Osteogenic Exercises

Original Editor - Ravi Kumar

Top Contributors - Angeliki Chorti, Kim Jackson, Ravi Kumar and Sivapriya Ramakrishnan  

Definition[edit | edit source]

Osteogenic exercises (Osteo=bone & Genic=stimulates growth) are the type of exercises that stimulate the growth of the bone and increase bone density by applying load to the bones. This load can be:

  • High-impact, such as jumping or running,
  • Low-impact, such as walking, or resistance training.

Osteogenic exercises are thought to work by increasing the number of bone-forming cells and by stimulating the production of new bone tissue. [1]

Osteogenic exercises are often recommended for people with osteoporosis because this can help increase the bone mineral density and reduce the risk of fractures. [2] Bone mineral density increases through exercise are important when attempting to prevent and treat osteoporosis. [3]

Benefits[edit | edit source]

3d-spine.jpg

Osteogenic exercises include various physical activities that stimulate bone growth and help prevent bone loss. Here are some potential benefits of osteogenic exercises:

  • Reduction of bone loss: A sedentary lifestyle, poor posture, poor balance, and weak muscles increase the risk of fractures. Osteogenic exercises can help reduce bone loss and conserve remaining bone tissue.
  • Improved bone density: Numerous studies have shown that weight-bearing exercise can help to slow bone loss, and several show it can even build bone. Activities that put stress on bones stimulate extra deposits of calcium and nudge bone-forming cells into action.[4]
  • Improved physical fitness: Osteogenic exercises can improve physical fitness, muscle strength, reaction time, mobility, balance, and coordination.
  • Reduced risk of fractures: Certain types of exercise strengthen muscles and bones, while other types are designed to improve balance, which can help prevent falls. A regular, properly designed exercise programme may actually help prevent falls and fractures.

Types of Osteogenic Exercises[edit | edit source]

Osteogenic exercises may be of low, moderate or high impact:

Types of Osteogenic Exercises
Low impact Moderate impact High impact
Walking Dancing Volleyball
Marching Jogging / Running Basketball
Stair climbing Low level jumping Track events
Stamping Tennis / Racquet sports Star jumps
Muscle strengthening Skipping and Hopping Tuck jumps
Low-impact aerobics Vigorous heel drops High level jumps

[2]

Clinical Guidelines Recommendations[edit | edit source]

The importance and specifics of osteogenic exercises are rarely analysed in clinical recommendations for bone loss and health. For example, Canadian [5], American, [6] UK [3] and European [7] guidance on the management of osteoporosis suggest that all adults with low bone density or osteoporosis should engage in regular weight bearing and muscle strengthening exercise as a preventive measure for further bone loss, tailored to the needs and abilities of the individual patient. However, very few information on parameters for optimal results is analysed. The 2018 UK guidelines [8] discuss on physical activity and exercise for people with osteoporosis proposing the following for optimal bone health:

Weight bearing / Impact exercise[edit | edit source]

  • Most days of the week; up to 50 moderate impacts
  • For frail, less mobile people or patients with vertebral or multiple low trauma fractures: up to 20 minutes of low impact activity
  • Avoid sitting for long periods

Muscle strengthening[edit | edit source]

  • Exercises to strengthen back muscles for improving spine health
  • Feel a mild push or pull on the muscles with exercise or activity
  • Frequency: at least twice a week
  • Intensity / Duration: 1-3 sets of 8-12 repetitions for each exercise
  • Type: 1 exercise per body part

Balance exercise[edit | edit source]

  • Follow if unsteady, over 65 and not taking regular exercise (2-3 times/week)

The above recommendations refer to people who have already lost bone strength and density, however, there are more specific suggestions from recent evidence on prevention and improving bone status throughout the lifespan. These are found below.

