Physical Activity and Bone Health

Karim Khan, MD, PhD, is a clinician-scientist at the University of British Columbia in Vancouver, Canada, and a consultant in the osteoporosis program at BC Women's & Children's Hospital. He has conducted extensive bone research. And coauthored the best-selling text Clinical Sports Medicine. He is on the editorial boards of the British Journal of Sports Medicine, Physician and Sportsmedicine and International SportMed Journal. Heather McKay, PhD, is an associate professor in the School of Human Kinetics at the University of British Columbia in Vancouver, Canada. She also is adjunct professor in the university's department of medicine and an associate in its Institute of Health Promotion Research. For many years, she has conducted research related to the bone health of women and girls and was involved in one of the earliest studies of amenorrhea in collegiate runners. Dr. McKay was key investigator in the University of Saskatchewan Pediatric Bone Mineral Accrual Study. Pekka Kannus, MD, PhD, is chief physician and head of the Accident and Trauma Research Center at the UKK Institute in Tampere, Finland. He also is a professor of injury prevention at the University of Tampere and an associate professor of sports medicine at the University of Jyvￜskylￜ in Finland. His scientific work has focused on basic and applied research of the musculoskeletal system of the human body. His primary interest is in bone research and prevention of osteoporotic fractures. Don Bailey, PhD, is a professor at the University of Saskatchewan in Saskatoon, Canada, and the University of Queensland in Brisbane, Australia. During his scientific career, he has studied child growth and development and the relationship between bone mineral accrual and physical activity in the growing years. He directed the landmark Saskatchewan Growth Study, a 10-year investigation of growth and physical fitness in school-age children. John Wark, MD, PhD, is a professor of medicine at the University of Melbourne in Australia. He is head of the Bone and Mineral Service at the Royal Melbourne Hospital and the director of the Centre of Osteoporosis and Bone Studies at the same leading teaching hospital campus. As both a specialist in endocrinology and an internationally recognized authority on bone metabolism, Dr. Wark covers a wide range of issues regarding bone, nutrition, and physical activity. He was the principal investigator in the first controlled trial of physical activity intervention in schoolgirls. Kim Bennell, PT, PhD, is an associate professor in the school of physiotherapy and head of the Centre for Sports Medicine Research and Education at the University of Melbourne in Australia. She also is a director of a private physiotherapy clinic that specializes in exercise prescription in the prevention and treatment of osteoporosis. Dr. Bennell earned her reputation in the bone field for her pivotal stress fracture research and work in physical activity and bone mineral in active people. She is the author of the first prospective study of the risk factors for stress fractures. Dr. Bennell is currently undertaking National Health and Medical Research Council funded research on the effect of ballet training in young girls.

Part I. Structure, Function, and Measurement of Bone
Chapter 1. Anatomy
Bone's Organic Makeup
Macroscopic and Microscopic Appearance
Bone Cells: Osteoblasts, Osteocytes, Osteoclasts
Summary
References

Chapter 2. Physiology
Calcium Homeostasis
Mechanotransduction
Modeling and Remodeling
Summary
References

Chapter 3. Biomechanics
Material Properties of Bone
Structural Properties of Bone
Bone's Response to Local Mechanical Loading
How Physical Activity Generates Loads on Bone
Summary
References

Chapter 4. Measuring the Properties of Bone
Dual Energy X-Ray Absorptiometry
Quantitative Ultrasound
Quantitative Computed Tomography
Measuring Bone Metabolism: Biochemical Markers
Summary
References

Part II. Determinants of Bone Mineral Other Than Physical Activity
Chapter 5. Age, Sex, Genetics, and Race
Age
Sex
Genetics
Race and Ethnicity
Summary
References

Chapter 6. Soft Tissue Determinants of Bone Mineral Density
Total Body Mass and BMD
Lean Mass and BMD
Fat Mass and BMD
Soft Tissue in Bone Research Studies
Summary
References

