Physical activity and bone health : FIMS Position Statement 2014

Bone is a remarkable, very strong and flexible structure. Running and jumping, together with muscle work, and lever arms generate ground reaction forces helping to model developing bone. Peak bone mass, strongly determined by genetic factors and exercise, is one of the most important factors in bone health. The amount of bone accrued, especially before the end of the third decade of life, is a major determinant of the risk of fractures in later life. Bones are a living tissue and constantly changing throughout one's lifetime, thus manifold osteopathies are known. The bone itself does not need to be the primary cause of diseases, but rather be affected in combination with other diseases. Besides osteopathies, such as fractures, achondroplasy, Morbus Paget, etc., osteoporosis which is defined as a systematic skeletal disease characterised by low bone mass and micro-architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture, according to the World Health Organization (WHO), is ranked among the ten prime widespread diseases. Bone mineral density (BMD) is used in diagnosing osteoporosis. Anamnesis and clinical findings, bone densitometry, medical imaging and the basic laboratory are basic diagnostics for osteoporosis. Physical inactivity, medication, sex, age, low body mass index, need to be regarded as risk factors for osteoporosis. Acute and chronic pain caused by osteoporosis restricts activities of daily living and diminishes quality of life. FRAX (a diagnostic tool), disregarding all advantages and disadvantages of the computer based algorithm, calculates the country-specific 10-year-probability of a major hip fracture. Several different bone disorders, especially osteoporosis, are among other reasons linked to a sedentary lifestyle and poor nutrition habits. Preventing osteoporosis is a lifelong task, involving aspects such as nutrition and body weight, physical activity, as well as the abuse of dependence-causing substances. Thus lifestyle modification, calcium, vitamin D3, physical activity, exercise and prevention of falls establish the basic therapy for osteoporosis. Building on this, secondary and tertiary prevention addresses the risk of fracture and repeated fracture prevention via medication. Physical medicine represents not merely an alternative, but rather a complementary and inevitable therapy option in treating bone disorders, especially osteoporosis. Consequently, physical exercise plays a key role in reducing fractures and repeated fractures. The study situation concerning physical activity and osteoporosis is so far not easy to evaluate, because interventions disagree on duration, intensity, specificity, and subject groups. Although there is a vast amount of literature on physical activity (described as one of the best medications against diseases of lifestyle), there is a lack of consensus according to the best dose-response correlation for bone health. In the context of bone health, particular attention is paid to whole body vibration. Whole body vibration may improve muscle strength and power and consequently bones and balance as well. However, the mechanism is not well understood and the exact role is still debated and cannot be uniformly prescribed. As society grows older and lifestyle becomes more and more sedentary, the occurrence of osteoporosis should be held as low as possible and therefore the diagnostic methods need to take action to recognise indications of osteoporosis as soon as possible and be able to determine the most effective treatment options.