Background/Purpose: Physical exercise helps maintain bone mineral density (BMD), prevent falls, and reduce fracture risk. Strength and weight-bearing exercises are particularly effective. However, individuals with inflammatory rheumatic diseases often face disease-related functional impairments that limit their ability to engage in such activities. The interactions between rheumatic diseases, exercise, and bone health remain underexplored.This study aimed to assess the impact of different types of physical activity on BMD in patients with inflammatory rheumatic diseases.

Methods: We analyzed data from the Rh-GIOP cohort, a prospective observational study of patients with immune-mediated inflammatory diseases. Participants underwent dual-energy X-ray absorptiometry (DXA) and systematic bone health assessments. Self-reported physical activity was categorized as any exercise, weight-bearing, high-impact, and low-impact. Frequency-based classifications (strength, aerobic, balance training ≥65 years) followed WHO criteria. Multivariable linear regression models assessed clinical, serological, and treatment-related predictors of lumbar spine and femoral T-score, trabecular bone score (TBS), and 3D-DXA-based femoral structure (3D-Shaper v2.12). Physical activity types were then added to these models. Missing data were handled via multiple imputation (10 replications).

Results: We included 1,870 patients (mean age 63 ± 13; 75% female, 90% postmenopausal) with rheumatoid arthritis (n=631), connective tissue diseases (n=424), vasculitides (n=274), and spondyloarthropathies (n=240). Median disease duration was 9.5 years (IQR 3.6–17.4). Regular exercise was reported by 63%; 59% performed low-impact, 52% weight-bearing, 34% aerobic, 23% strength, and 18% high-impact activities.Positive associations with lumbar spine T-score were found for weight-bearing (+0.16 [0.02;0.30], p=0.03), high-impact (+0.27 [0.09;0.45], p=0.003), strength (+0.19 [0.02;0.37], p=0.033), and balance training (+0.002 [0.00;0.04], p=0.013). Only high-impact activity was associated with femoral T-score (+0.16 [0.03;0.28], p=0.017). TBS at the spine was positively linked to weight-bearing exercise (+0.018 [0.003;0.033], p=0.022). High-impact activity was associated with femoral trabecular parameters (+4.62 [0.22;9.02], p=0.040), while endurance training benefited cortical structure (+0.01 [0.00;0.03], p=0.049). Trends toward benefit were observed for strength, weight-bearing, and low-impact activities. No exercise type was negatively associated with bone outcomes.

Conclusion: In patients with inflammatory rheumatic diseases, mechanical loading activities such as weight-bearing, strength, and high-impact exercises are most beneficial for improving BMD and microarchitecture. These findings support the development of tailored exercise programs based on individual capabilities to optimize bone health. Longitudinal studies with fracture outcomes will further clarify long-term benefits.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-different-types-of-physical-activity-on-bone-health-in-patients-with-inflammatory-rheumatic-diseases-a-cross-sectional-analysis-from-a-prospective-cohort-study/