Kadınlarda Fiziksel Aktivite ve Egzersizin Osteoporozu Önleme ve Tedavi Edici Rolü

Abstract

Osteoporoz neredeyse her iki kadından birini, hayatının herhangi bir noktasında etkileyen önemli bir morbidite ve mortalite nedenidir. Kemik yapısını bozan bu hastalığın önemli ve değiştirilebilir risk faktörlerinden biri fiziksel inaktivitedir. Fiziksel inaktivite kemik iliği kaynaklı mezenkimal kök hücre farklılaşmasını adipogeneze yaklaştırıp osteoblastogenezden uzaklaştırırken; fiziksel aktivite ve egzersiz sağladığı vaskülarizasyon ve oluşturduğu mekanik yükleme yoluyla; piezoelektrik etki oluşumu, hormon- sitokin salınımı, sinyal yolları ve kodlamayan RNA'ların düzenlemesini sağlayarak kemik yapısı üzerinde olumlu etkiler yaratmaktadır. Kemik sağlığını korumak, denge kaybı, düşme ve buna bağlı kırık vb. durumları önlemek, genel fiziksel uygunluğu sağlamak için fiziksel aktivite ve egzersiz, kadınların yaşamında vazgeçilmez bir unsur haline gelmelidir. Literatürde farklı yoğunlukta fiziksel aktivite ve vibrasyon eğitimi, aerobik, kuvvetlendirme, denge ve kombine egzersiz müdahaleleri gibi egzersize dayalı eğitimlerin kemik yapısı üzerindeki etkileri farklılık göstermektedir. Çalışmalarda en fazla etkiyi kombine egzersiz müdahalelerinin sağladığı ve direnç egzersizlerinin bu müdahalelerde önemli bir komponent olduğu bildirilmiştir. Fiziksel aktivite ve egzersizin düzenli uygulanması önerilmekte, uzun süreli uygulanan egzersiz programlarının osteoporoz tedavisinde daha fazla gelişme sağladığı bildirilmektedir. Ancak programa katılan kişinin fiziksel uygunluğu, kırık riski ve varlığı göz önünde bulundurulmalıdır. Literatürde güncelliğini koruyan ve oldukça tartışılan konuyla ilgili olarak bu derleme kapsamında; fiziksel aktivite ve egzersizin kadınlarda osteoporoz üzerine etkisi, kılavuz önerileri ve kaçınılması gereken egzersizler incelenmiştir.

Keywords

• Aktivite
• egzersiz
• osteoporoz
• kadın sağlığı
• kırık

The Role of Physical Activity and Exercise in Preventing and Treating Osteoporosis in Women

Abstract

Osteoporosis is an important cause of morbidity and mortality, affecting almost one out of every two women at any point in her life. One of the important and modifiable risk factors of this disease, which disrupts the bone structure, is physical inactivity. While physical inactivity brings bone marrow-derived mesenchymal stem cell differentiation closer to adipogenesis and away from osteoblastogenesis; physical activity and exercise provide vascularization and mechanical loading through; the formation of piezo electric effect, hormone-cytokine release, signaling pathways and regulation of non-coding RNAs by providing positive effects on bone structure. To maintain bone health, loss of balance, fall and related fracture, etc. in order to prevent situations, to ensure general physical fitness, physical activity and exercise should become an indispensable element in the life of women. In the literature, the effects of physical activity and exercise-based trainings such as and vibration training, aerobics, strengthening, balance and combined exercise interventions with different intensity on bone structure vary. In studies, it has been reported that combined exercise interventions provide the greatest effect and that resistance exercises are an important component in these interventions. It is recommended to regularly practice physical activity and exercise, and it is reported that long-term exercise programs provide more improvement in the treatment of osteoporosis. However, the physical fitness of the person participating in the program, the risk of fractures and their presence should be taken into account. Within the scope of this review, regarding the subject that is kept up-to-date and highly discussed in the literature; the effect of physical activity and exercise on osteoporosis in women, guideline recommendations and exercises to avoid were examined.

