The effects of acute exercise on bone turnover markers in middle-aged and older adults: A systematic review

Cassandra Smith; Alexander Tacey; Jakub Mesinovic; David Scott; Xuzhu Lin; Tara C Brennan-Speranza; Joshua R Lewis; Gustavo Duque; Itamar Levinger

doi:10.1016/j.bone.2020.115766

The effects of acute exercise on bone turnover markers in middle-aged and older adults: A systematic review

Bone. 2021 Feb:143:115766. doi: 10.1016/j.bone.2020.115766. Epub 2020 Nov 21.

Authors

Cassandra Smith¹, Alexander Tacey¹, Jakub Mesinovic², David Scott³, Xuzhu Lin⁴, Tara C Brennan-Speranza⁵, Joshua R Lewis⁶, Gustavo Duque⁷, Itamar Levinger⁸

Affiliations

¹ Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC, Australia; Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, VIC, Australia.
² School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia.
³ Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, VIC, Australia; School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia; Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia.
⁴ Diabetes & Metabolic Disease Laboratory, St. Vincent's Institute of Medical Research, Fitzroy, VIC, Australia.
⁵ Department of Physiology, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
⁶ School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia; Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Medical School, University Western Australia, Perth, WA, Australia.
⁷ Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, VIC, Australia; Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia.
⁸ Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC, Australia; Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, VIC, Australia. Electronic address: itamar.levinger@vu.edu.au.

PMID: 33227507
DOI: 10.1016/j.bone.2020.115766

Abstract

Background: Bone turnover is the cellular machinery responsible for bone integrity and strength and, in the clinical setting, it is assessed using bone turnover markers (BTMs). Acute exercise can induce mechanical stress on bone which is needed for bone remodelling, but to date, there are conflicting results in regards to the effects of varying mechanical stimuli on BTMs.

Objectives: This systematic review examines the effects of acute aerobic, resistance and impact exercises on BTMs in middle and older-aged adults and examines whether the responses are determined by the exercise mode, intensity, age and sex.

Methods: We searched PubMed, SCOPUS, Web of Science and EMBASE up to 22nd April 2020. Eligibility criteria included randomised controlled trials (RCTs) and single-arm studies that included middle-aged (50 to 65 years) and older adults (>65 years) and, a single-bout, acute-exercise (aerobic, resistance, impact) intervention with measurement of BTMs. PROSPERO registration number CRD42020145359.

Results: Thirteen studies were included; 8 in middle-aged (n = 275, 212 women/63 men, mean age = 57.9 ± 1.5 years) and 5 in older adults (n = 93, 50 women/43 men, mean age = 68.2 ± 2.2 years). Eleven studies included aerobic exercise (AE, 7 middle-aged/4 older adults), and two included resistance exercise (RE, both middle-aged). AE significantly increased C-terminal telopeptide (CTX), alkaline phosphatase (ALP) and bone-ALP in middle-aged and older adults. AE also significantly increased total osteocalcin (tOC) in middle-aged men and Procollagen I Carboxyterminal Propeptide and Cross-Linked Carboxyterminal Telopeptide of Type I Collagen in older women. RE alone decreased ALP in older adults. In middle-aged adults, RE with impact had no effect on tOC or BALP, but significantly decreased CTX. Impact (jumping) exercise alone increased Procollagen Type 1 N Propeptide and tOC in middle-aged women.

Conclusion: Acute exercise is an effective tool to modify BTMs, however, the response appears to be exercise modality-, intensity-, age- and sex-specific. There is further need for higher quality and larger RCTs in this area.

Keywords: Acute exercise; Ageing; Bone turnover markers; Intensity.

Publication types

Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Aged
Alkaline Phosphatase
Biomarkers
Bone Density
Bone Remodeling
Collagen Type I
Exercise
Female
Humans
Male
Middle Aged
Peptide Fragments*
Procollagen*

Substances

Biomarkers
Collagen Type I
Peptide Fragments
Procollagen
Alkaline Phosphatase