Körperliches Training, Fraktur und Knochendichte

Zusammenfassung

Studienziel

Ziel der Untersuchung war es, den Einfluss eines langjährigen körperlichen Trainings auf die Inzidenz klinischer Fraktu-ren zu erfassen.

Material und Methoden

137 frühpostmenopausale Frauen mit Osteopenie wurden 1998 in die EFOPS-Studie eingeschlossen. 86 Personen wählten den durchgängig überwachten Trainingsarm der Studie (TG), 51 traten der Kontrollgruppe (KG) bei. Primärer Endpunkt waren Frakturrate und -risiko von nied-rigtraumatischen klinischen Frakturen, se-kundärer Endpunkt die Knochendichte.

Ergebnisse

105 Teilnehmer mit ca. 1650 Teilnehmerjahren wurden in die 16-Jahres-Messung eingeschlossen. Frakturrisiko (Relatives Risiko: 0,51; 95%-Konfidenzintervall: 0,23–0,97) und -rate (0,42; 0,20–0,86) lagen in der Trainingsgruppe signifikant niedriger als in der Kontrollgruppe. In beiden Gruppen sank die Knochendichte an Lendenwirbelsäu-le (TG: –1,5 ± 5,0 % vs. KG: 5,8 ± 6,4 %) und Schenkelhals (TG: –6,5 ± 4,6 % vs. KG: 9,6 ± 5,0 %) signifikant ab, die Reduktion der KG lag jedoch für beide Regionen signifikant (p ≤ 0,001) höher.

Fazit

Die vorliegende Untersuchung bestätigt mit ausreichender statistischer Power den frakturpräventiven Effekt eines langjährigen körperlichen Trainings bei motivierten, post-menopausalen Frauen mit einem bewusst sportlich aktiven Lebensstil.

Summary

Aim of the study

Fragility and osteoporosis related fractures are an increasingly prominent health problem in our aging society. Physical exercising positively affects bone strength and fall rate and may therefore be an efficient option for actively preventing fracture on an autonomous basis at an advanced age. However, due to low statistical power no present study clearly determines the anti-fracture efficacy of exercise. Thus, the primary aim of this study was to evaluate the effect of exercise on clinical “overall” low-trauma fracture incidence in postmenopausal females.

Material and methods

137 early postmenopausal, osteopenic women living in the area of Erlangen-Nuremberg (Germany) were included in the Erlangen Fitness and Osteoporosis Prevention-study (EFOPS) in 1998. 86 subjects joined the exercise group (EG) and performed a sophisticated consistently supervised exercise training over 16 years, 51 subjects joined the non-training control group (CG) that was requested to maintain their physical activity level and lifestyle. Primary study-endpoint was low-trauma fracture rate and -risk, secondary study-endpoints were BMD at lumbar spine and femoral neck assessed by Dual-Energy X-Ray-Absorptio-metry.

Results

After 16 years of intervention, 105 subjects representing ≈ 1650 patient-years were included in the analysis. The groups significantly differed for “overall” clinical fracture number (rate ratio: 0.47; 95%-Confidence Interval [CI]: 0.24–0.92) and low-trauma overall clinical fracture number (rate ratio: 0.42; 95%-CI: 0.20–0.86) in favour of the exercise group. Bone Mineral Density at the lumbar spine (Mean ± SD: EG: –1.5 ± 5.0 % vs. CG: 5.8 ± 6.4 %) and femoral neck (EG: –6.5 ± 4.6 % vs. CG: –9.6 ± 5.0 %) significantly decreased in both groups, however, the reduction was significantly more pronounced in the CG (p ≤ 0.001).

Conclusion

Generally, this study evidenced the high anti-fracture efficiency of sophisticated multi-purpose exercise programs. With respect to the dimension of fracture reduction, this study averages in the range of potent pharmaceutical interventions. So far, we conclude that for subjects willing and able to exercise frequently, lifelong exercise may be the best choice for autonomous fracture prevention. However, due to the non-randomized study design ultimate evidence to conclude this issue has still to be provided.

Schlüsselwörter

Körperliches Training - Fraktur - Knochendichte - Menopause - Osteopenie

Keywords

Physical activity - exercise - fracture - bone mineral density - menopause - osteopenia

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