Keywords

• Activity
• exercise
• osteoporosis
• women
• fracture

References

1. Al Dahamsheh, Z., Al Rashdan, K., Al Hadid, A., Jaradat, R., Al Bakheet, M., ve Bataineh, Z. S. (2019). The Impact of Aerobic Exercise on Female Bone Health Indicators. Medical Archives (Sarajevo, Bosnia and Herzegovina), 73(1), 35-38. https://doi.org/10.5455/medarh.2019.73.35-38
2. Alonso Pérez, J. L., Martín Pérez, S., Battaglino, A., Villafañe, J. H., Alonso-Sal, A., ve Sánchez Romero, E. A. (2021). An Up-Date of the Muscle Strengthening Exercise Effectiveness in Postmenopausal Women with Osteoporosis: A Qualitative Systematic Review. Journal of Clinical Medicine, 10(11), 2229. https://doi.org/10.3390/jcm10112229
3. Alswat, K. A. (2017a). Gender Disparities in Osteoporosis. Journal of Clinical Medicine Research, 9(5), 382-387. https://doi.org/10.14740/jocmr2970w
4. Aziziyeh, R., Garcia Perlaza, J., Saleem, N., Kirazlı, Y., Akalın, E., McTavish, R. K., Duperrouzel, C., ve Cameron, C. (2020). The burden of osteoporosis in Turkey: A scorecard and economic model. Archives of Osteoporosis, 15(1), 128. https://doi.org/10.1007/s11657-020-00801-9
5. Benedetti, M. G., Furlini, G., Zati, A., ve Letizia Mauro, G. (2018). The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients. BioMed Research International, 2018, 4840531. https://doi.org/10.1155/2018/4840531
6. Borer, K. T. (2005). Physical activity in the prevention and amelioration of osteoporosis in women: Interaction of mechanical, hormonal and dietary factors. Sports Medicine (Auckland, N.Z.), 35(9), 779-830. https://doi.org/10.2165/00007256-200535090-00004
7. Brooke-Wavell, K., Skelton, D. A., Barker, K. L., Clark, E. M., De Biase, S., Arnold, S., Paskins, Z., Robinson, K. R., Lewis, R. M., Tobias, J. H., Ward, K. A., Whitney, J., ve Leyland, S. (2022). Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis. British Journal of Sports Medicine, bjsports-2021-104634. https://doi.org/10.1136/bjsports-2021-104634
8. Carter, M. I., ve Hinton, P. S. (2014). Physical Activity and Bone Health. Missouri Medicine, 111(1), 59-64.

