The strong bones study: Can we strengthen our bones with exercise?

The purpose of this study

• To investigate the effect of OsteoStrong-training compared to physical training on bone health among individuals with high fracture risk.
• To explore the participant's experiences and perceptions of the training methods.

Why is this study important?

Osteoporosis and fragility fractures are a major public health problem worldwide. Fragility fractures result in major functional impairments and suffering, while worldwide medical care costs skyrocket every year. Osteoporosis is very common in elderly populations (women and men) and particularly in women.

Physical activity and exercise constitute a critical success factor regarding prevention and treatment of osteoporosis and fragility fractures. Why? Because exercise has potential for strengthening the skeleton and preventing falls.

That said, increased knowledge and evidence are necessary regarding training effects on bone health. Consequently, this study intends to:

• Add to existing research on effects of exercise on bone health.
• Shed light on osteoporosis as a public health problem.
• Contribute to the expansion of the global musculoskeletal knowledge base.

Study designs

• Randomized controlled trial
• Qualitative interview study
• Longitudinal study

Training methods

Method 1: OsteoStrong concept

Participants train individually at an OsteoStrong studio in Solna, Sweden (one 20-minute session per week for nine months). Each session consists of (i) warm-ups (balance exercises) on a vibration platform and (ii) isometric exercises (static loading) on four devices. OsteoStrong staff members supervise the sessions.

Method 2: Individually adapted and combined physical training

Here, participants train in groups (two 60-minute sessions per week for nine months). Each session consists of exercises based on current recommendations and previous research regarding exercise for osteoporosis. The sessions focus on strength, balance, coordination, mobility, and cardio fitness. The training is supervised by a naprapath/personal trainer and is conducted at Swedish School of Sport and Health Sciences (GIH).

Measuring instruments and outcome measures

• Outcome measures for bone health: Dual energy X-ray absorptiometry (DEXA), Vertebral fracture assessment (VFA), Biomarkers of bone activity (blood tests), Microindentation – tests bone by measuring bone strength and quality.
• Questionnaires: Self-rated health (SF-36), Lifestyle habits, Falls efficacy scale (fear of falling), Downton fall risk index (fall risk), Osteoporosis questionnaire.
• Physical tests: Muscle strength, Muscle endurance, Balance tests, Balance with BTrackS™, Walking and movement tests
• Lung function: Dynamic spirometer (Welch Allyn).
• Physical behaviors: Accelerometer (detects body vibration or motion acceleration) and questionnaires, Physical activities and exercises documented daily in a diary that the participants maintain during the nine-month training period.
• Focus group interviews for the qualitative study.

Measurement occasions and follow-ups:

• All tests are conducted at baseline and post-intervention at 9 months.
• Three months after the training starts: Blood sample and follow-up via telephone.
• Six months after training ends: Surveys about physical activity, lifestyle, falls and self-rated health.

When will study results be made public?

Because the study continues until the summer of 2023, study results will probably be presented in 2024. 

Lead researcher