Osteoporosis is an increasingly important public health concern for women, contributing to over 1.3 million fractures per year. With the increase in the elderly population, a three fold increase in hip fractures, the most costly fracture, has been projected, with costs for treating all osteoporotic fractures increasing from $13.8 Billion in 1995 to $60 Billion by the year 2020. While the effects of dietary and hormonal interventions on BMD are being investigated in the Women's Health Initiative, the effects of exercise, a potentially effective stimulus for slowing and possibly reversing bone loss is not assessed. In this renewal we propose to complete intervention and assessments for a large partially randomized clinical trial evaluating the effect of one year of exercise on total body and regional BMD in two population (hormone replacement therapy (HRT) versus no HRT) of postmenopausal women. We also propose to add measurements of bone biomarkers and endocrine factors to our existing data base to investigate correlates of BMD underlying the potential response to exercise and to extend follow-up for an additional two years to assess the long-term effects in women who continue exercising versus women who do not exercise. We hypothesize that exercise will significantly increase BMD and that exercise plus HRT is a more effective stimulus than exercise or HRT alone. Thus, exercise will be an efficacious alternative to risk reduction of osteoporosis. The study is unique in its design (random assignment) population (HRT versus no HRT), sample size (N=279), and the comprehensive assessment of physiological, nutritional, and morphological correlates of BMD. Duplicate (one week apart) blood collections and DXA scans are done at each measurement period (baseline 6 and 12 months) to improve precision to follow changes in biomarkers, hormones, soft tissue composition, and axial and appendicular BMD. Extensive dietary intake data are collected using diet records and food frequency questionnaires. The exercise program (progressive resistance exercise and weight bearing aerobic exercise) is designed to provide high strain magnitudes, rates and a diverse distribution, all thought to be osteogenic stimuli. Exercise compliance is carefully monitored through extensive workout records of exercise frequency, intensity duration and type, and by measuring muscle strength gains. Study adherence for the initial four cohorts (of 6 cohorts) was 92 percent. Thus, as we show, we have excellent power to assess short-term and long- term exercise effects. Because of the paucity of information regarding long term effects of exercise, and because of the increased emphasis called for in the scientific community for evaluating the long-term efficacy of exercise for osteoporosis prevention, this comprehensive one year clinical trial and two year follow-up will make an important contribution to a valid prescription of exercise for the prevention of osteoporosis in two populations (HRT vs no HRT) of postmenopausal women.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR039559-09
Application #
6124134
Study Section
Special Emphasis Panel (ZRG4-EDC-1 (02))
Program Officer
Mcgowan, Joan A
Project Start
1989-08-05
Project End
2001-11-30
Budget Start
1999-12-01
Budget End
2001-11-30
Support Year
9
Fiscal Year
2000
Total Cost
$579,519
Indirect Cost
Name
University of Arizona
Department
Physiology
Type
Schools of Medicine
DUNS #
806345617
City
Tucson
State
AZ
Country
United States
Zip Code
85721
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Klimentidis, Y C; Bea, J W; Lohman, T et al. (2015) High genetic risk individuals benefit less from resistance exercise intervention. Int J Obes (Lond) 39:1371-5
Bea, Jennifer W; Lohman, Timothy G; Cussler, Ellen C et al. (2010) Lifestyle modifies the relationship between body composition and adrenergic receptor genetic polymorphisms, ADRB2, ADRB3 and ADRA2B: a secondary analysis of a randomized controlled trial of physical activity among postmenopausal women. Behav Genet 40:649-59
Bea, Jennifer W; Cussler, Ellen C; Going, Scott B et al. (2010) Resistance training predicts 6-yr body composition change in postmenopausal women. Med Sci Sports Exerc 42:1286-95
Farrell, Vanessa A; Harris, Margaret; Lohman, Timothy G et al. (2009) Comparison between dietary assessment methods for determining associations between nutrient intakes and bone mineral density in postmenopausal women. J Am Diet Assoc 109:899-904
Milliken, L A; Cussler, E; Zeller, R A et al. (2009) Changes in soft tissue composition are the primary predictors of 4-year bone mineral density changes in postmenopausal women. Osteoporos Int 20:347-54
Milliken, Laura A; Wilhelmy, Jennifer; Martin, Catherine J et al. (2006) Depressive symptoms and changes in body weight exert independent and site-specific effects on bone in postmenopausal women exercising for 1 year. J Gerontol A Biol Sci Med Sci 61:488-94
Maurer, Jaclyn; Harris, Margaret M; Stanford, Vanessa A et al. (2005) Dietary iron positively influences bone mineral density in postmenopausal women on hormone replacement therapy. J Nutr 135:863-9
Milliken, L A; Going, S B; Houtkooper, L B et al. (2003) Effects of exercise training on bone remodeling, insulin-like growth factors, and bone mineral density in postmenopausal women with and without hormone replacement therapy. Calcif Tissue Int 72:478-84
Teixeira, Pedro J; Going, Scott B; Houtkooper, Linda B et al. (2003) Resistance training in postmenopausal women with and without hormone therapy. Med Sci Sports Exerc 35:555-62

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