The role of physical activity in the prevention of osteoporosis in postmenopausal women-An update.

Context And Objective: Osteoporosis causes an increase in bone fragility. Its clinical significance mainly refers to (hip) fractures secondary to (low or moderate) trauma. In Europe and North America about 6% of men and 21% of women aged 50-84 years are classified to have osteoporosis. Although it is well accepted that exercise is essential for the management of osteoporosis, the exact role of physical activity in the primary and secondary prevention of osteoporotic fractures is still controversial.

Methods: The MEDLINE database and reference lists of selected publications were systematically searched for randomized controlled trials and prospective cohort studies, respectively, published since January 2000 regarding the association of physical activity and osteoporosis in postmenopausal women.

Results: Two prospective cohort studies indicate the clinical relevance of this association by showing an inverse relationship between physical activity and the risk of hip fracture. There is convincing evidence that physical activity effectively slows bone loss in postmenopausal women in a dose-dependent manner. Exercise programs may increase bone mineral density.

Conclusion: In order to maximize the goals of public health most effective, individually adapted, intense, high impact exercise programs are needed. However, they may be complicated to communicate and adherence on the population level may be hard to achieve. These programs must be weighed against popular and applicable existing programs (e.g. aerobic classes, Tai Chi, and walking) which appear to be easier to adhere to but appear to be less effective in the prevention of osteoporotic fractures in the individual postmenopausal women.