9. Cawthon, P. M., Fullman, R. L., Marshall, L., Mackey, D. C., Fink, H. A., Cauley, J. A., Cummings, S. R., Orwoll, E. S., Ensrud, K. E., ve Osteoporotic Fractures in Men (MrOS) Research Group. (2008). Physical performance and risk of hip fractures in older men. Journal of Bone and Mineral Research: The Official Journal of the American Society for Bone and Mineral Research, 23(7), 1037-1044. https://doi.org/10.1359/jbmr.080227
10. Cosman, F., de Beur, S. J., LeBoff, M. S., Lewiecki, E. M., Tanner, B., Randall, S., Lindsay, R., ve National Osteoporosis Foundation. (2014). Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporosis International: A Journal Established as Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 25(10), 2359-2381. https://doi.org/10.1007/s00198-014-2794-2
11. Cussler, E. C., Lohman, T. G., Going, S. B., Houtkooper, L. B., Metcalfe, L. L., Flint-Wagner, H. G., Harris, R. B., ve Teixeira, P. J. (2003). Weight lifted in strength training predicts bone change in postmenopausal women. Medicine and Science in Sports and Exercise, 35(1), 10-17. https://doi.org/10.1097/00005768-200301000-00003
12. Çergel, Y., Topuz, O., Alkan, H., Sarsan, A., ve Sabir Akkoyunlu, N. (2019). The effects of short-term back extensor strength training in postmenopausal osteoporotic women with vertebral fractures: Comparison of supervised and home exercise program. Archives of Osteoporosis, 14(1), 82. https://doi.org/10.1007/s11657-019-0632-z
13. Daly, R. M., Dalla Via, J., Duckham, R. L., Fraser, S. F., ve Helge, E. W. (2019). Exercise for the prevention of osteoporosis in postmenopausal women: An evidence-based guide to the optimal prescription. Brazilian Journal of Physical Therapy, 23(2), 170-180. https://doi.org/10.1016/j.bjpt.2018.11.011
14. Dohrn, I.-M., Hagströmer, M., Hellenius, M.-L., ve Ståhle, A. (2016). Gait Speed, Quality of Life, and Sedentary Time are Associated with Steps per Day in Community-Dwelling Older Adults with Osteoporosis. Journal of Aging and Physical Activity, 24(1), 22-31. https://doi.org/10.1123/japa.2014-0116
15. Eastell, R., O’Neill, T. W., Hofbauer, L. C., Langdahl, B., Reid, I. R., Gold, D. T., ve Cummings, S. R. (2016). Postmenopausal osteoporosis. Nature Reviews. Disease Primers, 2, 16069. https://doi.org/10.1038/nrdp.2016.69
16. ElDeeb, A. M., ve Abdel-Aziem, A. A. (2020). Effect of Whole-Body Vibration Exercise on Power Profile and Bone Mineral Density in Postmenopausal Women With Osteoporosis: A Randomized Controlled Trial. Journal of Manipulative and Physiological Therapeutics, 43(4), 384-393. https://doi.org/10.1016/j.jmpt.2019.12.003
17. Ferrara, P. E., Salini, S., Maggi, L., Foti, C., Maccauro, G., ve Ronconi, G. (2019). Evaluation of quality of life and static balance in postmenopausal osteoporosis women after Tai Chi Chuan practice: An observational randomized case control study. Journal of Biological Regulators and Homeostatic Agents, 33(2 Suppl. 1), 163-169. XIX Congresso Nazionale S.I.C.O.O.P. Societa' Italiana Chirurghi Ortopedici Dell'ospedalita' Privata Accreditata.
18. Feskanich, D., Willett, W., ve Colditz, G. (2002). Walking and leisure-time activity and risk of hip fracture in postmenopausal women. JAMA, 288(18), 2300-2306. https://doi.org/10.1001/jama.288.18.2300
19. Forest, HM. (1988). Vital biomechanics: Proposed general concepts for skeletal adaptations to mechanical usage. Calcified Tissue International, 42(3). https://doi.org/10.1007/BF02556327
20. Giangregorio, L. M., McGill, S., Wark, J. D., Laprade, J., Heinonen, A., Ashe, M. C., MacIntyre, N. J., Cheung, A. M., Shipp, K., Keller, H., Jain, R., ve Papaioannou, A. (2015). Too Fit To Fracture: Outcomes of a Delphi consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral fractures. Osteoporosis International: A Journal Established as Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 26(3), 891-910. https://doi.org/10.1007/s00198-014-2881-4
21. Giangregorio, L. M., ve Ponzano, M. (2022). Exercise and physical activity in individuals at risk of fracture. Best Practice ve Research. Clinical Endocrinology ve Metabolism, 36(2), 101613. https://doi.org/10.1016/j.beem.2021.101613
22. Gonzalo-Encabo, P., McNeil, J., Boyne, D. J., Courneya, K. S., ve Friedenreich, C. M. (2019). Dose-response effects of exercise on bone mineral density and content in post-menopausal women. Scandinavian Journal of Medicine ve Science in Sports, 29(8), 1121-1129. https://doi.org/10.1111/sms.13443
