Exercise and bone mineral density.

A decrease in physical activity may lead to an increased loss of bone and an increase in the incidence of osteoporotic fractures. Studies have demonstrated increases in bone formation in animals and increases in bone mineral density in humans. Studies of animals show that bone has enhanced physical and mechanical properties following periods of increased stress. Strains which are high in rate and magnitude, and of abnormal distribution, but not necessarily long in duration, are best for inducing new bone formation, resulting in the strengthening of bone by increased density. Cross-sectional studies show that athletes, especially those who are strength-trained, have greater bone mineral densities than nonathletes, and that strength, muscle mass and maximal oxygen uptake correlate with bone density. Longitudinal training studies indicate that strength training and high impact endurance training increase bone density. Strain induction, the deformation that occurs in bone under loading, may cause a greater level of formation and an inhibition of resorption within the normal remodelling cycle of bone, or it may cause direct activation of osteoblastic bone formation from the quiescent state. Various mechanisms have been proposed for the transformation of mechanical strain into biochemical stimuli to enhance bone formation. These include prostaglandin release, piezoelectric and streaming potentials, increased bone blood flow, microdamage and hormonally mediated mechanisms. These mechanisms may act on their own or in concert, depending on the loading situation and the characteristics of the bone.