Effects of exercise training on bone health in elderly people with type 2 diabetes without osteoporosis: A randomised clinical trial

Aims: To assess the effects of exercise on non-invasive measures of bone health in elderly individuals with type 2 diabetes without osteoporosis. Methods: In this randomized clinical trial, 200 elderly individuals with type 2 diabetes without osteoporosis were randomized 1:1 to a two-year, specifically-designed exercise training program (Exercise group) or standard care (Control group). Coprimary outcomes were trabecular bone score (TBS), a surrogate measure of bone quality, and bone mineral density (BMD) at three sites. Secondary outcomes were other bone measures and muscle and physical function parameters. Results: The coprimary endpoints increased in the Exercise group and decreased in the Control group. Significant between-group differences were observed for TBS (mean, 0.016 [95% confidence interval, 0.011–0.021], p < 0.0001, which disappeared after adjusting for abdominal fat indices), and lumbar spine (0.014 [0.005–0.024], p = 0.004), femoral neck (0.017 [0.006–0.028], p = 0.003), and total hip (0.020 [0.010–0.030], p=<0.0001) BMD. Significant between-group differences were observed also for other bone measures, body composition, muscle strength and quality, physical performance, and cardiorespiratory fitness. There were no between-group differences in adverse events. Conclusions: A two-year exercise training improved several non-invasive measures of bone health, together with muscle and physical function parameters, potentially reducing fracture risk in people with type 2 diabetes.