Bad to the Bone

Josh Rajan
Beth Dungey
Beverly Stup
Intern Mentor
5/5/17
BAD TO THE BONE 1

Abstract

Musculoskeletal diseases, such as Osteoporosis and Rheumatoid Arthritis, have caused a

variety of suffering for its victims in the forms of physical and financial hardships. Such

problems will only continue to grow as more elderly individuals will be expected to live and be

plagued by such diseases in future generations. This research project will investigate how

exercise is able to prevent such an onslaught of these diseases from occurring by promoting bone

growth in these individuals. Research that was collected for the project was conducted through

meta analyses of various medical case studies that examined how exercise affected the bone

mass in these various demographics groups. The results of the research showed that exercise

which is land based, involved stress on bones, and occurred in childhood adolescence promoted

the best growths in bone mass, which later would prevent musculoskeletal diseases. In order to

present the information from the project, a book was created that advocated to adolescent

children the importance of exercise throughout their lives to prevent musculoskeletal diseases

and their harmful effects. Adolescent and younger kids are the main demographic targeted by the

project because the research shows how they are at the primary age to gain the most bone mass

through exercise. Thus, such research and results can help future generations of the world

promote a healthier, and financially stable society that can avoid musculoskeletal diseases in

their elderly years.

BAD TO THE BONE 2

Introduction

Musculoskeletal diseases have caused around $461.5 billion losses in revenue for

individuals as a whole each year (Middlesworth, 2011). These musculoskeletal diseases are any

injury of a joint or bone in the body that reduces movement and causes pain and weakness in the

region. Though not life threatening, musculoskeletal diseases have caused individuals to endure

lives of dependence on others as they lose function of their crucial body parts. Various

predictions have stated that musculoskeletal diseases are not only a current problem, but will

grow in prevalence and become an overwhelming problem for societies and economies to deal

with in the elderly populations in the future. In order to prevent such an increase in cases of

musculoskeletal diseases, medical professionals have recommended a continuous practice of

exercise throughout an individual's lifetime, which promotes bone mass and prevent such

diseases from occurring within elderly populations. Thus, exercise can have a positive impact on

a person's bone density, improving their bone health throughout their lives and mitigating the

physical and economic defects of the disease.

Literature Review

There are numerous physical ramifications for those who suffer from musculoskeletal

diseases. Bones grow weaker as a person ages due to hormone reduction and less nutrient

absorption. Research conducted by Dr. Demonitero and his colleagues regarding the loss of bone

mass in elderly individuals shows that sex steroids aid in bone development by producing

hormones which simulate bone mineral growth. However, these steroids are inefficient in a

persons elderly years, causing less bone mineral to develop (Demonitero, Vidal, & Duque,

2012). Throughout a persons life, his or her bones are grown and strengthened by a balance of
BAD TO THE BONE 3

the processes of bone formation and bone resorption from the sex hormones. These bones can be

severely affected by loss of such crucial nutrients, leading to structural damage and fragileness.

Dr. Demonierto and his colleagues also concluded their research stating that as an individual

ages, his or her bones progressively become more involved in bone formation and less with bone

resorption (Demonitero, Vidal, & Duque, 2012). With less bone mineral and nutrients being

produced and absorbed, an individual will lack the proper materials necessary for his or her body

to build structurally dense bones, a lack which can impede proper bone formation from

occurring. A study done by Dr. Sarah Allison and her fellow colleagues to research how exercise

can affect the pelvic bones of the hip in adults showed that deterioration of the cortical and

trabecular bone layers occurs more frequently than bone formation in the elderly (Allison et al,

2015). Bones in older individuals break down faster than the rate which they form, causing them

to become fragile and susceptible to bone fractures.

The prevention of proper bone growth and deterioration of bone tissues due to

musculoskeletal diseases can affect multitudes of elderly people as the frequency as such

symptoms will increase due to the increased life expectancy of citizens. Surgeon General

Richard Carmona (2004) reported on the effects of bone diseases around the globe, compiling

various research and data about the elderly populations across the world. Studies in Sweden

reported that individuals with longer lifespans have a greater chance to fracture bones such as the

hip, as it is increased to 23% in women and 11% in men (Carmona, 2004). Research compiled by

Dr. Goo Hyun Baek (2010) from the Seoul National University College of Medicine in South

Korea examined the trends in elderly population in the future. Elderly people are reported to

become 22.7% of the male population and 27.7% of the women population in 2050. This is an

increase from being 11% of the male population and 15.1% of the female population in 2000
BAD TO THE BONE 4

(Baek, 2010). This shows a significant growth in the elderly population for the future. As this

elderly population is predicted to increase in the future, the prevalence of musculoskeletal

diseases will also increase due to increasingly weaker bones in elderly individuals. As

musculoskeletal diseases are predicted to grow in prevalence, more individuals will see a drop in

their respective quality in life because of such diseases.

