Original ArticleInfluence of Physical Activity Level on Composite Indices of Femoral Neck Strength in a Group of Young Overweight Men
Introduction
Physical activity (PA) is known to be an important factor affecting bone mineral density (BMD) (1). PA by the mechanical stresses it exerts on the skeleton directly regulates bone remodeling which leads to increasing mineralization, periosteal diameter and cortical thickness (2). The recommendation of the World Health Organization to improve health is to do at least 150 minutes of moderate-intensity per week or 75 minutes of vigorous-intensity per week (3). However, the needed duration to optimize bone health remains unclear.
Osteoporosis is an abnormal fragility of bones which leads to an increased risk of fracture. It is a worldwide major public health (1,4). BMD measured by dual-energy X-ray absorptiometry (DXA) is considered as the reference standard to diagnose osteoporosis (5) and the best determinant of bone strength (4). Nevertheless, just 50%–70% of bone strength can be explained by BMD (6). Importantly, hip bone strength is also influenced by other factors such as femoral neck (FN) width and bending strength (7,8). Karlamangla et al (8) have examined the prediction of incident hip fracture risk by composite indices of FN strength (compression strength index [CSI], bending strength index [BSI], and impact strength index [ISI]) constructed from DXA scans of the hip. These indices integrate FN size and body size with bone density (9). CSI, BSI, and ISI reflect the ability of the FN to withstand axial compressive and bending forces and to absorb energy from an impact (9). These indices have been shown to improve hip fracture risk and bone strength assessments in the elderly (8, 9, 10). Trabecular bone score (TBS) is a bone strength index at the lumbar spine which can predict the incidence of osteoporotic fractures in the elderly (10). Implementing strategies to increase peak bone mass is an interesting method to prevent the appearance of osteopenia and osteoporosis later in life (11).
Although body weight is a positive determinant of BMD, recent studies showed that obesity and overweight are associated with decreased composite indices of FN strength (12,13). In fact, several studies have suggested that BMD is not well adapted to the increased body weight in obese and overweight subjects (12, 13, 14, 15). Importantly, obese men are not protected against hip fracture, as is seen in obese women (14,15). In fact, the Multicentre Osteoporotic Fracture in Men Study conducted in the United States included 5995 males aged 65 years or over found that a higher body mass index (BMI) was associated with increased fracture risk (14). The negative influence of obesity on bone health in men comprises several mechanisms including increased production of inflammatory cytokines, reduced free testosterone levels, and activation of peroxisome proliferator-activated receptor gamma which leads to inhibition of bone formation and stimulation of bone resorption (14, 15, 16).
Recent studies found higher composite indices of FN strength in soccer players when compared to control subjects (17,18). On the other hand, 2 recent studies have found positive associations between maximum oxygen consumption (ml/kg/min) and composite indices of FN strength in young overweight and obese adults (19,20). A study conducted on prepubertal children has found that vigorous PA is positively associated with CSI, BSI, and ISI values (21). Only one study conducted on adult women found that a greater PA level is associated with higher composite indices of FN strength (22). However, to our knowledge, there were no similar studies conducted on men. The aim of the present study was to explore the effects of PA level on composite indices of FN strength in a group of young overweight men. To do so, we compared composite indices of FN strength in active overweight men and insufficiently active overweight men.
Section snippets
Subjects and Study Design
The present study was carried out in accordance with the declaration of Helsinki (regarding human experimentation developed for the medical community by the World Medical Association). Ninety-six young overweight (BMI > 25 kg/m2) men whose ages range from 18 to 35 years participated in our study. The population was divided into 2 groups based on the level of PA: 70 active overweight men and 26 insufficiently active overweight men. Being insufficiently active was defined as “doing some physical
Clinical Characteristics and Bone Variables of the Study Population
Weight, height, BMI, lean mass, fat mass, DCI, and DPI were not significantly different between the 2 groups. L1–L4 BMD, TH BMD, FN BMD, TBS, CSA, CSMI, and Z were significantly higher in active overweight men compared to insufficiently active overweight men. Composite indices of FN strength (CSI, BSI, and ISI) were also significantly higher in active overweight men compared to insufficiently active overweight men (Table 1). Power values were sufficient to run the analyses and to test the
Discussion
This study conducted on a group of young adult overweight men mainly shows that CSI, BSI, and ISI are significantly higher in active men compared to insufficiently active men. To our knowledge, this is the first study that shows significant differences regarding composite indices of FN strength between active and insufficiently active overweight men.
Calcium, proteins, and vitamin D are essential nutritional elements for bone health throughout life to reach and maintain peak bone mass (31, 32, 33
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2021, Journal of Clinical DensitometryCitation Excerpt :Two studies found that soccer players have higher composite indices of FN strength when compared to control subjects (26,27). Zakhem et al (28) found that adult active men have higher composite indices of FN strength compared to age-matched inactive men. Two studies demonstrated that maximum oxygen consumption (ml/mn/kg) is significantly correlated to composite indices of FN strength in young overweight and obese adults (29,30).
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The authors state that they have no conflicts of interest.
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Both authors contributed equally to this manuscript.