Advertisement
Mayo Clinic Proceedings Home

The Relationship Between Cardiorespiratory Fitness and Bone Mineral Density in Men

A Cross-sectional Study

      Abstract

      Objective

      To determine the relationship between estimated cardiorespiratory fitness (CRF) and femoral neck (FN) bone mineral density (BMD) in men.

      Patients and Methods

      This cross-sectional study included 2569 men aged 50 to 90 years (mean, 63.5 years) who had at least 1 health examination at a preventive medicine clinic between January 27, 1998, and February 24, 2015. Maximal treadmill tests were conducted using the Balke protocol and were used to estimate CRF. We stratified patients into low, moderate, and high CRF categories. The FN BMD was measured by dual-energy x-ray absorptiometry. Odds ratios (ORs) for T-scores of −2.5 or less (osteoporosis) and −1.0 or less (low BMD) were calculated for categorical CRF and were adjusted for weight, age, and days per week of resistance activity.

      Results

      The sample prevalence of osteoporosis in the FN was 4.1% and of low BMD was 49.4%. There was a significant inverse association between higher CRF category and osteoporosis measured at the FN (moderate vs low: OR=0.34; 95% CI, 0.16-0.74; high vs low: OR=0.19; 95% CI, 0.09-0.42) and low BMD (moderate vs low: OR=0.64; 95% CI, 0.43-0.96; high vs low: OR=0.43; 95% CI, 0.29-0.65).

      Conclusion

      In men, CRF is directly associated with BMD. These results suggest that moderate-to-high CRF levels attained through regular physical activity may attenuate age-related decline in BMD. Further studies are needed to determine whether this translates to a lower risk of osteoporotic fracture in more fit men.

      Abbreviations and Acronyms:

