Abstract
Summary
We examined the independent and combined effects of a multi-component exercise program and calcium–vitamin-D3-fortified milk on bone mineral density (BMD) in older men. Exercise resulted in a 1.8% net gain in femoral neck BMD, but additional calcium–vitamin D3 did not enhance the response in this group of older well-nourished men.
Introduction
This 12-month randomised controlled trial assessed whether calcium–vitamin-D3-fortified milk could enhance the effects of a multi-component exercise program on BMD in older men.
Methods
Men (n = 180) aged 50–79 years were randomised into: (1) exercise + fortified milk; (2) exercise; (3) fortified milk; or (4) controls. Exercise consisted of high intensity progressive resistance training with weight-bearing impact exercise. Men assigned to fortified milk consumed 400 mL/day of low fat milk providing an additional 1,000 mg/day calcium and 800 IU/day vitamin D3. Femoral neck (FN), total hip, lumbar spine and trochanter BMD and body composition (DXA), muscle strength 25-hydroxyvitamin D and parathyroid hormone (PTH) were assessed.
Results
There were no exercise-by-fortified milk interactions at any skeletal site. Exercise resulted in a 1.8% net gain in FN BMD relative to no-exercise (p < 0.001); lean mass (0.6 kg, p < 0.05) and muscle strength (20–52%, p < 0.001) also increased in response to exercise. For lumbar spine BMD, there was a net 1.4–1.5% increase in all treatment groups relative to controls (all p < 0.01). There were no main effects of fortified milk at any skeletal site.
Conclusion
A multi-component community-based exercise program was effective for increasing FN BMD in older men, but additional calcium–vitamin D3 did not enhance the osteogenic response.
Similar content being viewed by others
References
Access Economics (2001) The burden of brittle bones: costing osteoporosis in Australia. Access Economics Pty Ltd, Canberra
Bergstrom I, Landgren B, Brinck J et al (2008) Physical training preserves bone mineral density in postmenopausal women with forearm fractures and low bone mineral density. Osteoporos Int 19(2):177–83
Kerr D, Morton A, Dick I et al (1996) Exercise effects on bone mass in postmenopausal women are site-specific and load-dependent. J Bone Miner Res 11(2):218–25
Kerr D, Ackland T, Maslen B et al (2001) Resistance training over 2 years increases bone mass in calcium-replete postmenopausal women. J Bone Miner Res 16(1):175–81
Nelson ME, Fiatarone MA, Morganti CM et al (1994) Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. A randomized controlled trial. JAMA 272(24):1909–14
Dawson-Hughes B, Dallal GE, Krall EA et al (1990) A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. N Engl J Med 323(13):878–83
Reid IR, Ames RW, Evans MC et al (1995) Long-term effects of calcium supplementation on bone loss and fractures in postmenopausal women: a randomized controlled trial. Am J Med 98(4):331–5
Prince RL, Devine A, Dhaliwal SS et al (2006) Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women. Arch Intern Med 166(8):869–75
Trivedi DP, Doll R, Khaw KT (2003) Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ 326(7387):469
Bischoff-Ferrari HA, Willett WC, Wong JB et al (2005) Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 293(18):2257–64
Specker BL (1996) Evidence for an interaction between calcium intake and physical activity on changes in bone mineral density. J Bone Miner Res 11(10):1539–1544
Lau EM, Woo J, Leung PC et al (1992) The effects of calcium supplementation and exercise on bone density in elderly Chinese women. Osteoporos Int 2(4):168–73
Prince RL, Smith M, Dick IM et al (1991) Prevention of postmenopausal osteoporosis. A comparative study of exercise, calcium supplementation, and hormone-replacement therapy. N Eng J Med 325(17):1189–95
Prince R, Devine A, Dick I et al (1995) The effects of calcium supplementation (milk powder or tablets) and exercise on bone density in post-menopausal women. J Bone Miner Res 10(7):1068–1075
American College of Sports Medicine (2000) ACSM guidelines for exercise testing and prescription, 6th edn. Lippincott, Williams & Wilkins, Philadelphia
Daly RM, Brown M, Bass S et al (2006) Calcium- and vitamin d(3)-fortified milk reduces bone loss at clinically relevant skeletal sites in older men: a 2-year randomized controlled trial. J Bone Miner Res 21(3):397–405
Stewart AL, Mills KM, King AC et al (2001) CHAMPS physical activity questionnaire for older adults: outcomes for interventions. Med Sci Sports Exerc 33(7):1126–41