Also, musculoskeletal diseases have made individuals more physically dependent on

others, decreasing their respective qualities of life. A report done by the Surgeon General Richard

Carmona (2004) examined how bone diseases affect individuals across the world. The report

stated that musculoskeletal diseases have a great chance to disable individuals and remove their

simple motor functions. At most 21% of patients were not able to conduct their independent,

regular lifestyle practices such as dressing themselves or walking (Carmona, 2010). This

percentage shows the great risk that musculoskeletal diseases can have on an individuals health

by making him/her handicapped. These disabilities can be detrimental to a persons confidence,

as they cannot function without another person to help them. Also, Dr. Goo Hyun Baek (2010)

from the Seoul National University College of Medicine in South Korea examined the trends of

the elderly population in the future. He stated in his report that, The primary aim of orthopedic

treatment for these elderly patients must be the return of function, yet in certain patients who

have severe comorbidities, the aim of treatment can be a return to independent life...This

independency should be provided to maintain the dignity of human beings... When patients can

not achieve independency, they may lose their will to continue life (Baek, 2010, para. 4 ).

Musculoskeletal diseases interfere with an individuals ability to enjoy a healthy, pain free life as

well as allow themselves to move and live independently without need for others. If not relieved,

such problems pose a grave threat to individuals confidence and happiness in their respective
BAD TO THE BONE 5

lives, which shows one of the main reasons why such diseases must be avoided at all costs.

Musculoskeletal diseases also pose a grave threat to the finances of individuals and economies.

Apart from the physical effects, there are numerous fiscal ramifications from

musculoskeletal diseases. Musculoskeletal diseases can become a financial burden on countries

and individuals due to costs in treatment and care. An infographic created by Matt Middlesworth

(2011) from the Ergonomics Plus company, who specializes in economics and the effects that

diseases have on economies around the globe, examined the financial effects of musculoskeletal

diseases. According to the infographic, the Direct costs of MSDs are $20 billion a year. Indirect

costs of an MSD case can be up to five times the direct costs (Middlesworth, 2011). These

costs are not only charged to the patient affected by musculoskeletal diseases but also affect

hospitals who provide treatment and the patients job or company though worker compensation

costs. Both the immediate costs of musculoskeletal diseases like surgery costs and the long

lasting expenditures such as equipment costs and medicine have made musculoskeletal diseases a

hefty expense for an individual, hospital, and company to deal with, leaving debt and financial

problems afterwards. The effect of such costs have affected economies and is shown in a study

done by Dr. Peter Coyte and his colleagues. This study examined hospital records and finances

throughout Canada during that year to identify the hospital treatment costs that Canada had spent

on musculoskeletal diseases in 1994. Musculoskeletal diseases have cost Canada a total of $25.6

billion, as this is 3.4% of the countrys GDP, in 1994 (Coyte, Asche, Croxford, & Chan, 1998).

Similar to Canadas situation, multiple countries have been seen to use up their resources and

budget to pay for healthcare and medical research to alleviate the problem of musculoskeletal

diseases, which harm them financially in the long run. These diseases will continue to plague

individuals and countries financially, as such effects will increase in the future. The Bone and
BAD TO THE BONE 6

Joint Initiative USA, an organization researching the various economic problems various

musculoskeletal diseases have caused, reported musculoskeletal diseases have risen 100% in

prices for an individual, as it was $4,832 in 1998 and increased to $7,768 in 2011 (The Burden,

2013) . This increase in price over the 13 year interval has shown the ability for musculoskeletal

diseases to financially burden individuals, institutions, and economies across the globe. The

extent of economic damage by musculoskeletal diseases is expanded when taking in the damage

the diseases do to jobs and workplaces.