      ACSM (American College of Sports Medicine), BMD (bone mineral density), BMI (body mass index), CCLS (Cooper Center Longitudinal Study), CRF (estimated cardiorespiratory fitness), DXA (dual-energy x-ray absorptiometry), FN (femoral neck), MET (metabolic equivalent), OR (odds ratio), serum vitamin D (25-hydroxyvitamin D), SMR (standardized mortality ratio), WHO (World Health Organization)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Looker A.C.
        • Borrud L.G.
        • Dawson-Hughes B.
        • Shepherd J.A.
        • Wright N.C.
        Osteoporosis or low bone mass at the femur neck or lumbar spine in older adults: United States, 2005-2008.
        NCHS Data Brief. 2012; : 1-8
        • Johnell O.
        • Kanis J.
        Epidemiology of osteoporotic fractures.
        Osteoporos Int. 2005; 16: S3-S7
        • Melton III, L.J.
        • Chrischilles E.A.
        • Cooper C.
        • Lane A.W.
        • Riggs B.L.
        Perspective: how many women have osteoporosis?.
        J Bone Miner Res. 1992; 7: 1005-1010
        • Melton III, L.J.
        • Achenbach S.J.
        • Atkinson E.J.
        • Therneau T.M.
        • Amin S.
        Long-term mortality following fractures at different skeletal sites: a population-based cohort study.
        Osteoporos Int. 2013; 24: 1689-1696
        • Kiebzak G.M.
        • Beinart G.A.
        • Perser K.
        • Ambrose C.G.
        • Siff S.J.
        • Heggeness M.H.
        Undertreatment of osteoporosis in men with hip fracture.
        Arch Intern Med. 2002; 162: 2217-2222
        • Trombetti A.
        • Herrmann F.
        • Hoffmeyer P.
        • Schurch M.A.
        • Bonjour J.P.
        • Rizzoli R.
        Survival and potential years of life lost after hip fracture in men and age-matched women.
        Osteoporos Int. 2002; 13: 731-737
        • Haentjens P.
        • Magaziner J.
        • Colon-Emeric C.S.
        • et al.
        Meta-analysis: excess mortality after hip fracture among older women and men.
        Ann Intern Med. 2010; 152: 380-390
        • Gruntmanis U.
        Male osteoporosis: deadly, but ignored.
        Am J Med Sci. 2007; 333: 85-92
        • Kohrt W.M.
        • Bloomfield S.A.
        • Little K.D.
        • Nelson M.E.
        • Yingling V.R.
        American College of Sports Medicine Position Stand: physical activity and bone health.
        Med Sci Sports Exerc. 2004; 36: 1985-1996
        • Physical Activity Guidelines Advisory Committe
        2008 Physical Activity Guidelines Advisory Committee Report.
        Department of Health and Human Services, Washington, DC2008
        • Haskell W.L.
        • Lee I.M.
        • Pate R.R.
        • et al.
        Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association.
        Med Sci Sports Exerc. 2007; 39: 1423-1434
        • Swift D.L.
        • Lavie C.J.
        • Johannsen N.M.
        • et al.
        Physical activity, cardiorespiratory fitness, and exercise training in primary and secondary coronary prevention.
        Circ J. 2013; 77: 281-292
        • Bouchard C.
        • Blair S.N.
        • Katzmarzyk P.T.
        Less sitting, more physical activity, or higher fitness?.
        Mayo Clin Proc. 2015; 90: 1533-1540
        • Kanis J.A.
        • for the World Health Organization Scientific Group
        Assessment of Osteoporosis at the Primary Health Care Level.
        World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK2007
        • Ainsworth B.E.
        • Haskell W.L.
        • Herrmann S.D.
        • et al.
        2011 Compendium of Physical Activities: a second update of codes and MET values.
        Med Sci Sports Exerc. 2011; 43: 1575-1581
        • Pollock M.L.
        • Bohannon R.L.
        • Cooper K.H.
        • et al.
        A comparative analysis of four protocols for maximal treadmill stress testing.
        Am Heart J. 1976; 92: 39-46
      1. Thompson W.R. Gordon N.F. Pescatello L.S. ACSM's Guidelines for Exercise Testing and Prescription. 8th ed. Lippincott Williams & Wilkins, Philadelphia, PA2009
        • Blair S.N.
        • Kohl III, H.W.
        • Paffenbarger Jr., R.S.
        • Clark D.G.
        • Cooper K.H.
        • Gibbons L.W.
        Physical fitness and all-cause mortality: a prospective study of healthy men and women.
        JAMA. 1989; 262: 2395-2401
        • Willis B.L.
        • Morrow Jr., J.R.
        • Jackson A.W.
        • Defina L.F.
        • Cooper K.H.
        Secular change in cardiorespiratory fitness of men: Cooper Center Longitudinal Study.
        Med Sci Sports Exerc. 2011; 43: 2134-2139
        • Kampert J.B.
        • Blair S.N.
        • Barlow C.E.
        • Kohl III, H.W.
        Physical activity, physical fitness, and all-cause and cancer mortality: a prospective study of men and women.
