Protocol for a randomized controlled trial to compare bone-loading exercises with risedronate for preventing bone loss in osteopenic postmenopausal women

Laura D. Bilek, Nancy L. Waltman, Joan M. Lappe, Kevin A. Kupzyk, Lynn R. Mack, Diane M. Cullen, Kris Berg, Meghan Langel, Melissa Meisinger, Ashlee Portelli-Trinidad, Molly Lang

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Abstract

Background: In the United States, over 34 million American post-menopausal women have low bone mass (osteopenia) which increases their risk of osteoporosis and fractures. Calcium, vitamin D and exercise are recommended for prevention of osteoporosis, and bisphosphonates (BPs) are prescribed in women with osteoporosis. BPs may also be prescribed for women with low bone mass, but are more controversial due to the potential for adverse effects with long-term use. A bone loading exercise program (high-impact weight bearing and resistance training) promotes bone strength by preserving bone mineral density (BMD), improving bone structure, and by promoting bone formation at sites of mechanical stress. Methods/Design: The sample for this study will be 309 women with low bone mass who are within 5 years post-menopause. Subjects are stratified by exercise history (≥2 high intensity exercise sessions per week; < 2 sessions per week) and randomized to a control or one of two treatment groups: 1) calcium+vitamin D (CaD) alone (Control); 2) a BP plus CaD (Risedronate); or 3) a bone loading exercise program plus CaD (Exercise). After 12 months of treatment, changes in bone structure, BMD, and bone turnover will be compared in the 3 groups. Primary outcomes for the study are bone structure measures (Bone Strength Index [BSI] at the tibia and Hip Structural Analysis [HSA] scores). Secondary outcomes are BMD at the hip and spine and serum biomarkers of bone formation (alkaline phosphase, AlkphaseB) and resorption (Serum N-terminal telopeptide, NTx). Our central hypothesis is that improvements in bone strength will be greater in subjects randomized to the Exercise group compared to subjects in either Control or Risedronate groups. Discussion: Our research aims to decrease the risk of osteoporotic fractures by improving bone strength in women with low bone mass (pre-osteoporotic) during their first 5 years' post-menopause, a time of rapid and significant bone loss. Results of this study could be used in developing a clinical management pathway for women with low bone mass at their peak period of bone loss that would involve lifestyle modifications such as exercises prior to medications such as BPs. Trial registration: Clinicaltrials.gov NCT02186600. Initial registration: 7/7/2014.

Original languageEnglish (US)
Article number59
JournalBMC Women's Health
Volume16
Issue number1
DOIs
StatePublished - Aug 30 2016

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Randomized Controlled Trials
Exercise
Bone and Bones
Diphosphonates
Vitamin D
Bone Density
Osteoporosis
Calcium
Postmenopause
Risedronate Sodium
Osteogenesis
Hip
Mechanical Stress
Osteoporotic Fractures
Critical Pathways
Resistance Training
Bone Remodeling
Metabolic Bone Diseases
Weight-Bearing
Serum

All Science Journal Classification (ASJC) codes

  • Medicine(all)
  • Reproductive Medicine
  • Obstetrics and Gynecology

Cite this

Protocol for a randomized controlled trial to compare bone-loading exercises with risedronate for preventing bone loss in osteopenic postmenopausal women. / Bilek, Laura D.; Waltman, Nancy L.; Lappe, Joan M.; Kupzyk, Kevin A.; Mack, Lynn R.; Cullen, Diane M.; Berg, Kris; Langel, Meghan; Meisinger, Melissa; Portelli-Trinidad, Ashlee; Lang, Molly.

In: BMC Women's Health, Vol. 16, No. 1, 59, 30.08.2016.

Research output: Contribution to journalArticle

Bilek, LD, Waltman, NL, Lappe, JM, Kupzyk, KA, Mack, LR, Cullen, DM, Berg, K, Langel, M, Meisinger, M, Portelli-Trinidad, A & Lang, M 2016, 'Protocol for a randomized controlled trial to compare bone-loading exercises with risedronate for preventing bone loss in osteopenic postmenopausal women', BMC Women's Health, vol. 16, no. 1, 59. https://doi.org/10.1186/s12905-016-0339-x
Bilek, Laura D. ; Waltman, Nancy L. ; Lappe, Joan M. ; Kupzyk, Kevin A. ; Mack, Lynn R. ; Cullen, Diane M. ; Berg, Kris ; Langel, Meghan ; Meisinger, Melissa ; Portelli-Trinidad, Ashlee ; Lang, Molly. / Protocol for a randomized controlled trial to compare bone-loading exercises with risedronate for preventing bone loss in osteopenic postmenopausal women. In: BMC Women's Health. 2016 ; Vol. 16, No. 1.
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N2 - Background: In the United States, over 34 million American post-menopausal women have low bone mass (osteopenia) which increases their risk of osteoporosis and fractures. Calcium, vitamin D and exercise are recommended for prevention of osteoporosis, and bisphosphonates (BPs) are prescribed in women with osteoporosis. BPs may also be prescribed for women with low bone mass, but are more controversial due to the potential for adverse effects with long-term use. A bone loading exercise program (high-impact weight bearing and resistance training) promotes bone strength by preserving bone mineral density (BMD), improving bone structure, and by promoting bone formation at sites of mechanical stress. Methods/Design: The sample for this study will be 309 women with low bone mass who are within 5 years post-menopause. Subjects are stratified by exercise history (≥2 high intensity exercise sessions per week; < 2 sessions per week) and randomized to a control or one of two treatment groups: 1) calcium+vitamin D (CaD) alone (Control); 2) a BP plus CaD (Risedronate); or 3) a bone loading exercise program plus CaD (Exercise). After 12 months of treatment, changes in bone structure, BMD, and bone turnover will be compared in the 3 groups. Primary outcomes for the study are bone structure measures (Bone Strength Index [BSI] at the tibia and Hip Structural Analysis [HSA] scores). Secondary outcomes are BMD at the hip and spine and serum biomarkers of bone formation (alkaline phosphase, AlkphaseB) and resorption (Serum N-terminal telopeptide, NTx). Our central hypothesis is that improvements in bone strength will be greater in subjects randomized to the Exercise group compared to subjects in either Control or Risedronate groups. Discussion: Our research aims to decrease the risk of osteoporotic fractures by improving bone strength in women with low bone mass (pre-osteoporotic) during their first 5 years' post-menopause, a time of rapid and significant bone loss. Results of this study could be used in developing a clinical management pathway for women with low bone mass at their peak period of bone loss that would involve lifestyle modifications such as exercises prior to medications such as BPs. Trial registration: Clinicaltrials.gov NCT02186600. Initial registration: 7/7/2014.

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