Not only do such diseases demand high expenses but also can prevent individuals from

working, furthering harm to economies by affecting workplaces and jobs. The Bone and Joint

Initiative USA, in a report dealing findings from the 2012 National Health Interview Survey in

the U.S., reported that 70% of respondents stated that their absence from their profession was

caused by a musculoskeletal related illness (The Burden, 2013). This report shows that

musculoskeletal diseases are one of the main reasons why individuals miss their jobs. Similarly,

a report by the Ergonomics Plus company proves a similar trend about musculoskeletal diseases

and professions. The company stated in an infographic that examined the effects that

musculoskeletal diseases can pose on an individuals workplace performance by stating how

such diseases have been the reason for one third of all job absences each year for the past decade

(Middlesworth, 2011). Both statistics show the sizable contribution that musculoskeletal diseases

provide in causing individuals to miss out on their jobs. These absences accumulate in missed

productivity and workers compensation costs, thus providing an economic toll on such

companies. Musculoskeletal diseases, through having high costs and preventing workplace

productivity, prevent financial success and stability for multiple groups and individuals in

society, supporting the fact that such diseases need to be prevented in the future generations.
BAD TO THE BONE 7

Mitigating the health and fiscal issues can be done through increasing exercise

throughout the course of an individuals lifetime. Weight bearing exercises are particularly

effective at increasing bone mass. The Irish Osteoporosis Society, an organization that works to

research the effects of osteoporosis and other musculoskeletal diseases in various individuals,

reported on the effect that sports and exercise have on preventing musculoskeletal diseases.

The report stated that bone formation is simulated by workouts that promote stress on certain

bone sites. Weight- bearing workouts promote that greatest amount of stress on such sites,

more than workouts that promote zero weight, such as swimming (Brien, 2010). Bone mass

will increase through continual stress and endurance on bones from weight bearing exercise,

which will prevent musculoskeletal diseases by promoting healthy bones. Also, according to

Dr. Guadalupe- Grau and her fellow colleagues, a study that was performed to research the

bone densities of different demographics groups resulted in support to the fact that exercises

that combine weight bearing with fast paced, intense workouts are the most efficient in bone

mass growth (Guadalupe-Grau, Fuentes, Guerra, & Calbet, 2009, para.1). Besides weight

bearing stress, intensity, or how how difficult the workouts are for an individual, is another

important factor that promotes bone mass growth in the dones of individuals. Exercise

throughout adolescence also promotes increased bone growth for an individual, thus being able

to prevent musculoskeletal diseases.

Apart from weight bearing exercise, exercising during puberty can have a positive, long

term effect in a persons lifetime. A journal article reported a study that investigated the

differences in bone density between 45 active, prepubescent gymnasts, 36 retired gymnasts,

and 50 common people. The results of the study show that gymnasts who did gymnastics

before their adolescent years had 7% higher bone mineral density than non gymnasts during
BAD TO THE BONE 8

their middle aged years (Bass et al., 1998). Individuals who participated in activities that

promoted weight bearing exercise, such as gymnastics, often saw increase in bone mass

exceeding higher than other individuals in their adulthood. The same study also investigated

the bone differences in tennis players. Results showed that the prepubescent tennis players had

recorded a 24% higher bone mineral density in their playing arm compared to the non playing

arm. As the study analyzed the bones of the players, it was recorded that the cortical bone layer

of the tennis players humerus was 35% higher than the nonplaying humerus (Bass et al.,

1998). Such statistics demonstrates how prepubescent exercise can promote greater bone mass

not only between different individuals but also between the different bones in the body, thus

emphasizing the importance of the activity. Preventing bone degradation and promoting bone

mass shows the importance of exercise throughout puberty in an individuals life. With an

increase in bone mass, individuals will be less likely to see the detrimental effects of

musculoskeletal diseases on their bones and health. This can prevent the harmful physical and

financial effects of musculoskeletal diseases by avoiding the diseases all together.

Exercise is the greatest method to prevent the onslaught of physical and economic defects

due to musculoskeletal diseases through improving bone health by increasing bone density.

Physical ramifications for those who suffer from musculoskeletal diseases result in negative

consequences for their health and well-being . Apart from the physical effects, there are multiple

fiscal consequences ensued by musculoskeletal diseases. Mitigating the health and fiscal issues

can be done through increasing exercise throughout the course of an individuals lifetime by use

of weight bearing exercise and practice of exercise during the adolescence of an individuals life.

Musculoskeletal diseases are currently an ever growing problem that can be destructive to the

lives of individuals and the strength of economies across the globe. Individuals, whether an
BAD TO THE BONE 9

adult, an elderly citizen, and especially an adolescent child, must start exercising in order to

prevent an influx of such harmful problems of musculoskeletal diseases from plaguing the future

generations.

Data Collection and Methods

The question of how exercise can prevent detrimental effects of musculoskeletal diseases

is answered through the meta analysis of multiple medical journal case studies. These case

studies involve individuals of certain age demographics exercising and training over a certain

amount of months, during which time their bone mass densities were recorded as training was

monitored. The first journal article, The influence of high-impact exercise on cortical and

trabecular bone mineral content and 3D distribution across the proximal femur in older men: A

randomized controlled unilateral intervention, was a study conducted by Dr. Sarah Allison and

her team of researchers that examined the relationship between intense exercise and bone growth

in the femoral bone area in men, ages 60-85, for 12 months as they regularly participated in high-

intensive exercise and measured the bone mass density of their femoral areas through CT

imaging. The study concluded that after the 12 months of exercise, individuals who exercised

saw increases of up to 5-6% in the bone mass content of multiple femoral areas as compared to

the control group.

