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Am Fam Physician. 2005;71(4):796-798

Exercise has been shown to reduce some of the negative effects of menopause on women’s bodies. One of the changes that exercise may alter is the loss of bone mass, which increases rapidly at the start of menopause. To prevent bone loss, fitness regimens need to include high-impact exercises. Recent studies have shown the positive impact of exercise on bone mass, but the studies tend to be short and usually target only one risk factor. The time frame for showing effect of exercise on bone mass needs to be longer than the one year that most studies used. Because of the limitations of the published literature, the Erlangen Fitness Osteoporosis Prevention Study was developed to evaluate the effects of exercise on the prevention of menopause-induced bone mass. Another objective of the study was to determine whether the exercise program would have any influence on fitness and quality of life. Kemmler and associates evaluated the first two years of this study.

The study population included women who had gone through menopause within one to eight years and had been diagnosed with osteopenia at the lumbar spine or hip using dual-energy x-ray absorptiometry (DEXA). The definition of osteopenia that was used was the World Health Organization cutoff of a T-score between 1.0 and 2.4 standard deviations. Women were excluded from the study if they had an osteoporotic fracture, had a disease or used medications that would alter bone metabolism, participated in athletic activities, or had inflammatory diseases, a history of cardiovascular disease, or a very low physical capacity.

The participants were divided into an exercise group and a control group. The control group was asked to continue their usual lifestyle, and the exercise group was placed on a fitness program. The program included two group sessions and two home training sessions per week that included high-impact exercises. Physical fitness was determined by maximum strength and cardiovascular performance. Bone density was evaluated by a DEXA scan of the lumbar spine, proximal femur, and forearm. In addition, the lumbar spine bone density was assessed by quantitative computer tomography. Bone density measurements were obtained before the study started and after 26 months. Lipid levels and serum markers for bone formation and resorption also were assessed. Participants completed a questionnaire about vasomotor symptoms and pain at the end of the study.

There were 50 women who were completely compliant with the exercise program and 33 women in the control group. At the end of the trial, the exercise group had significantly better physical fitness than the control group. The bone mineral density at the lumbar spine showed a small improvement based on the DEXA scan and quantitative computer tomography for the exercise group, and the control group showed a significant difference, with a decline in bone mineral density by DEXA computed tomography of the trabecular and cortical regions. The total hip, femoral neck, trochanter, and intertrochanter bone mineral density bone loss was significantly less in the exercise group than in the control group. At the end of the study, the exercise group had a decrease in pain at the cervical, thoracic, and lumbar spine. They did not have any significant change in pain frequency or intensity in the major joints when comparing baseline with final data. The exercise group had better serum total cholesterol and triglyceride levels at the end of the study. The impact on vasomotor symptoms followed a positive trend, with the exception of mood and insomnia.

The authors conclude that a general-purpose exercise program with emphasis on bone density has a positive impact on osteopenic women who are in the early years of menopause. They add that the exercise program also can improve strength and endurance, reduce back pain, and improve lipid levels.

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Copyright © 2005 by the American Academy of Family Physicians.

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