Osteopenia is a serious and growing public health concern for women. Untreated osteopenic women are at high risk of becoming osteoporotic, and also are at greater risk for fractures than women with normal bone mineral densities (BMD). Low BMD-related fractures are associated with significant long-term impairment, high morbidity rates and high medical costs. In contrast to the treatment guidelines for osteoporosis, optimal preventive and sustainable interventions for osteopenic women are not yet well-defined. Current guidelines for the treatment of osteopenic women generally include the recommendation of regular exercise. Tai Chi, a mind-body exercise that is growing in popularity in the U.S., shows strong potential as an effective, sustainable, safe and practical intervention for women with low bone density. Preliminary studies suggest Tai Chi can reduce rates of BMD decline in post-menopausal women. While suggestive, these studies are small, have numerous design limitations, and include primarily Asian women who are known to have lower BMD and different bone geometry and fracture risk than other ethnic groups. Tai Chi has also been shown to be effective in improving balance, reducing falls and increasing musculoskeletal strength and flexibility. Moreover, Tai Chi has been shown to be safe in aging and de-conditioned populations. We propose a pilot randomized controlled trial to assess the efficacy and feasibility of Tai Chi as an adjunct to standard care for post-menopausal osteopenic women. Forty-eight osteopenic (T-scores -1.0 to -2.5) women ages 45-65 will be recruited from a large multispecialty group practice. Our primary aim is to assess the feasibility of recruiting and retaining osteopenic women into a randomized controlled trial of 9 months of Tai Chi. Our secondary aim is to collect preliminary data on the efficacy of Tai Chi in reducing rates of bone loss in osteopenic women using sensitive markers of bone turnover and dual-energy x-ray absorptiometry. For a subset of participants (n=16), biomechanical responses to Tai Chi (e.g. bone-specific mechanical loading and postural stability) will also be assessed. The results of this study will inform the design of a future trial evaluating the benefits and safety of Tai Chi for osteopenic women, as well as the biomechanical and physiological mechanisms through which Tai Chi may impact BMD and fracture risks associated with osteopenia. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Center for Complementary & Alternative Medicine (NCCAM)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21AT003503-04
Application #
7473785
Study Section
Special Emphasis Panel (ZAT1-JH (16))
Program Officer
Khalsa, Partap Singh
Project Start
2006-09-30
Project End
2010-08-31
Budget Start
2008-09-01
Budget End
2009-08-31
Support Year
4
Fiscal Year
2008
Total Cost
$216,327
Indirect Cost
Name
Harvard University
Department
Type
Schools of Medicine
DUNS #
047006379
City
Boston
State
MA
Country
United States
Zip Code
02115
Fischer, Mary; Fugate-Woods, Nancy; Wayne, Peter M (2014) Use of pragmatic community-based interventions to enhance recruitment and adherence in a randomized trial of Tai Chi for women with osteopenia: insights from a qualitative substudy. Menopause 21:1181-9
Wayne, Peter M; Kiel, Douglas P; Buring, Julie E et al. (2012) Impact of Tai Chi exercise on multiple fracture-related risk factors in post-menopausal osteopenic women: a pilot pragmatic, randomized trial. BMC Complement Altern Med 12:7
Wayne, Peter M; Buring, Julie E; Davis, Roger B et al. (2010) Tai Chi for osteopenic women: design and rationale of a pragmatic randomized controlled trial. BMC Musculoskelet Disord 11:40
Wayne, Peter M; Kaptchuk, Ted J (2008) Challenges inherent to t'ai chi research: part II-defining the intervention and optimal study design. J Altern Complement Med 14:191-7
Wayne, Peter M; Kiel, Douglas P; Krebs, David E et al. (2007) The effects of Tai Chi on bone mineral density in postmenopausal women: a systematic review. Arch Phys Med Rehabil 88:673-80