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The reduction in bone strength and resultant increase in low-trauma fractures associated with ageing represents a prominent and growing societal problem. Although numerous pharmacological agents have been developed to prevent and treat reductions in bone strength as a means to reduce fractures, a commonly advocated intervention is the prescription of load-bearing exercise.1 The skeleton is mechanosensitive across the lifespan and responds and adapts to its prevailing mechanical environment. This concept is supported by two independent, yet related, articles in this issue of the BJSM.2 3 These papers highlight the potential role of exercise on bone health at two differing stages of the lifespan. Kato et al2 performed a cross-sectional study to show that exercise when young may have lasting effects on bone health during ageing, whereas Martyn-St James and Carroll3 performed a systematic review and meta-analysis to demonstrate that exercise can have beneficial effects on the postmenopausal skeleton.
Exercise during growth may have lasting effects on bone health
A dichotomy exists between when the skeleton is most responsive to exercise and when it is prone to osteoporotic fracture. Reduced bone strength is predominantly an age-related phenomenon,4 whereas the ability of the skeleton to respond to mechanical loading is greatest during childhood and decreases with age.5 In fact, the skeletal benefit of a lifetime of exercise seems to occur mainly during the years of skeletal development.6 7 This disparate response of the skeleton to mechanical loading with ageing and the reduction in bone strength with age has raised the question of whether exercise-induced bone changes during growth persist into adulthood where they would be most advantageous in reducing fracture risk.
Kato et al2 address this issue in their study of postmenopausal bone health in former adolescent athletes and controls. Weight-bearing exercise when young was found to have persistent effects on bone mass …