        Ann Epidemiol. 1996; 6: 452-457
        • Sui X.
        • Blair S.N.
        Cardiorespiratory fitness as a predictor of nonfatal cardiovascular events in asymptomatic women and men.
        Am J Epidemiol. 2007; 165: 1413-1423
        • Wei M.
        • Gibbons L.W.
        • Mitchell T.L.
        • Kampert J.B.
        • Lee C.D.
        • Blair S.N.
        The association between cardiorespiratory fitness and impaired fasting glucose and type 2 diabetes mellitus in men.
        Ann Intern Med. 1999; 130: 89-96
        • Hind K.
        • Oldroyd B.
        • Truscott J.G.
        In vivo precision of the GE Lunar iDXA densitometer for the measurement of total-body, lumbar spine, and femoral bone mineral density in adults.
        J Clin Densitom. 2010; 13: 413-417
        • Rajamanohara R.
        • Robinson J.
        • Rymer J.
        • Patel R.
        • Fogelman I.
        • Blake G.M.
        The effect of weight and weight change on the long-term precision of spine and hip DXA measurements.
        Osteoporos Int. 2011; 22: 1503-1512
        • Shepherd J.A.
        • Fan B.
        • Lu Y.
        • Lewiecki E.M.
        • Miller P.
        • Genant H.K.
        Comparison of BMD precision for Prodigy and Delphi spine and femur scans.
        Osteoporos Int. 2006; 17: 1303-1308
        • Hsieh Y.F.
        • Robling A.G.
        • Ambrosius W.T.
        • Burr D.B.
        • Turner C.H.
        Mechanical loading of diaphyseal bone in vivo: the strain threshold for an osteogenic response varies with location.
        J Bone Miner Res. 2001; 16: 2291-2297
        • Kelley G.A.
        • Kelley K.S.
        • Kohrt W.M.
        Exercise and bone mineral density in men: a meta-analysis of randomized controlled trials.
        Bone. 2013; 53: 103-111
        • Kelley G.A.
        • Kelley K.S.
        • Tran Z.V.
        Exercise and bone mineral density in men: a meta-analysis.
        J Appl Physiol. 2000; 88: 1730-1736
        • Huuskonen J.
        • Vaisanen S.B.
        • Kroger H.
        • et al.
        Determinants of bone mineral density in middle aged men: a population-based study.
        Osteoporos Int. 2000; 11: 702-708
        • Huuskonen J.
        • Vaisanen S.B.
        • Kroger H.
        • Jurvelin J.S.
        • Alhava E.
        • Rauramaa R.
        Regular physical exercise and bone mineral density: a four-year controlled randomized trial in middle-aged men: the DNASCO study.
        Osteoporos Int. 2001; 12: 349-355
        • Orwoll E.S.
        • Klein R.F.
        Osteoporosis in men.
        Endocr Rev. 1995; 16: 87-116
        • Kelepouris N.
        • Harper K.D.
        • Gannon F.
        • Kaplan F.S.
        • Haddad J.G.
        Severe osteoporosis in men.
        Ann Intern Med. 1995; 123: 452-460
        • Seeman E.
        • Melton III, L.J.
        • O'Fallon W.M.
        • Riggs B.L.
        Risk factors for spinal osteoporosis in men.
        Am J Med. 1983; 75: 977-983
        • Ebeling P.R.
        Clinical practice: osteoporosis in men.
        N Engl J Med. 2008; 358: 1474-1482
        • Qaseem A.
        • Snow V.
        • Shekelle P.
        • Hopkins Jr., R.
        • Forciea M.A.
        • Owens D.K.
        Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians.
        Ann Intern Med. 2008; 148: 680-684
        • Moayyeri A.
        • Soltani A.
        • Tabari N.K.
        • Sadatsafavi M.
        • Hossein-Neghad A.
        • Larijani B.
        Discordance in diagnosis of osteoporosis using spine and hip bone densitometry.
        BMC Endocr Disord. 2005; 5: 3
        • Myers J.
        • Arena R.
        • Franklin B.
        • et al.
        Recommendations for clinical exercise laboratories: a scientific statement from the American Heart Association.
        Circulation. 2009; 119: 3144-3161
        • Defina L.F.
        • Haskell W.L.
        • Willis B.L.
        • et al.
        Physical activity versus cardiorespiratory fitness: two (partly) distinct components of cardiovascular health?.
        Prog Cardiovasc Dis. 2015; 57: 324-329
        • Duncan J.J.
        • Gordon N.F.
        • Scott C.B.
        Women walking for health and fitness: how much is enough?.
        JAMA. 1991; 266: 3295-3299
        • Skinner J.S.
        • Jaskolski A.
        • Jaskolska A.
        • et al.
        Age, sex, race, initial fitness, and response to training: the HERITAGE Family Study.
        J Appl Physiol. 2001; 90: 1770-1776
        • Martin C.K.
        • Church T.S.
        • Thompson A.M.
        • Earnest C.P.
        • Blair S.N.
        Exercise dose and quality of life: a randomized controlled trial.
        Arch Intern Med. 2009; 169: 269-278