National Health and Medical Research Council (2006) Nutrient reference values for Australia and New Zealand including recommended dietary intakes: Canberra: Department of Health and Ageing
Kohrt WM, Ehsani AA, Birge SJ Jr. (1997) Effects of exercise involving predominantly either joint-reaction or ground-reaction forces on bone mineral density in older women. J Bone Miner Res 12(8):1253–61
Korpelainen R, Keinanen-Kiukaanniemi S, Heikkinen J et al (2006) Effect of impact exercise on bone mineral density in elderly women with low BMD: a population-based randomized controlled 30-month intervention. Osteoporos Int 17(1):109–18
Engelke K, Kemmler W, Lauber D et al (2006) Exercise maintains bone density at spine and hip EFOPS: a 3-year longitudinal study in early postmenopausal women. Osteoporos Int 17(1):133–42
Vainionpaa A, Korpelainen R, Leppaluoto J et al (2005) Effects of high-impact exercise on bone mineral density: a randomized controlled trial in premenopausal women. Osteoporos Int 16(2):191–7
Mosley JR, Lanyon LE (1998) Strain rate as a controlling influence on adaptive modeling in response to dynamic loading of the ulna in growing male rats. Bone 23(4):313–8
Turner CH, Owan I, Takano Y (1995) Mechanotransduction in bone: role of strain rate. Am J Physiol 269(3 Pt 1):E438–42
Rubin CT, Lanyon LE (1984) Regulation of bone formation by applied dynamic loads. J Bone Joint Surg Am 66(3):397–402
Heinonen A, Kannus P, Sievanen H et al (1996) Randomised controlled trial of effect of high-impact exercise on selected risk factors for osteoporotic fractures. Lancet 348(9038):1343–7
Vainionpaa A, Korpelainen R, Vihriala E et al (2006) Intensity of exercise is associated with bone density change in premenopausal women. Osteoporos Int 17(3):455–63
Jamsa T, Vainionpaa A, Korpelainen R et al (2006) Effect of daily physical activity on proximal femur. Clin Biomech (Bristol, Avon) 21(1):1–7
Frost HM (1987) Bone “mass” and the “mechanostat”: a proposal. Anat Rec 219(1):1–9
Lotz JC, Cheal EJ, Hayes WC (1995) Stress distributions within the proximal femur during gait and falls: implications for osteoporotic fracture. Osteoporos Int 5(4):252–61
Lovejoy CO (1988) Evolution of human walking. Sci Am 259(5):118–25
Beck TJ, Looker AC, Mourtada F et al (2006) Age trends in femur stresses from a simulated fall on the hip among men and women: evidence of homeostatic adaptation underlying the decline in hip BMD. J Bone Miner Res 21(9):1425–32
Mayhew PM, Thomas CD, Clement JG et al (2005) Relation between age, femoral neck cortical stability, and hip fracture risk. Lancet 366(9480):129–35
Hsieh YF, Robling AG, Ambrosius WT et al (2001) Mechanical loading of diaphyseal bone in vivo: the strain threshold for an osteogenic response varies with location. J Bone Miner Res 16(12):2291–7
Martyn-St James M, Carroll S (2006) High-intensity resistance training and postmenopausal bone loss: a meta-analysis. Osteoporos Int 17(8):1225–40
Riggs BL, O'Fallon WM, Muhs J et al (1998) Long-term effects of calcium supplementation on serum parathyroid hormone level, bone turnover, and bone loss in elderly women. J Bone Miner Res 13(2):168–74
Bischoff-Ferrari HA, Giovannucci E, Willett WC (2006) Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 84(1):18–28
Heaney RP (2002) The importance of calcium intake for lifelong skeletal health. Calcif Tissue Int 70(2):70–3
Lanyon LE, Rubin CT, Baust G (1986) Modulation of bone loss during calcium insufficiency by controlled dynamic loading. Calcif Tissue Int 38(4):209–16
Acknowledgements
This study was financially supported by a grant from the Australian Research Council (ARC) Linkage Scheme. Associate Professor Robin Daly was supported by an Osteoporosis Australia Research Fellowship and a National Health and Medical Research Council (NHMRC) Career Development Award (ID 425849). We thank Murray Goulburn Co-operative Co Ltd, in particular Peter Hobman and Michelle Rowney, for providing the calcium–vitamin D3 low fat UHT-fortified milk used in the study. The authors thank The City of Greater Geelong and Ocean View Health Club for their generous provision of the gymnasium facilities used throughout the study. The authors also thank the following people for contributions to this study: Nicole Petrass, Joanne Daly, and Sam Korn.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kukuljan, S., Nowson, C.A., Bass, S.L. et al. Effects of a multi-component exercise program and calcium–vitamin-D3-fortified milk on bone mineral density in older men: a randomised controlled trial. Osteoporos Int 20, 1241–1251 (2009). https://doi.org/10.1007/s00198-008-0776-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-008-0776-y