INTRODUCTION
Age-related alterations occur in the skeletal system associated with bone loss and increased fracture risks, leading to a myriad of pathological developments such as bone diseases like osteopenia and osteoporosis.[
1] Osteoporosis can be conceived as a disorganized bone remodeling process where bone-forming cell, osteoblast, activity and bone resorption cell, osteoclast, activity were unbalanced, thereby the level of bone formation is smaller than that of bone resorption.[
2] Osteoporosis causes chronic pain and reduced quality of life when it is in more severe expressions,[
3] leading to increased healthcare-related funds and an important health issue [
4] and increased mortality.[
5,
6] Even though the presence of known unfavorable clinical and experimental findings,[
7-
9] treatment options for osteoporosis in the elderly are available, such as a well-known bone anabolic agent treatment for osteoporosis, intermittent parathyroid hormone (iPTH),[
10] and osteoclast activity inhibitor, denosumab.[
9] Despite the fact that pharmaceutical methods are beneficial, non-pharmacochemical approaches, including nutrition and exercise, have been highlighted to prevent age-associated bone loss and osteoporosis.
Maintenance of a healthy lifestyle including habitual exercise with loading is a renowned non-pharmaceutical intervention that effectively improves bone metabolism by stimulating bone adaptation to mechanical forces.[
11,
12] The mechanical force induced by weight-bearing exercise (i.e., jumping) promotes osteocyte activity and mechano-sensor cells in bone tissue, stimulating bone remodeling via osteoblast and osteoclast differentiation and activity.[
13] In addition, load-induced mechanical force generation during exercise inhibits osteoclastogenesis by stimulating osteoprotegerin expressions.[
14] Indirectly to bone tissue, exercise also enhances bone vascular function, blood flow, and bone-associated skeletal nerve fiber density, which also alter the osteoblasts and osteoclasts differentiation via nitric oxide (NO)-mediated pathway [
15,
16] and via exercise-induced differential expression of microRNA.[
17] Indeed, there have been several investigations reporting the beneficial effects of exercise on bone mineral density (BMD) and other bone properties.[
18-
20] However, to date, a fundamental understanding of how to exercise volumes within the same intensity modulates bone mineralization and bone volume (BV) as well as attenuate age-associated bone loss is lacking and is the focus of the current investigation.
To achieve this aim, we tested the hypothesis that a higher volume of long-term moderate-intensity aerobic exercise would result in greater increases in femoral BMD, bone mineral content (BMC), trabecular bone microarchitecture, and cortical bone strength parameters compared to lower volume moderate-intensity exercise and no exercise. To test this hypothesis, middle-aged mice (14-months old) were randomly assigned to 8-weeks of either (1) non-exercise (CON; N=6); (2) moderate-intensity with high-volume exercise (EX_MHV; N=7); (3) moderate-intensity with low-volume exercise (EX_MLV; N=7).
DISCUSSION
Current data indicate that long-term moderate-intensity aerobic exercise training, overall, beneficially preserves BMD and attenuates age-associated trabecular bone loss in the distal femora of middle-aged male mice. Moreover, we show that 8-weeks of moderate-intensity exercise training increased soleus and gastrocnemius muscle mass and reduced epididymal fat. These hypotheses generating data highlight the potential of moderate-intensity exercise training as a robust non-pharmaceutical therapy for the prevention of osteoporosis.
Osteoporosis is a common but destructive age-related metabolic disease caused by low BMD and decreasing BV.[
1] Dysfunction or dysregulation of bone remodeling leads to the reduction in bone microstructure, which further causes an increased risk of fracture.[
1] Incidence of bone fracture increases approximately 3.5 fold in the elderly over 60 years of age compared to a young population aged 15 to 24 years,[
1,
22] likely caused by a ~30% and ~41% reduction in BMD and BMC, respectively.[
23,
24] Moreover, preclinical evidence suggests that aging is associated with a 57% reduction in osteoblast activity and a 40% reduction in bone mineralization, thereby leading to lower bone cell turnover, resulting in ~53% lower BV in the distal femoral trabecular bone microarchitecture.[
25] Although the pharmacological treatment options could lead to some side effects,[
7,
8,
26] the development and use of a number of pharmacological therapies have led to the main treatment options to treat multifactorial processes of osteoporosis progression. For example, iPTH administration is a common therapy for treating osteoporosis.[
10] Moreover, antiresorptive medication denosumab is a novel treatment drug for osteoporosis that hinders receptor activator of nuclear factor-κB ligand (RANKL), which reduces the binding of RANKL to osteoclast receptor, RANK, so that osteoclast-mediated bone resorption is lowered.[
9] Nonetheless, alternative non-pharmacological therapeutic options, such as exercise and diet, are warranted. Specifically, exercise training has emerged as a prominent non-pharmacochemical option that effectively improves bone remodeling and regeneration by stimulating bone remodeling cellular responses to mechanical forces.[
12] Despite this need, evidence around the optimal exercise regimen for the prevention of osteoporosis remains equivocal.
