal role in the homeostatic and adaptive regulation of bone strength.

Condition effects:

  • Improved Muscle Strength and Tone
  • Improved Balance and Reduced Fall Risk
  • Improved Blood Circulation and Lymphatic Mobility
  • Increased Bone Density
  • Hormone Balancing
  • Improved Flexibility
  • Reduced Low Back Pain

Studies – Osteoporosis

Study Summaries:

  • 12-week intervention, the WBV group experienced a 2.2% increase in BMD at the lateral spine (p=0.013) while the control group decreased 1.7%. These preliminary results suggest that WBV with resistance exercise is a potential training method that can be used to increase BMD, and thereby lower future risk of osteoporosis. (ACSM Annual Meeting, 2011)
  • Increased bone density, postural control, balance and mobility in the aging population. (The Journal of Bone and Mineral Research 2004, and Gait & Posture 2007)
  • Vibration training is assumed to stimulate bone-tissue maintenance through the pull of the tensed muscles on the underlying bones. Bed Rest Study Berlin. ESA Human Spaceflight, European Space Agency, 2003.
  • Acute Physiological Effects of Training with Galileo: Considering the comparatively mild cardiovascular and respiratory effects and the marked muscular fatigue, we conclude, that training with Galileo may be a promising issue in the therapy of bone mineral loss in the elderly. (J. Rittweger, et al; Osteoporosis Int.1998)

Improve Bone Mass & Osteoporosis

Sports Med. 2012 Apr 1;42(4):301-25. doi: 10.2165/11597670-000000000-00000.

Effects of training on bone mass in older adults: a systematic review.

Gómez-Cabello A, Ara I, González-Agüero A, Casajús JA, Vicente-Rodríguez G.

Source:  GENUD-Growth, Exercise, NUtrition and Development Research Group, Universidad de Zaragoza, Huesca, Spain.

Abstract:

Purpose: It is widely recognized that the risk of fractures is closely related to the typical decline in bone mass during the ageing process in both women and men. Exercise has been reported as one of the best non-pharmacological ways to improve bone mass throughout life. However, not all exercise regimens have the same positive effects on bone mass, and the studies that have evaluated the role of exercise programmes on bone-related variables in elderly people have obtained inconclusive results.

Method: This systematic review aims to summarize and update present knowledge about the effects of different types of training programmes on bone mass in older adults and elderly people as a starting point for developing future interventions that maintain a healthy bone mass and higher quality of life in people throughout their lifetime. A literature search using MEDLINE and the Cochrane Central Register of Controlled Trials databases was conducted and bibliographies for studies discussing the effect of exercise interventions in older adults published up to August 2011 were examined.

Results:

  • Inclusion criteria were met by 59 controlled trials, 7 meta-analyses and 8 reviews.
  • The studies included in this review indicate that bone-related variables can be increased, or at least the common decline in bone mass during ageing attenuated, through following specific training programmes.
  • Walking provides a modest increase in the loads on the skeleton above gravity and, therefore, this type of exercise has proved to be less effective in osteoporosis prevention.
  • Strength exercise seems to be a powerful stimulus to improve and maintain bone mass during the ageing process.
  • Multi-component exercise programmes of strength, aerobic, high impact and/or weight-bearing training, as well as whole-body vibration (WBV) alone or in combination with exercise, may help to increase or at least prevent decline in bone mass with ageing, especially in postmenopausal women.
  • This review provides, therefore, an overview of intervention studies involving training and bone measurements among older adults, especially postmenopausal women.

Conclusion: Some novelties are that WBV training is a promising alternative to prevent bone fractures and osteoporosis. Because this type of exercise under prescription is potentially safe, it may be considered as a low impact alternative to current methods combating bone deterioration. In other respects, the ability of peripheral quantitative computed tomography (pQCT) to assess bone strength and geometric properties may prove advantageous in evaluating the effects of training on bone health. As a result of changes in bone mass becoming evident by pQCT even when dual energy X-ray absortiometry (DXA) measurements were unremarkable, pQCT may provide new knowledge about the effects of exercise on bone that could not be elucidated by DXA. Future research is recommended including longest-term exercise training programmes, the addition of pQCT measurements to DXA scanners and more trials among men, including older participants.

PMID:  22376192

Improve Physical Function

J Musculoskelet Neuronal Interact. 2012 Sep;12(3):136-43

Whole body vibration exercise improves body balance and walking velocity in postmenopausal osteoporotic women treated with alendronate: Galileo and Alendronate Intervention Trail (GAIT).

Iwamoto J, Sato Y, Takeda T, Matsumoto H.

Source:  Institute for Integrated Sports Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.

