School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, 4222, Australia.
Menzies Health Institute Queensland, Gold Coast, Queensland, Australia.
Osteoporos Int. 2019 May;30(5):957-964. doi: 10.1007/s00198-018-04829-z. Epub 2019 Jan 5.
UNLABELLED: Our aim was to assess risk of vertebral fracture during high-intensity resistance and impact training (HiRIT) for postmenopausal women with low bone mass. HiRIT did not induce vertebral fracture, as evidenced by a reduction in kyphosis following 8 months of training and a lack of change in vertebral morphology. INTRODUCTION: The LIFTMOR trial demonstrated a novel, HiRIT program notably improved bone mass in postmenopausal women with osteopenia and osteoporosis. While no clinical signs or symptoms of vertebral crush fracture were evident during the trial, anecdotal feedback suggests that concerns about safety of HiRIT in the osteoporosis demographic remain. The aim of the current work was to assess vertebral body morphology, Cobb angle, and clinical measures of thoracic kyphosis in participants in the LIFTMOR trial for evidence of vertebral fracture following 8 months of supervised HiRIT. METHODS: Participants were randomized to either 8 months of 30-min, twice-weekly, supervised HiRIT or unsupervised, low-intensity, home-based exercise (CON). Lateral thoracolumbar DXA scans (Medix DR, Medilink, France) were performed at baseline and follow-up. Cobb angle was determined, and vertebral fracture identification was performed using the semiquantitative Genant method. Clinical kyphosis measurements were performed in relaxed standing (neutral posture) and standing tall using an inclinometer and a flexicurve. RESULTS: The HiRIT group exhibited a reduction in inclinometer-determined standing tall thoracic kyphosis compared to CON (- 6.7 ± 8.2° vs - 1.6 ± 8.1°, p = 0.031). Both the HiRIT and CON groups exhibited within-group improvement in kyphosis in relaxed standing as measured by both inclinometer and flexicurve (p < 0.05). There were no changes in vertebral fracture classification in the HiRIT group post-intervention. A single, new, wedge deformity was observed for CON. CONCLUSIONS: Supervised HiRIT was not associated with an increased risk of vertebral fracture in postmenopausal women with low bone mass. Indeed, a clinically relevant improvement in thoracic kyphosis was observed following 8 months of supervised HiRIT, further supporting its efficacy as an osteoporosis intervention for postmenopausal women with low to very low bone mass.
未标注：我们的目的是评估低骨量绝经后妇女进行高强度抗阻和冲击训练（HiRIT）时发生椎体骨折的风险。8 个月的训练后，脊柱后凸减少，椎体形态无变化，表明 HiRIT 并未引起椎体骨折。
引言：LIFTMOR 试验表明，一种新的高强度抗阻和冲击训练方案可显著增加骨质疏松和骨量低下的绝经后妇女的骨量。虽然在试验过程中没有出现临床椎体压缩性骨折的迹象或症状，但传闻反馈表明，骨质疏松人群对 HiRIT 安全性的担忧仍然存在。本研究的目的是评估 LIFTMOR 试验中参与者的椎体形态、Cobb 角和胸椎后凸的临床测量值，以评估 8 个月监督 HiRIT 后是否有椎体骨折的证据。
方法：参与者被随机分为 8 个月、每周 2 次、监督 HiRIT 或非监督、低强度、家庭锻炼（CON）。在基线和随访时进行腰椎侧位 DXA 扫描（Medix DR，Medilink，法国）。确定 Cobb 角，并使用半定量 Genant 方法进行椎体骨折识别。在放松站立（中立姿势）和使用测角器和 Flexicurve 站立时进行临床胸椎后凸测量。
结果：HiRIT 组与 CON 组相比，测角器测定的站立时胸椎后凸明显减小（-6.7±8.2° vs -1.6±8.1°，p=0.031）。HiRIT 和 CON 组在放松站立时的脊柱后凸均有改善，两种方法的测量值均有改善（p<0.05）。干预后 HiRIT 组的椎体骨折分类没有变化。CON 组出现了一个新的楔形畸形。
结论：监督 HiRIT 并未增加低骨量绝经后妇女发生椎体骨折的风险。事实上，在监督 HiRIT 8 个月后，观察到胸椎后凸有临床相关的改善，进一步支持其作为低至极低骨量绝经后妇女骨质疏松症干预措施的疗效。
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