Various durations and intensities of aerobic exercise training (i.e., treadmill running, swimming, etc.) for 8 to 14 weeks have been shown to have differential outcomes in bone quality, bone mass, and BV in rodents.[
18,
19,
27-
29] One group found that total femoral BMD of young male Wistar rats was improved by ~8% following 10 weeks of high-intensity treadmill running,[
18] while others found no differences in total BMD and BMC following 8 weeks and 6 months of moderate-intensity exercise.[
28,
29] Moreover, 8 weeks of swimming training (90 min/d, 5 day/week) in young female Sprague Dawley rats showed a 15% and 29% enlargement of tibial diaphysis cross-sectional area and moment of inertia, respectively, whereas total and cortical volumetric BMD did not change after the exercise.[
27] Similarly, inconsistencies exist as to whether aerobic exercise enhances trabecular bone microarchitecture and mid-diaphysis cortical parameters in the hindlimb long bones. For instance, there is some evidence to suggest that 8 weeks of moderate-intensity aerobic exercise results in no changes in trabecular bone microarchitecture and cortical bone geometry [
28]; while there is also some evidence of ~33% improvements in distal femoral trabecular bone following 10 weeks of high-intensity aerobic exercise training in rats.[
18] The discrepancies in the previous findings may represent distinct physiological responses among the different bone regions of interest and aerobic exercise training modes.
The protective role of long-term exercise against chronic diseases such as osteoporosis, diabetes, and cardiovascular diseases, as well as beneficial outcomes of long-term exercise on disease conditions have been documented, thereby showing improvement in health status.[
30] The current study agrees with this notion supporting the importance of long-term moderate-intensity aerobic exercise in preventing osteoporosis progression in middle-aged mice. In the present study, hindlimb BMD was significantly preserved with the high volume of moderate-intensity exercise, and age-related distal femoral trabecular bone loss was attenuated by various volumes of moderate-intensity aerobic exercise-trained mice. The mechanism by which moderate-intensity aerobic exercise can stimulate an increase in bone metabolism and bone remodeling may be related to prolonged periods of mechanical force, even during the moderate-intensity treadmill exercise, which facilitates dynamic changes of bone interstitial fluid flow.[
31] Indeed, changes in the flow of interstitial fluid by mechanical loading further promote osteoblasts and osteoclasts activation and stimulates osteoprotegerin.[
12-
14] In addition, alterations in bone interstitial fluid flow and pressure initiate shear stress within bone, which stimulates the release of osteoblast differentiation factors, such as NO and prostaglandin E
2 (PGE
2).[
32] For example, NO and PGE
2 secretion from the osteoblasts were considerably increased with fluid shear stress over 12 dynes/cm
2 compared to no fluid shear stress.[
33] Upregulation of NO resulted in the 3-fold increased osteoblasts differentiation in the L-arginine-dependent pathway,[
34] whereas increased NO inhibits osteoclasts-mediated bone resorption by 56%.[
35] Also, PGE
2 significantly augmented osteoblast markers, alkaline phosphatase (ALP), and osteocalcin (OCN). While direct measurement of PGE
2 and NO were beyond the scope of the current investigation, these 2 mechanisms likely stimulated the changes in BMD seen following moderate-intensity exercise training. Thus, the profound changes in BMD and distal femoral trabecular bone following different volumes of moderate-intensity aerobic exercise training for 8 weeks, may be attributable to the increased mechanical force-induced osteoblast recruitment and reactivity.
In the current investigation, we hypothesized that moderate-intensity aerobic exercise for 8 weeks would improve cortical bone parameters in the mid-diaphysis of long bones, allowing for augmenting the strength of long bones as a training effect. However, contrary to our hypothesis, cortical bone parameters, including cortical volume, area, cross-sectional thickness, and pMOI following moderate-intensity aerobic exercise, did not differ from the non-exercise group. Discrepancies may relate to the intensity and volume of aerobic exercise. Cortical bone strength gain may be more susceptible to weight-bearing exercises such as jumping and landing instead of treadmill aerobic exercise.[
20] For example, the cross-sectional area and pMOI in cortical bone of femora were higher by 15% in 8 weeks of step jumping exercise in rats compared to treadmill exercise.[
20] Thus, given its similarity among groups, moderate-intensity aerobic exercise is less suitable for improving the cortical bone strength than a jumping and landing exercise regimen.
The current study has some limitations worthy of discussion. Firstly, the omission of a young control group limits our ability to strictly describe whether moderate-intensity exercise attenuated age-associated bone loss in the distal femoral trabecular bone. However, in comparing non-exercise mice with mice that performed exercise, the same species, strain, and age offset the confounding variables, which support the notion that moderate-intensity exercise improved femoral BMD and trabecular bone microarchitecture. Second, due to the limitations of the methodology applied herein, we were not able to assess the mechanical force-derived bone cellular activity and recruitment, including osteoblast and osteoclast activity and recruitment. Future work should include bone histomorphometry analysis with Goldner’s trichrome and immunohistochemical analysis of ALP or OCN to confirm the osteoblast activity and recruitment following moderate-intensity exercise.
In conclusion, the current results demonstrate that femoral BMD is beneficially preserved following 8 weeks of high volume moderate-intensity but not the low volume of moderate-intensity aerobic exercise training. Age-related trabecular bone loss was mitigated by various volumes of moderate-intensity exercise, which is presumably stimulated by increased mechanical force-derived osteoblast activity and recruitment in the distal femur. This investigation highlights the clinical impact of long-term moderate-intensity treadmill exercise as a non-pharmacological therapy for preventing bone loss and osteoporosis progression in the elderly.