Research Translation In Action: Nine Years Of ‘Real World’ Therapeutic Exercise To Prevent Osteoporotic Fracture

We have shown in multiple trials that high intensity resistance and impact training (HiRIT) reduces risk for osteoporotic fracture by improving bone, muscle, posture and functional ability. The implementation of HiRIT into a translational research clinic allows ongoing examination of important pragmatic determinants of therapeutic success such as comorbidity, appeal, and cost, for people at high risk of osteoporotic fracture. PURPOSE: The aim of this report is to assess the effect of HiRIT in a ‘real world’ clinical setting on risk factors for osteoporotic fracture. METHODS: In this longitudinal cohort study, 1056 women (age = 61.4 ± 7.9 yrs, 162 ± 6 cm, 62.0 ± 10.8 kg, lumbar spine T score -2.2 ± 1.1, total hip T score -1.6 ± 0.7) were examined between 2015-2024 for bone mineral density (BMD), posture and functional performance at baseline and after a minimum of 10 months exposure (max 33 mths) to HiRIT. Attendance (adherence) to twice-weekly supervised HiRIT was self-selected. Those with over 50% attendance were considered the treatment group (n = 360). Change in BMD and function were assessed using linear models adjusted for confounding variables (baseline BMD, bone medication, menopause status, calcium intake and adherence). Falls and fractures were tracked. RESULTS: Treatment group participants improved lumbar spine (+1.7%), total hip (+1.1%), femoral neck (+0.7%) and whole-body BMD (+1.2%), 5x sit-to-stand (-11.4%), back extensor strength (+23.0%) and functional reach (+6.6%) (all P < 0.001). Based on predictive estimates, greater BMD improvements were expected in premenopausal (+2.1-4.2%) compared to postmenopausal women (+1.2-2.5%). Fall risk was 12% lower and fracture risk was 40% lower in participants with >50% adherence than those who did not undertake supervised HiRIT at the clinic (both NS P > 0.333). CONCLUSIONS: Supervised HiRIT improved BMD and function in older women at risk for osteoporotic fracture. Both pre- and postmenopausal women improved BMD, however, improvements are likely to be greater in pre-menopause. This unique translational dataset continues to support the benefits of targeted supervised HiRIT for the prevention of osteoporotic fracture in the ‘real world’.