Strengthening Evidence For High-intensity Resistance And Impact Training For Osteoporosis: Eight Years Of Real-world Data

Trials have shown that high intensity resistance and impact training (HiRIT aka ONERO™) improves bone, muscle and function in older people with low bone mass, but some worry that fracture risk, comorbid conditions, and lack of Medicare reimbursement are barriers to broad implementation for osteoporosis therapy. A dedicated translational research clinic, The Bone Clinic (Brisbane, Australia) was therefore established to examine effectiveness, safety and feasibility in real-world clinical practice. PURPOSE: The aim of the current report is to describe the bone, functional, falls and fragility fracture outcomes following 12 mths of HiRIT at The Bone Clinic. METHODS: Clinic clients undergo comprehensive testing for biometrics, bone mineral density (BMD), muscle, function, falls and fractures at baseline and annually thereafter. Twice-weekly supervised HiRIT is undertaken on a voluntary basis. Adherence and injuries are recorded. As all clients are offered treatment in this clinical sample, comparisons were made between clients having either 0-10% (control, n = 532) or > 10% adherence to HiRIT (n = 619) over 12 months. Between group differences in 12 mth percent change were examined by repeated measures GLM, adjusting for adherence. RESULTS: Outcomes from 1165 women and men (5.5%) attending The Bone Clinic from 2015-2023 (61.4 ± 8.1 yrs, 163.1 ± 6.9 cm, 62.7 ± 11.4 kg, lumbar spine [LS] T score -2.1 ± 1.1, total hip [TH] T score -1.6 ± 0.7) are reported. Percent improvement was greater in the HiRIT than control group at all BMD sites LS BMD (1.3 vs 0.2%, P < 0.00002), FN BMD (1.2 vs 0.0%, P < 0.0002), TH BMD (1.1 vs 0.3%, 0.003), WB BMD (1.4 vs 0.3%, <0.00008), as well as functional reach (5.8 vs 3.2%, P < 0.004), back extensor strength (21 vs 13%, P < 0.0006), 5 x sit to stand (-9.6 vs -7.2%, P < 0.02), and kyphosis (2.8 vs 8.8%, P < 0.006). There was a trend for fewer fractures in the HiRIT group (P = 0.075). CONCLUSIONS: 12 months of real-world supervised ONERO™ reduced risk of fragility fracture by improving bone mass, function, and posture with a trend to reduced fracture incidence in high-risk individuals. Ongoing monitoring of this unique translational dataset continues to confirm the effectiveness, acceptability, and feasibility of targeted supervised high intensity exercise therapy for osteoporosis in a ‘real world’ clinical setting.