The next journal article, Effect of deconditioning on cortical and cancellous bone

growth in the exercise trained young rats, was about a study conducted by Dr. Iwamoto Jun and

other researchers that investigated the effects of not exercising on bone mass of a population of

rats. The study was done on the rats, though age was not reported; after considerably exercising

on a treadmill for either 8 or 12 weeks, they were then subjected to not exercising for the same
BAD TO THE BONE 10

amount of weeks. The study concluded that the rats built a considerable amount of bone mass

from exercising, but when not exercising, these bone mass gains were reversed.

The next article,The effect of land versus aquatic exercise program on bone mineral

density and physical function in postmenopausal women with osteoporosis: A randomized

controlled trial, followed a study led by Dr. Ardiana Murtezani and other researchers that

measured the effectiveness between land and aquatic exercise for Osteoporosis patients to

increase bone mass. The study followed the two different groups of postmenopausal women for

10 months, as bone mass density of the lumbar spine and physical endurance were measured.

The study concluded that the land exercise group progressively increased the bone mass of the

women and were beneficial to the individuals compared to the aquatic groups.

The last journal article used, Effectiveness of manual physical therapy and exercise in

osteoarthritis of the knee: A randomized, controlled trial, examined a study by Dr. Gail Deyle

and other researchers that tested if physical therapy can work better than other medication in

improving the motion of the hip, ankle, and spine in elderly patients. The study followed 83

elderly patients, who all had knee osteoarthritis, as one group went to practice physical therapy

and the other went to practice an ultrasound therapy. The study concluded that those who

practiced physical therapy felt less pain and stiffness in the knee, thus bettering the symptoms of

the osteoarthritis.

Data Analysis

The results of the meta analyses of the studies reveals a positive correlation between

exercise and an improvement in bone health of the individuals in the various demographics

groups.
BAD TO THE BONE 11

Both the Osteoporotic women in the third study, and the patients with osteoarthritis in the

fourth study, demonstrated that exercise was able to lessen the pain associated with their

respective musculoskeletal diseases. In the third study, both the land exercise group and aquatic

exercise group showed less reported pain after engaging in their respective exercise programs.

This is evident as the land exercise groups reported an 81% decrease in their pain levels on the

visual analogue scale (VAS), as the aquatic groups reported a 32% decrease in the pain levels.

The Osteoarthritis patients also reported such relief in their symptoms of their diseases, as the

reported Western Ontario and McMaster Osteoarthritis index (WOMAC), based off of VAS, was

55.8% lower in the exercise groups. Such data results shows how exercise was able to reduce

pain in musculoskeletal disease patients.

All four demographic groups in each of the studies demonstrated that exercise was able to

lower fracture risks from their respective musculoskeletal diseases. All four groups had measured

higher bone mass content and masses after their respective exercise programs. This is seen in

such studies such as in study 1,as the bone mineral content (BMC) of the exercise leg of the

individual participants increased by 12.6% of the cortical layer in the trochanter bone. Such

statistics that prove a growth in BMC demonstrate that there was a growth in the bones that were

stressed in response to the exercise programs. Thus, these studies illustrate that this bone growth

would aid in preventing fractures.

Both the elderly men group in study 1 and the osteoporotic women group in study 3

demonstrated the most effective type of exercise to promote bone growth. In Study 1, the gains

in BMC were only achieved after subjects were involved in highly intensive exercises that

focused stress on certain bones, such as the femoral neck, trochanter, and introchanter bones. In

study 3, subjects in the land exercise group had a 5% increase in their bone mineral densities
BAD TO THE BONE 12

(BMD), which is a greater growth compared to the aquatic exercise groups who has an average

of 1.6% increase in BMD. These statistics show that such gains in bone growth can be traced

back to exercise that is land based, intensive, and promotes stress on certain bones. Thus, these

types of exercises are most effective in promoting bone growth

The demographic groups in studies 1, 2 , and 3 all were able to demonstrate

measurements of bone growth in response to exercise. The rats in study 2 showed a increase in

the BMD of the tibias in the rats, however these gains were reversed, as the BMD percents

decreased. These statistics, as well as the increase in BMD seen in study 1 and study 3, support

the fact that in response to exercise, bone will grow in BMD and BMC, thus demonstrating

sufficient growth.

