What is the role of exercise in the treatment of organ transplantation-related osteoporosis?

Updated: Jul 02, 2020
  • Author: Carmel M Fratianni, MD, FACE; Chief Editor: George T Griffing, MD  more...
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Answer

Exercise that provides a mechanical load to bone represents an osteogenic stimulus. A 6-month, randomized, controlled clinical trial in heart transplant recipients showed that resistance exercise training in addition to alendronate can reverse glucocorticoid-induced osteoporosis.

In this study, 25 heart transplant recipients were randomly assigned to alendronate 10 mg daily, alendronate plus specific resistance exercises, or a nonintervention control group. Resistance training included lumbar extension exercises performed 1 day per week and 8 variable resistance exercises performed twice per week.

Pretransplantation BMD did not differ between the 3 groups. The control group had ongoing significant losses of BMD after 3 and 6 months. Once alendronate was begun, no further regional loss of BMD was noted. Combined therapy of alendronate with resistance exercise was more effective than alendronate alone in restoring BMD. This combination restored BMD of the whole body, femur neck, and lumbar vertebra to within 0.9%, 2.1%, and 3.4% of pretransplantation levels, respectively. [118]

Similar exercise-associated preservation of bone mass was demonstrated in the same population in a prospective study of nasal calcitonin with and without resistance exercise in 18 heart transplant recipients. Lumbar BMD declined to 16.9% below pretransplant levels in the calcitonin-only group, whereas the calcitonin-plus-exercise group achieved BMD results to within 5% of their pretransplant levels by 8 months after transplant. [119]

Regular weightbearing and muscle-strengthening exercises are recommended to reduce the risk of fracture (when medically possible) as first-line therapy for osteoporosis. Improving overall fitness is recommended to minimize the risk of falling. Following transplantation, weightbearing exercise should be resumed as soon as possible, and a prescribed rehabilitation program encouraged. [69]


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