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Warm up
A blueprint for bone health across the lifespan: engaging novel team members to influence fracture rates
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  1. S K Boyd1,
  2. R E Rhodes2,
  3. J Wharf Higgins2,
  4. H A McKay3,
  5. K M Khan3
  1. 1Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada
  2. 2School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada
  3. 3Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to K M Khan, Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; karim.khan{at}ubc.ca

https://doi.org/10.1136/bjsports-2011-090054

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    Physical activity is a key, and increasingly recognised lifestyle determinant of bone health. For the mildly sceptical reader, we remind you that 26% of adult bone mass is laid down in two growing years around puberty,1 resistance training mitigates a proportion of postmenopausal bone loss and Cochrane systematic reviews conclude that strength and balance training reduce falls by 35% (and thus, fall-related fractures) in older people. A 2008 BMJ cover article emphasised that preventing falls was key in the battle against fractures. The term, ‘fall-related’ is a more accurate primary label than ‘osteoporotic’ for appendicular fractures among older people. And 80% of fractures occur in those who do not have osteoporosis.2

    Positive next steps – crossing discipline barriers

    Nihilism has no place when physical activity is a proven therapeutic agent. But there is also no point in adding to the long list of cross-sectional or athlete studies showing that exercise is associated with greater bone mass as measured by dual-energy x-ray absorptiometry (DXA). There are many great options and we admire the body of brilliant work in bone science and activity going on all over the globe. Here, we respectfully outline a few possible next steps in the spirit of sharing, capacity building and teamwork. Think Wikinomics rather than Moses' tablets.

    Both RCTs and cohort studies provide tremendous value for society

    There has been a rightful emphasis on randomised controlled trials (RCTs) (and systematic reviews) with the wisdom of evidence-based practice. It behooves us to recall that well-executed cohort studies complement RCTs. The Study of Osteoporotic Fractures and EPIDOS are just two of many wonderful bone cohort studies that point to mechanisms, address the inter-related determinants that are a factor of real life and provide a great opportunity for …

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