Evidence on Osteogenic Exercises[edit | edit source]

Several studies have been conducted on the benefits of osteogenic exercises for improving bone strength and density. Here are some key findings from these studies:

  1. Exercise interventions during the maturation phase, and especially during peripubertal development, are likely to be highly beneficial for maximising peak bone mass; [9] this is because exercise during skeletal growth is more osteogenic than exercise during adulthood. [10]
  2. Bone changes rely on the dose and intensity of impact and are threshold dependent. [11] Osteogenic exercises stimulate the growth of bones through optimal loading of the bones, in order to help improve Bone Density.[1] A 4+ times body weigth is required to stimulate this process in adolescents. [12]
  3. The frequency and pattern of intermittence between periods of physical activity and sedentary behavior, rather than the volume, is critical for bone mineral content in younger age. Short bouts of activity in between long sedentary periods may be more beneficial than activities more evenly spread in time.[13]
  4. Despite controversy on some forms of exercise, [14] physical exercise is generally recognised as an effective means to stimulate bone osteogenesis after the fourth decade of life [15] and in osteoporotic patients. [16]Supplementation with Vitamin D has not yet demonstrated any additive effect on bone mineral density, when combined with exercise. [17]
  5. Mind-body exercise, followed by resistance exercise are considered the most effective types for improving bone mineral density in the lumbar spine and femoral neck of patients with osteopenia and osteoporosis. [18]
  6. Mind-body exercise aims at improving flexibility, body balance and allievating pain. In elderly people with osteoporosis, mind-body exercises show promising results in outcomes such as bone mineral density, bone mineral content, quality of life, lower extremity function, and reducing pain and fearing level. [19]
  7. Weight-bearing activities, such as brisk walking (5-6km/h) and running have been found to safely preserve or increase the osteogenic potential of physical exercise in postmenopausal women.[20]
  8. Progressive resistance training, is suggested to be the best type of muscle strengthening for helping build bone density and improve muscle strength. [2][21] Lower training frequencies (<2/week) [22] and high intensity exercise regimes [23] are the suggested parameters for optimal results in postmenauposal women.
  9. Combining aerobic and anaerobic exercises and using variety in osteogenic protocols are also important for optimal results.[2]
  10. Finally, exercise with >70% adherence (in this case, to ACSM recommendations) tends to have higher positive outcomes regarding bone mineral density of the lumbar spine and femoral neck. [24]

References[edit | edit source]