Chapter 7. Influence of Normal Endocrine Function on Bone Mineral
Estrogen
Progesterone
Effects of Pregnancy and Lactation
Testosterone
Growth Hormone and Insulin-Like Growth Factor I
Corticosteroid Hormones
Thyroid Hormone
Summary
References

Chapter 8. Dietary Intake and Bone Mineral
Calcium Intake and Bone Mineral Density at Various Life Stages
Vitamin D and Bone Mineralization
Dietary Supplementation and Fracture Risk
Interaction of Calcium and Physical Activity
Other Lifestyle Factors and Bone Mineral Density
Summary
References

Part III. Evidence and Prescription: A Life Span Approach
Chapter 9. Measurement of Physical Activity
Inherent Limitations
Traditional Methods
Suggestions for Measuring Physical Activity in Bone Studies
Summary
References

Chapter 10. Physical Activity and Bone in Childhood and Adolescence
Exercise, Bone Mineral Response, and Age
Normal Bone Mineral Accrual
Targeted Bone Loading and Bone Mineral
Generalized Physical Activity and Bone Mineral
Exercise Prescriptions
Summary
References

Chapter 11. Physical Activity, Targeted Bone Loading, and Bone Mineral in Premenopausal Women
Longitudinal Studies: Exercise Intervention
Cross-Sectional Studies: Athletes Versus Controls
Longitudinal Studies: Athletes Versus Controls
Cross-Sectional Studies: Generalized Physical Activity
Mechanism of Bone Augmentation
Exercise Prescription
Summary
References

Chapter 12. Physical Activity, Targeted Bone Loading, and Bone Mineral in Postmenopausal Women
Vertebral BMD and Targeted Bone Loading
Vertebral BMD and Minimal Bone Loading
Proximal Femoral BMD and Targeted Bone Loading
Mechanism of Bone Changes
Mechanism of Mechanical Load Adaptation
Exercise Prescription
Summary
References

Chapter 13. Physical Activity and Bone Mineral in Men
Controlled Trials of Exercise and BMD
Longitudinal Observational Studies
Cross-Sectional Studies of Athletes and Controls
Studies Examining Physical Activity As a Determinant of BMD
Mechanism of Bone Gain
Exercise Prescriptions
Summary
References

Chapter 14. Exercise and Fall Prevention
Falling, Fracture, and Age-Related Physiological Changes Among Older Adults
Can Exercise Decrease the Incidence of Falls?
Guidelines for Exercise Prescription
Summary
References

Chapter 15. Exercise Prescription for People With Osteoporosis
The Problem of Osteoporosis
Finer Point: Commonly Prescribed Treatments for Osteoporosis
Exercise Prescriptions
Summary
References

Part IV. Intense Physical Activity and Bone Health
Chapter 16. Skeletal Effects of Menstrual Disturbance
Delayed Menarche and Bone Mass
Intense Physical Training and Linear Growth
Menstrual Disturbance and Bone
Other Factors Contributing to Osteopenia
Athlete Menstrual Disturbance and Osteoporosis
Mechanism of Bone Loss
Treatment of Amenorrheic Women
References

Chapter 17. Stress Fractures
Continuum of Bone Overuse Injury
Why Stress Fractures Occur—Pathophysiology
Clinical Aspects
Treatment of Stress Fractures
Risk Factors
Summary
References

Part V. Research Opportunities: Physical Activity and Bone Health
Chapter 18. Getting Involved in Bone Research
Studies: Bone at the Molecular, Cellular, and Tissue Levels
Summary
References

Chapter 19. Research Projects Suitable for a Master's Thesis Course Work
Studies Appropriate for a Master's Thesis
Summary
References

Chapter 20. Research Projects Suitable for a PhD Thesis
Recent Bone and Physical Activity Doctoral Theses
Current Questions in the Field
Summary
References

Appendix A. Tables
Appendix B. Questionnaires