Tai Chi for Osteopenic Women: A Pilot Randomized Controlled Trial

描述（由申请人提供）：骨质减少是妇女面临的一个严重且日益严重的公共卫生问题。未经治疗的骨质减少症女性患骨质疏松症的风险很高，而且与骨密度正常的女性相比，骨折的风险也更大。低骨密度相关骨折与显著的长期损伤、高发病率和高医疗费用相关。与骨质疏松症的治疗指南相反，骨质减少妇女的最佳预防和可持续干预措施尚未明确定义。目前治疗骨质减少妇女的指南一般包括定期运动的建议。太极拳是一种身心运动，在美国越来越受欢迎，对于骨密度低的女性来说，它显示出强大的潜力，可以作为一种有效、可持续、安全和实用的干预手段。初步研究表明，太极拳可以降低绝经后妇女骨密度下降的速度。虽然具有启发性，但这些研究规模小，设计上有很多局限性，研究对象主要是亚洲女性，她们的骨密度较低，骨骼几何形状和骨折风险与其他种族不同。太极拳也被证明能有效地改善平衡，减少跌倒，增加肌肉骨骼的力量和灵活性。此外，太极拳已被证明对老年人和条件不佳的人群是安全的。我们建议进行一项随机对照试验，以评估太极拳作为绝经后骨质减少妇女标准治疗的有效性和可行性。48名年龄在45-65岁之间的骨质减少症（t评分为-1.0到-2.5）女性将从一个大型的多专业团体实践中招募。我们的主要目的是评估招募和保留骨质减少的女性进入9个月的太极拳随机对照试验的可行性。我们的第二个目的是收集太极在减少骨质减少妇女骨质流失率方面的初步数据，使用骨转换敏感标志物和双能x线吸收仪。对于一部分参与者（n=16），还将评估太极的生物力学反应（例如骨骼特异性机械负荷和姿势稳定性）。这项研究的结果将为未来试验的设计提供信息，以评估太极对骨质减少妇女的益处和安全性，以及太极可能影响骨质疏松和骨折风险的生物力学和生理机制。

DESCRIPTION (provided by applicant): Osteopenia is a serious and growing public health concern for women. Untreated osteopenic women are at high risk of becoming osteoporotic, and also are at greater risk for fractures than women with normal bone mineral densities (BMD). Low BMD-related fractures are associated with significant long-term impairment, high morbidity rates and high medical costs. In contrast to the treatment guidelines for osteoporosis, optimal preventive and sustainable interventions for osteopenic women are not yet well-defined. Current guidelines for the treatment of osteopenic women generally include the recommendation of regular exercise. Tai Chi, a mind-body exercise that is growing in popularity in the U.S., shows strong potential as an effective, sustainable, safe and practical intervention for women with low bone density. Preliminary studies suggest Tai Chi can reduce rates of BMD decline in post-menopausal women. While suggestive, these studies are small, have numerous design limitations, and include primarily Asian women who are known to have lower BMD and different bone geometry and fracture risk than other ethnic groups. Tai Chi has also been shown to be effective in improving balance, reducing falls and increasing musculoskeletal strength and flexibility. Moreover, Tai Chi has been shown to be safe in aging and de-conditioned populations. We propose a pilot randomized controlled trial to assess the efficacy and feasibility of Tai Chi as an adjunct to standard care for post-menopausal osteopenic women. Forty-eight osteopenic (T-scores -1.0 to -2.5) women ages 45-65 will be recruited from a large multispecialty group practice. Our primary aim is to assess the feasibility of recruiting and retaining osteopenic women into a randomized controlled trial of 9 months of Tai Chi. Our secondary aim is to collect preliminary data on the efficacy of Tai Chi in reducing rates of bone loss in osteopenic women using sensitive markers of bone turnover and dual-energy x-ray absorptiometry. For a subset of participants (n=16), biomechanical responses to Tai Chi (e.g. bone-specific mechanical loading and postural stability) will also be assessed. The results of this study will inform the design of a future trial evaluating the benefits and safety of Tai Chi for osteopenic women, as well as the biomechanical and physiological mechanisms through which Tai Chi may impact BMD and fracture risks associated with osteopenia.