  1. ↑ 1.0 1.1 American Bone Health. Osteogenic loading. Available from: https://americanbonehealth.org/exercise/bonesense-on-osteogenic-loading/ [accessed 30/6/2023]
  2. ↑ 2.0 2.1 2.2 2.3 Royal Osteoporosis Society. Exercise for bones. Available from: https://theros.org.uk/information-and-support/bone-health/exercise-for-bones/ [accessed 2/7/2023]
  3. ↑ 3.0 3.1 Gregson CL, Armstrong DJ, Bowden J, Cooper C, Edwards J, Gittoes NJL, Harvey N, Kanis J, Leyland S, Low R, McCloskey E, Moss K, Parker J, Paskins Z, Poole K, Reid DM, Stone M, Thomson J, Vine N, Compston J. UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos. 2022 Apr 5;17(1):58.
  4. ↑ Russo CR. The effects of exercise on bone. Basic concepts and implications for the prevention of fractures. Clin Cases in Miner Bone Metab. 2009 Sep;6(3):223-28.
  5. ↑ Brown JP, Josse RG; Scientific Advisory Council of the Osteoporosis Society of Canada. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ. 2002 Nov 12;167(10 Suppl):S1-34.
  6. ↑ Kohrt WM, Bloomfield SA, Little KD, Nelson ME, Yingling VR; American College of Sports Medicine. American College of Sports Medicine Position Stand: physical activity and bone health. Med Sci Sports Exerc. 2004 Nov;36(11):1985-96.
  7. ↑ Kanis JA, Cooper C, Rizzoli R, Reginster J-Y. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2019; 30(1): 3–44.
  8. ↑ Royal Osteoporosis Society. Strong, Steady and Straight: Physical Activity and Exercise for Osteoporosis. Quick guide: summary (for use in conjunction with full Expert Consensus Statement). Available from: https://theros.org.uk/media/0o5h1l53/ros-strong-steady-straight-quick-guide-february-2019.pdf [accessed 9/9/2023]
  9. ↑ Santos L, Elliott-Sale KJ, Sale C. Exercise and bone health across the lifespan. Biogerontology. 2017 Dec;18(6):931-946
  10. ↑ Turner CH, Robling AG. Exercises for improving bone strength. Br J Sports Med. 2005 Apr 1;39(4):188-9.
  11. ↑ Jamsa T, Ahola R, Korpelainen R. Measurement of Osteogenic Exercise – How to Interpret Accelerometric Data? Front Physiol 2011; 2: 73.
  12. ↑ Deere K, Sayers A, Rittweger J, Tobias JH. Habitual levels of high, but not moderate or low, impact activity are positively related to hip BMD and geometry: results from a population-based study of adolescents. J Bone Miner Res. 2012 Sep;27(9):1887-95.
  13. ↑ Chastin SF, Mandrichenko O, Skelton DA. The frequency of osteogenic activities and the pattern of intermittence between periods of physical activity and sedentary behaviour affects bone mineral content: the cross-sectional NHANES study. BMC Public Health. 2014 Dec;14(1):1-2.
  14. ↑ Wei X, Xu A, Yin Y, Zhang R. The potential effect of Wuqinxi exercise for primary osteoporosis: A systematic review and meta-analysis. Maturitas. 2015 Dec;82(4):346-54.
  15. ↑ Santos L, Elliott-Sale KJ, Sale C. Exercise and bone health across the lifespan. Biogerontology. 2017 Dec;18(6):931-946.
  16. ↑ Benedetti MG, Furlini G, Zati A, Letizia Mauro G. The effectiveness of physical exercise on bone density in osteoporotic patients. BioMed Res Int. 2018 Oct;2018:4840531.
  17. ↑ Fischer C, Jakob F, Kohl M, Kast S, Von Stengel S, Kerschan-Schindl K, Lange U, Thomasius F, Peters S, Uder M, Kemmler W. Additive Effects of Exercise and Vitamin D Supplementation (with and without Calcium) on Bone Mineral Density in Older Adults: A Systematic Review and Meta-Analysis. J Osteoporos. 2023 Aug 8;2023:5570030.
  18. ↑ Zhang S, Huang X, Zhao X, Li B, Cai Y, Liang X, Wan Q. Effect of exercise on bone mineral density among patients with osteoporosis and osteopenia: A systematic review and network meta-analysis. J Clin Nurs. 2022 Aug;31(15-16):2100-2111.
  19. ↑ Li H, Jiang H, Wang J, Zhou J, Liang H, Chen G, Guo Z, Yang S, Zhang Y. Effects of Mind-Body Exercises for Osteoporosis in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Geriatr Orthop Surg Rehabil. 2023 Aug 14;14:21514593231195237.
  20. ↑ Pellikaan P, Giarmatzis G, Vander Sloten J, Verschueren S, Jonkers I. Ranking of osteogenic potential of physical exercises in postmenopausal women based on femoral neck strains. PloS One. 2018 Apr 4;13(4):e0195463.
  21. ↑ Brown SE. Osteogenic loading—A key to reversing osteoporosis. Available from: https://www.betterbones.com/exercise/osteogenic-loading/ [accessed 30/6/2023]
  22. ↑ Shojaa M, von Stengel S, Kohl M, Schoene D, Kemmler W. Effects of dynamic resistance exercise on bone mineral density in postmenopausal women: a systematic review and meta-analysis with special emphasis on exercise parameters. Osteoporos Int. 2020 Aug;31(8):1427-1444.
  23. ↑ Kitagawa T, Hiraya K, Denda T, Yamamoto S. A comparison of different exercise intensities for improving bone mineral density in postmenopausal women with osteoporosis: A systematic review and meta-analysis. Bone Rep. 2022 Oct 21;17:101631.
  24. ↑ Cui W, Li D, Jiang Y, Gao Y. Effects of exercise based on ACSM recommendations on bone mineral density in individuals with osteoporosis: a systematic review and meta-analyses of randomized controlled trials. Front Physiol. 2023 Jul 17;14:1181327.
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