23. Hong, A. R., ve Kim, S. W. (2018). Effects of Resistance Exercise on Bone Health. Endocrinology and Metabolism (Seoul, Korea), 33(4), 435-444. https://doi.org/10.3803/EnM.2018.33.4.435
24. Howe, T. E., Shea, B., Dawson, L. J., Downie, F., Murray, A., Ross, C., Harbour, R. T., Caldwell, L. M., ve Creed, G. (2011). Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews, 7. https://doi.org/10.1002/14651858.CD000333.pub2
25. Hu, X., Ma, S., Yang, C., Wang, W., ve Chen, L. (2019). Relationship between senile osteoporosis and cardiovascular and cerebrovascular diseases. Experimental and Therapeutic Medicine, 17(6), 4417-4420. https://doi.org/10.3892/etm.2019.7518
26. Johnell, O., ve Kanis, J. A. (2006). An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis International: A Journal Established as Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 17(12), 1726-1733. https://doi.org/10.1007/s00198-006-0172-4
27. Kanis, J. A., Cooper, C., Rizzoli, R., Reginster, J.-Y., ve Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) and the Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF). (2019). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis International: A Journal Established as Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 30(1), 3-44. https://doi.org/10.1007/s00198-018-4704-5
28. Kohrt, W. M., Bloomfield, S. A., Little, K. D., Nelson, M. E., Yingling, V. R., ve American College of Sports Medicine. (2004). American College of Sports Medicine Position Stand: Physical activity and bone health. Medicine and Science in Sports and Exercise, 36(11), 1985-1996. https://doi.org/10.1249/01.mss.0000142662.21767.58
29. Lane, J. M., ve Nydick, M. (1999). Osteoporosis: Current modes of prevention and treatment. The Journal of the American Academy of Orthopaedic Surgeons, 7(1), 19-31. https://doi.org/10.5435/00124635-199901000-00003
30. Lee, M. S., Pittler, M. H., Shin, B.-C., ve Ernst, E. (2008). Tai chi for osteoporosis: A systematic review. Osteoporosis International: A Journal Established as Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 19(2), 139-146. https://doi.org/10.1007/s00198-007-0486-x
31. Lewczuk, E., ve Białoszewski, D. (2006). The level of physical activity in patients with osteoporosis in relation to the risk and prevention of falls. Ortopedia, Traumatologia, Rehabilitacja, 8(4), 412-421.
32. Li, H., ve Li, L. (2018). Low magnitude whole-body vibration and postmenopausal osteoporosis. Sheng wu yi xue gong cheng xue za zhi = Journal of biomedical engineering = Shengwu yixue gongchengxue zazhi, 35, 301-306. https://doi.org/10.7507/1001-5515.201801071
33. Marín-Cascales, E., Alcaraz, P. E., Ramos-Campo, D. J., Martinez-Rodriguez, A., Chung, L. H., ve Rubio-Arias, J. Á. (2018). Whole-body vibration training and bone health in postmenopausal women: A systematic review and meta-analysis. Medicine, 97(34), e11918. https://doi.org/10.1097/MD.0000000000011918
34. Marini, S., Barone, G., Masini, A., Dallolio, L., Bragonzoni, L., Longobucco, Y., ve Maffei, F. (2020). The Effect of Physical Activity on Bone Biomarkers in People With Osteoporosis: A Systematic Review. Frontiers in Endocrinology, 11, 585689. https://doi.org/10.3389/fendo.2020.585689
35. McGee-Lawrence, M. E., Carey, H. V., ve Donahue, S. W. (2008). Mammalian hibernation as a model of disuse osteoporosis: The effects of physical inactivity on bone metabolism, structure, and strength. American Journal of Physiology. Regulatory, Integrative and Comparative Physiology, 295(6), R1999-2014. https://doi.org/10.1152/ajpregu.90648.2008
36. McMillan, L. B., Zengin, A., Ebeling, P. R., ve Scott, D. (2017). Prescribing Physical Activity for the Prevention and Treatment of Osteoporosis in Older Adults. Healthcare (Basel, Switzerland), 5(4), E85. https://doi.org/10.3390/healthcare5040085
37. Miko, I., Szerb, I., Szerb, A., Bender, T., ve Poor, G. (2018). Effect of a balance-training programme on postural balance, aerobic capacity and frequency of falls in women with osteoporosis: A randomized controlled trial. Journal of Rehabilitation Medicine, 50(6), 542-547. https://doi.org/10.2340/16501977-2349
38. Mosti, M. P., Kaehler, N., Stunes, A. K., Hoff, J., ve Syversen, U. (2013). Maximal strength training in postmenopausal women with osteoporosis or osteopenia. Journal of Strength and Conditioning Research, 27(10), 2879-2886. https://doi.org/10.1519/JSC.0b013e318280d4e2