Abstract

Purpose:  A randomized controlled trial was conducted to determine the effect of 6 months of whole body vibration (WBV) exercise on physical function in postmenopausal osteoporotic women treated with alendronate.

Method:  Fifty-two ambulatory postmenopausal women with osteoporosis (mean age: 74.2 years, range: 51-91 years) were randomly divided into two groups: an exercise group and a control group. A four-minute WBV exercise was performed two days per week only in the exercise group. No exercise was performed in the control group. All the women were treated with alendronate.

Results:  After 6 months of the WBV exercise, the indices for flexibility, body balance, and walking velocity were significantly improved in the exercise group compared with the control group. The exercise was safe and well tolerated. The reductions in serum alkaline phosphatase and urinary cross-linked N-terminal telopeptides of type I collagen during the 6-month period were comparable between the two groups.

Conclusion:  The present study showed the benefit and safety of WBV exercise for improving physical function in postmenopausal osteoporotic women treated with alendronate.

PMID: 22947545

Prevent Bone Fractures & Osteoporosis

Sports Med. 2012 Apr 1;42(4):301-25. doi: 10.2165/11597670-000000000-00000.

Effects of training on bone mass in older adults: a systematic review.

Gómez-Cabello A, Ara I, González-Agüero A, Casajús JA, Vicente-Rodríguez G.

Source:  GENUD-Growth, Exercise, NUtrition and Development Research Group, Universidad de Zaragoza, Huesca, Spain.

Abstract:

Purpose: It is widely recognized that the risk of fractures is closely related to the typical decline in bone mass during the aging process in both women and men. Exercise has been reported as one of the best non-pharmacological ways to improve bone mass throughout life. However, not all exercise regimens have the same positive effects on bone mass, and the studies that have evaluated the role of exercise programmes on bone-related variables in elderly people have obtained inconclusive results.

Method: This systematic review aims to summarize and update present knowledge about the effects of different types of training programmes on bone mass in older adults and elderly people as a starting point for developing future interventions that maintain a healthy bone mass and higher quality of life in people throughout their lifetime. A literature search using MEDLINE and the Cochrane Central Register of Controlled Trials databases was conducted and bibliographies for studies discussing the effect of exercise interventions in older adults published up to August 2011 were examined.

Results:

  • Inclusion criteria were met by 59 controlled trials, 7 meta-analyses and 8 reviews.
  • The studies included in this review indicate that bone-related variables can be increased, or at least the common decline in bone mass during ageing attenuated, through following specific training programmes.
  • Walking provides a modest increase in the loads on the skeleton above gravity and, therefore, this type of exercise has proved to be less effective in osteoporosis prevention.
  • Strength exercise seems to be a powerful stimulus to improve and maintain bone mass during the ageing process.
  • Multi-component exercise programmes of strength, aerobic, high impact and/or weight-bearing training, as well as whole-body vibration (WBV) alone or in combination with exercise, may help to increase or at least prevent decline in bone mass with ageing, especially in postmenopausal women.
  • This review provides, therefore, an overview of intervention studies involving training and bone measurements among older adults, especially postmenopausal women.

Conclusion: Some novelties are that WBV training is a promising alternative to prevent bone fractures and osteoporosis. Because this type of exercise under prescription is potentially safe, it may be considered as a low impact alternative to current methods combating bone deterioration. In other respects, the ability of peripheral quantitative computed tomography (pQCT) to assess bone strength and geometric properties may prove advantageous in evaluating the effects of training on bone health. As a result of changes in bone mass becoming evident by pQCT even when dual energy X-ray absortiometry (DXA) measurements were unremarkable, pQCT may provide new knowledge about the effects of exercise on bone that could not be elucidated by DXA. Future research is recommended including longest-term exercise training programmes, the addition of pQCT measurements to DXA scanners and more trials among men, including older participants.

PMID:  22376192

Osteopenic Women

Int J Sports Med. 2013 Apr 2. [Epub ahead of print]

Vibration or Balance Training on Neuromuscular Performance in Osteopenic Women

Stolzenberg N, Belavý DL, Rawer R, Felsenberg D.

Source

Centre for Muscle and Bone Research, Charité Berlin, Berlin, Germany

Abstract

Maintaining neuromuscular function in older age is an important topic for aging societies, especially for older women with low bone density who may be at risk of falls and bone fracture. This randomized controlled trial investigated the effect of resistive exercise with either whole-body vibration training (VIB) or coordination/balance training (BAL) on neuromuscular function (countermovement jump, multiple 1-leg hopping, sit-to-stand test). 68 postmenopausal women with osteopenia or osteoporosis were recruited for the study. 57 subjects completed the 9-month, twice weekly, intervention period. All subjects conducted 30 min of resistance exercise each training day. The VIB-group performed additional training on the Galileo vibration exercise device. The BAL-group performed balance training. An “intent-to-treat” analysis showed greater improvement in the VIB-group for peak countermovement power (p=0.004). The mean [95% confidence interval] effect size for this parameter was a + 0.9[0.3 to 1.5] W/kg greater change in VIB than BAL after 9 months. In multiple 1-leg hopping, a significantly better performance in the VIB-group after the intervention period was seen on a “per-protocol” analysis only. Both groups improved in the sit-to-stand test.

