Postmenopausal women with low bone mass should be advised adequate calcium and vitamin D as well as bone-loading exercises, according to preliminary findings from the Heartland Osteoporosis Prevention Study (HOPS) published in the journal Osteoporosis International. These findings were also presented at the American Society of Bone and Mineral Research (ASBMR) 2021 Annual Meeting.

The study included 276 postmenopausal women who had osteopenia. Women who had osteoporosis, had an increased risk of a major fracture or hip fracture; had been on bisphosphonates within the last 6 months; were currently on estrogen, tamoxifen, or aromatase inhibitors; had a serum vitamin D level < 10 mg/mL or > 100 mg/mL were excluded from the study.

In the study, women who had entered menopause within the previous 6 months and had osteopenia (low bone mass, T score –1.0 to –2.49) were randomized to two treatment groups for 12 months. One group received bone-loading and resistance exercise + calcium (1200 mg/day) and vitamin D (1000-3000 IU/day) supplements, while the second group was given risedronate (150 mg) along with calcium and vitamin D supplements. The control group was treated with only calcium and vitamin D supplements. The participants in the exercise group were required to visit the fitness centers three times in a week for the bone loading exercises (jogging using a weighted vest and resistance exercises) under supervision.

The study outcome measures were BMD at the total hip, femoral neck, and spine, serum biomarkers of bone turnover - NtX (resorption) and Alkphase B (formation), peripheral quantitative computed tomography (pQCT) at the tibia and Hip Structural Analysis (HAS) and adherence (to exercise) rates.

After 12 months, a significant increase in BMD at the spine was observed with risedronate treatment compared to women in the exercise group or the control group (+1.9%, +0.9% and –0.4%, respectively). The risedronate group also showed greater decreases in rates of bone resorption, as evident by decline in serum levels of NtX and Alkphase B.

Exercise was associated with positive changes in intertrochanter hip structural analysis measures suggesting that exercise improved strength at the hip joint through changes in structure and not BMD. These results will be announced in a forthcoming study, according to the authors.

These findings suggest that prescription for osteopenic postmenopausal women should include both calcium and vitamin D and bone loading exercises. Bisphosphonates such as risedronate may be prescribed in addition for its beneficial effect in increasing BMD.

Laura D Bilek, from the College of Allied Health Professionals, University of Nebraska Medical Center and study coauthor said, “The key takeaway for clinicians is that bone health is about more than just density! In postmenopausal women, exercise appears to improve strength at the hip through changes in structure, not BMD.”

Reference

1.      Waltman N, 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. 2021 Sep 14. doi: 10.1007/s00198-021-06083-2.

2.      Exercise appears to improve bone structure, not density - Medscape - Oct 06, 2021