39. Nevitt, M. C., Ettinger, B., Black, D. M., Stone, K., Jamal, S. A., Ensrud, K., Segal, M., Genant, H. K., ve Cummings, S. R. (1998). The association of radiographically detected vertebral fractures with back pain and function: A prospective study. Annals of Internal Medicine, 128(10), 793-800. https://doi.org/10.7326/0003-4819-128-10-199805150-00001
40. Nichols, D. L. ve Pavlovic A. (2018). Osteo. İçinde Klinik egzersiz fizyolojisi (3. bs). 'Osteoporoz'. (İ. Çıtak Karakaya, çev.). Klinik Egzersiz Fizyolojisi (3. Baskı). J. K. Erhman, P. M. Gordon, P. S. Visich, S. J. Keteyian (Eds.). (pp. 447-457). İstanbul: İstanbul Medikal Sağlık ve Yayıncılık,2018.
41. Office of the Surgeon General (US). (2004). Bone Health and Osteoporosis: A Report of the Surgeon General. Office of the Surgeon General (US). http://www.ncbi.nlm.nih.gov/books/NBK45513/
42. Otero, M., Esain, I., González-Suarez, Á. M., ve Gil, S. M. (2017). The effectiveness of a basic exercise intervention to improve strength and balance in women with osteoporosis. Clinical Interventions in Aging, 12, 505-513. https://doi.org/10.2147/CIA.S127233
43. Ozcivici, E., Luu, Y. K., Adler, B., Qin, Y.-X., Rubin, J., Judex, S., ve Rubin, C. T. (2010). Mechanical signals as anabolic agents in bone. Nature Reviews. Rheumatology, 6(1), 50-59. https://doi.org/10.1038/nrrheum.2009.239
44. Pines, A. (2009). Lifestyle and diet in postmenopausal women. Climacteric: The Journal of the International Menopause Society, 12 Suppl 1, 62-65. https://doi.org/10.1080/13697130902785449
45. Ricci, C., Gervasi, F., Havemann Nel, L., Smuts, C. M., Kruger, S. H., ve Leitzmann, M. F. (2019). Substitution of sedentary time with light physical activity is related to increased bone density in U.S. women over 50 years old. An iso-temporal substitution analysis based on the National health and Nutrition Examination Survey. European Journal of Sport Science, 19(10), 1404-1413. https://doi.org/10.1080/17461391.2019.1600588
46. Skelton, D. A., ve Mavroeidi, A. (2018). Which strength and balance activities are safe and efficacious for individuals with specific challenges (osteoporosis, vertebral fractures, frailty, dementia)?: A Narrative review. Journal of Frailty, Sarcopenia and Falls, 3(2), 85-104. https://doi.org/10.22540/JFSF-03-085
47. Stanghelle, B., Bentzen, H., Giangregorio, L., Pripp, A. H., Skelton, D. A., ve Bergland, A. (2020). Physical fitness in older women with osteoporosis and vertebral fracture after a resistance and balance exercise programme: 3-month post-intervention follow-up of a randomised controlled trial. BMC Musculoskeletal Disorders, 21(1), 471. https://doi.org/10.1186/s12891-020-03495-9
48. Taaffe, D., Daly, R., Suominen, H., Galvão, D., ve Bolam, K. (2013). Physical activity and exercise in the maintenance of the adult skeleton and the prevention of osteoporotic fractures. Faculty of Science, Medicine and Health - Papers: part A, 683-719. https://doi.org/10.1016/B978-0-12-415853-5.00029-7
49. Tański, W., Kosiorowska, J., ve Szymańska-Chabowska, A. (2021). Osteoporosis—Risk factors, pharmaceutical and non-pharmaceutical treatment. European Review for Medical and Pharmacological Sciences, 25(9), 3557-3566. https://doi.org/10.26355/eurrev_202105_25838
50. Tong, X., Chen, X., Zhang, S., Huang, M., Shen, X., Xu, J., ve Zou, J. (2019). The Effect of Exercise on the Prevention of Osteoporosis and Bone Angiogenesis. BioMed Research International, 2019, 8171897. https://doi.org/10.1155/2019/8171897
51. Trans, T., Aaboe, J., Henriksen, M., Christensen, R., Bliddal, H., ve Lund, H. (2009). Effect of whole body vibration exercise on muscle strength and proprioception in females with knee osteoarthritis. The Knee, 16(4), 256-261. https://doi.org/10.1016/j.knee.2008.11.014
52. Türkmen, C., ve Kose, N. (2016). Vibrasyon: Fizyoterapide Kullanımı ve EtkileriA. Karaduman, Ö. Ülger, N. Vardar Yağlı, M. Kılınç, S. Serel Arslan (Eds.). Fizyoterapi Seminerleri (ss. 11-16).
53. Wright, N. C., Looker, A. C., Saag, K. G., Curtis, J. R., Delzell, E. S., Randall, S., ve Dawson-Hughes, B. (2014). The Recent Prevalence of Osteoporosis and Low Bone Mass in the United States Based on Bone Mineral Density at the Femoral Neck or Lumbar Spine. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 29(11), 2520-2526. https://doi.org/10.1002/jbmr.2269
54. Zhao, R., Zhang, M., ve Zhang, Q. (2017). The Effectiveness of Combined Exercise Interventions for Preventing Postmenopausal Bone Loss: A Systematic Review and Meta-analysis. The Journal of Orthopaedic and Sports Physical Therapy, 47(4), 241-251. https://doi.org/10.2519/jospt.2017.6969