Results

The current study provides evidence that short-duration whole-body vibration exercise can have a greater impact on some aspects of neuromuscular function in post-menopausal women with low bone density than proprioceptive training.

© Georg Thieme Verlag KG Stuttgart · New York.

PMID: 23549694

Galileo Prevents Bone Loss

Bone, 2010; 46(1): 137-47,

Prevention of bone loss during 56 days of strict bed rest by side-alternating resistive vibration exercise

Rittweger J, Beller G, Armbrecht G, Mulder E, Buehring B, Gast U, Dimeo F, Schubert H, de Haan A, Stegeman DF, Schiessl H, Felsenberg D

Institute for Biomedical Research into Human Movement and Health, Manchester Metropolitan University, Manchester, UK. j.rittweger@mmu.ac.uk

Abstract

Purpose:  Bed rest is a recognized model for muscle atrophy and bone loss in space flight and in clinical medicine. We hypothesized that whole body vibration in combination with resistive exercise (RVE) would be an effective countermeasure.

Method:  Twenty healthy male volunteers underwent horizontal bed rest for 56 days and were randomly assigned either to a group that performed RVE 11 times per week or to a group that underwent bed rest only (Ctrl). Bone mineral content (BMC) was assessed by peripheral quantitative computed tomography (pQCT) in the tibia and the radius and by dual x-ray absorptiometry (DXA) in the hip and lumbar spine at baseline and at regular intervals during bed rest and a 12-month follow-up.

Results:  RVE appeared to protect muscle size and function, and it also prevented bone loss (p-values between <0.001 and 0.01). Bone losses were largest in the distal tibia epiphysis, where BMC declined from 421.8 mg/mm (SD 51.3) to 406.6 mg/mm (SD 52.7) in Ctrl, but only from 411.1 mg/mm (SD 56.6) to 409.6 mg/mm (SD 66.7) in RVE. Most of the BMC losses were recovered by 12-month follow-up. Analyses showed that the epiphyseal cortex, rather than spongiosa, depicted the most pronounced changes during bed rest and recovery.

Conclusion:  These results suggest that the combined counter measure applied in this study is effective to prevent bone losses from the tibia. This underlines the importance of mechanical usage for the maintenance of the human skeleton.

PMID: 19732856 Copyright (c) 2009 Elsevier Inc.

Improved Muscle Strength and Significantly Increased BMD of the Hip

J Bone Miner Res. 2004 Mar;19(3):352-9. Epub 2003 Dec 22.

Effect of 6-month whole body vibration training on hip density, muscle strength, and postural control in postmenopausal women: a randomized controlled pilot study.

Abstract

High-frequency mechanical strain seems to stimulate bone strength in animals. In this randomized controlled trial, hip BMD was measured in postmenopausal women after a 24-week whole body vibration (WBV) training program. Vibration training significantly increased BMD of the hip. These findings suggest that WBV training might be useful in the prevention of osteoporosis.

INTRODUCTION:

High-frequency mechanical strain has been shown to stimulate bone strength in different animal models. However, the effects of vibration exercise on the human skeleton have rarely been studied. Particularly in postmenopausal women-who are most at risk of developing osteoporosis-randomized controlled data on the safety and efficacy of vibration loading are lacking. The aim of this randomized controlled trial was to assess the musculoskeletal effects of high-frequency loading by means of whole body vibration (WBV) in postmenopausal women.

MATERIALS AND METHODS:

Seventy volunteers (age, 58-74 years) were randomly assigned to a whole body vibration training group (WBV, n = 25), a resistance training group (RES, n = 22), or a control group (CON, n = 23). The WBV group and the RES group trained three times weekly for 24 weeks. The WBV group performed static and dynamic knee-extensor exercises on a vibration platform (35-40 Hz, 2.28-5.09g), which mechanically loaded the bone and evoked reflexive muscle contractions. The RES group trained knee extensors by dynamic leg press and leg extension exercises, increasing from low (20 RM) to high (8 RM) resistance. The CON group did not participate in any training. Hip bone density was measured using DXA at baseline and after the 6-month intervention. Isometric and dynamic strength were measured by means of a motor-driven dynamometer. Data were analyzed by means of repeated measures ANOVA.