Thus, the meta analyses of the case studies can prove the trend that musculoskeletal

diseases and the financial and physical effects associated with such diseases can be averted by

exercise. Such studies prove that exercise can boost bone mass densities in the bones of any

demographic, thus preventing the occurrence of musculoskeletal diseases in such individuals.

Table 1
Study 1 Study 2 Study 3 Study 4

Decrease in Land exercises Exercises can

Pain Levels provided provide relief in
improvements in pain from
muscular Osteoarthritis in
strength, the knee, while
flexibility, and restoring
less pain for function
individuals with
Osteoporosis.

Reduced High bone Exercises that Bones with Bones that have
BAD TO THE BONE 13

fracture risk mineral densities improve bone higher bone been involved in
are essential in mass are mineral content continual
strengthening constant in are shown to practice of
bones and preventing have a reduced exercise have
preventing fracture in the fracture risk. less of a risk of
fractures individuals fracture.

Effective type of High impact Resistance

exercise exercises exercises on dry
centralized on surfaces are
certain body more effective in
regions are best building bone
for improving mass than those
bone mass in an aquatic
based setting.

Improved Bone Exercises Continual Land exercise

Mass improves the practice of was shown to
bone mineral exercise has improve bone
content across caused mineral density
regions in the improvements in of individuals.
femur bone of bone mass of
the hip the specialized
groups, as those
who were
sedentary did
not see such
improvements.

Discussion/Conclusion

As shown by the data results, exercise can promote healthy bone growth by use of

weight bearing, land based activities, especially during the adolescence of an individuals life.

The data collections shows bone growth and reduction of musculoskeletal diseases and their

effects in the individual groups of the respective studies due to exercise. Thus, these results

correlate with the literature review as it proves how exercise is the greatest method to prevent

the outgrowth of musculoskeletal diseases in the future generations. Exercise must be heavily

advocated to the current generation of adolescent and young children in order to assure the

world a healthier and financially stable society for tomorrow.

BAD TO THE BONE 14

References

Allison, S., Poole, K., Treece, G., Gee, A., Tonkin, C., Rennie, W., . . . Brooke-Wavell, K.

(2015). The influence of high-impact exercise on cortical and trabecular bone mineral

content and 3D distribution across the proximal femur in older men: A randomized

controlled unilateral intervention. Journal of Bone and Mineral Research, 30(9), 1709-

1716. http://dx.doi.org/10.1002/jbmr.2499

Baek, G. H. (2010). Are we prepared for geriatric orthopedics? Clinics in Orthopedic

Surgery, 2(3). http://dx.doi.org/10.4055/cios.2010.2.3.129

BAD TO THE BONE 15

Bass, S., Pearce, G., Bradney, M., Henricks, E., Delmas, P. D., Harding, A., & Seemar, E.

(1998). Exercise before puberty may confer residual benefits in bone density in

adulthood: Studies in active prepubertal and retired female gymnasts. Journal of Bone

and Mineral Research, 13(3). http://dx.doi.org/10.1359/jbmr.1998.13.3.500

Brien, M. O. (2010, March 24). Osteoporosis in athletes. Retrieved from Irish

Osteoporosis Society website:

http://www.irishosteoporosis.ie/index.php/expert_views/osteoporosis_in_athletes/

The burden of musculoskeletal diseases in the united states. (2013). Retrieved from The

Bone and Joint Initiative website: http://www.boneandjointburden.org/facts-brief

Carmona, R. H. (2004). Bone health and osteoporosis: A report of the surgeon general.

Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK45502/

Coyte, P. C., Asche, C. V., Croxford, R., & Chan, B. (1998). The economic cost of

musculoskeletal disorders. Arthritis & Rheumatology, 11(5), 315-325.

http://dx.doi.org/10.1002/art.1790110503

Demonitero, O., Vidal, C., & Duque, G. (2012). Aging and bone loss: New insights for

the clinician. Therapeutic Advances in Musculoskeletal Disease, 4(2), 61-76.

http://dx.doi.org/10.1177/1759720X11430858

Guadalupe-Grau, A., Fuentes, T., Guerra, B., & Calbet, J. (2009). Exercise and bone mass

in adults. Sports Medicine, 39(6), 439-468. http://dx.doi.org/10.2165/00007256-

200939060-00002

Middlesworth, M. (2011, July 23). The cost of musculoskeletal disorders (MSDs)

[Infographic]. Retrieved from http://ergo-plus.com/cost-of-musculoskeletal-disorders-

infographic/
BAD TO THE BONE 16