RESULTS:

No vibration-related side effects were observed. Vibration training improved isometric and dynamic muscle strength (+15% and + 16%, respectively; p < 0.01) and also significantly increased BMD of the hip (+0.93%, p < 0.05). No changes in hip BMD were observed in women participating in resistance training or age-matched controls (-0.60% and -0.62%, respectively; not significant). Serum markers of bone turnover did not change in any of the groups.

CONCLUSION:

These findings suggest that WBV training may be a feasible and effective way to modify well-recognized risk factors for falls and fractures in older women and support the need for further human studies.

Improved Muscle Power

Arch Phys Med Rehabil 2003;84:1854–7

High-frequency vibration training increases muscle power in postmenopausal women

Russo CR, Lauretani F, Bandinelli S, Bartali B, Cavazzini C, Guralnik JM, Ferrucci L.

Abstract 

Objective:   To test whether training on a high-frequency (28Hz) vibrating platform improves muscle power and bone characteristics in postmenopausal women.

Design:  Randomized controlled trial with 6-month follow-up.

Setting:  Outpatient clinic in a general hospital in Italy.

Participants:  Twenty-nine postmenopausal women (intervention group, n=14; matched controls, n=15).

Intervention:  Participants stood on a ground-based oscillating platform for three 2-minute sessions for a total of 6 minutes per training session, twice weekly for 6 months. The controls did not receive any training. Both groups were evaluated at baseline and after 6 months.

Main outcome measure:  Muscle power, calculated from ground reaction forces produced by landing after jumping as high as possible on a forceplate, cortical bone density, and biomarkers of bone turnover.

Results: Over 6 months, muscle power improved by about 5% in women who received the intervention, and it remained unchanged in controls (P=.004). Muscle force remained stable in both the intervention and control groups. No significant changes were observed in bone characteristics.

Conclusion:  Reflex muscular contractions induced by vibration training improve muscle power in postmenopausal women.

Keywords:  Bone density, Exercise, Muscles, Postmenopause, Rehabilitation, Vibration, Women

 

Improvement in aBMD & BMC

Osteoporos Int. 2013 May;24(5):1623-36. doi: 10.1007/s00198-012-2144-1. Epub 2012 Sep 26.

Effect of whole body vibration (WBV) therapy on bone density and bone quality in osteopenic girls with adolescent idiopathic scoliosis: a randomized, controlled trial.

Lam TP, Ng BK, Cheung LW, Lee KM, Qin L, Cheng JC.

 

Source:  Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China. tplam@ort.cuhk.edu.hk

Abstract

PURPOSE:  The aim of this randomized controlled trial was to determine whether whole body vibration (WBV) therapy was effective for treating osteopenia in adolescent idiopathic scoliosis (AIS) patients. Results showed that WBV was effective for improving areal bone mineral density (aBMD) at the femoral neck of the dominant side and lumbar spine BMC in AIS subjects.

INTRODUCTION:  AIS is associated with osteopenia. Although WBV was shown to have skeletal anabolic effects in animal studies, its effect on AIS subjects remained unknown. The objective of this study was to determine whether WBV could improve bone mineral density (BMD) and bone quality for osteopenia in AIS subjects.

METHODS:  This was a randomized, controlled trial recruiting 149 AIS girls between 15 and 25 years old and with bone mineral density (BMD) Z-scores <-1. They were randomly assigned to the Treatment or Control groups. The Treatment group (n = 61) stood on a low-magnitude high-frequency WBV platform 20 min/day, 5 days/week for 12 months. The Control group (n = 63) received observation alone. Bone measurement was done at baseline and at 12 months: (1) aBMD and BMC at femoral necks and lumbar spine using dual-energy X-ray absorptiometry (DXA) and (2) bone quality including bone morphometry, volumetric BMD (vBMD), and trabecular bone microarchitecture using high-resolution peripheral quantitative computed tomography (HR-pQCT) for nondominant distal radius and bilateral distal tibiae.

RESULTS: The Treatment group had numerically greater increases in all DXA parameters with a statistically significant difference being detected for the absolute and percentage increases in femoral neck aBMD at the dominant leg (0.015 (SD = 0.031)g/cm(2), 2.15 (SD = 4.32)%) and the absolute increase in lumbar spine BMC (1.17 (SD = 2.05)g) in the Treatment group as compared with the Control group (0.00084 (SD = 0.026)g/cm(2), 0.13 (SD = 3.62)% and 0.47 (SD = 1.88)g, respectively). WBV had no significant effect for other bone quality parameters.

CONCLUSIONS:  WBV was effective for improving aBMD at the femoral neck of the dominant side and lumbar spine BMC in AIS subjects.

PMID:  23011683