Background: Physical exercise is important for maintaining bone mineral density (BMD), preventing falls, and reducing fracture risk, especially as it empowers patients to actively improve their bone health. Strength and weight-bearing exercises are particularly effective in this regard [1]. However, individuals with inflammatory rheumatic diseases often face disease-related functional impairments, limiting their ability to engage in such beneficial activities. The specific interactions between rheumatic diseases, physical exercise, and bone health remain underexplored.

Objectives: To examine the impact of different types of physical activity on BMD in patients with inflammatory rheumatic diseases.

Methods: We analyzed data from the Rh-GIOP study, a prospective observational cohort of patients with immune-mediated inflammatory diseases. Participants underwent dual-energy X-ray absorptiometry (DXA) scans and systematic bone health assessments. Open-ended responses regarding physical activity were categorized in a standardized manner into the following groups: any physical exercise, weight-bearing, high-impact, and low-impact activities. To account for frequency, physical activities were further classified according to WHO criteria into strength, aerobic, and balance exercises (for patients ≥ 65 years). Multivariable linear regression models were used to identify clinical, serological, and treatment-related factors associated with T-Score, trabecular bone score (TBS; enCORE V18 iNsight®, Med-Imaps SA), and femoral structural parameters (3D-Shaper v2.12, 3D-Shaper Medical). Physical activity categories were then included in these models to evaluate their impact on outcomes. Missing data were addressed using multiple imputation with 10 replications.

Results: We analyzed 1,870 patients (mean age 63 ± 13 years; 75% female, 90% postmenopausal) with immune-mediated inflammatory diseases, including 631 with rheumatoid arthritis, 424 with connective tissue diseases, 274 with vasculitides, and 240 with spondyloarthropathies. The median disease duration was 9.5 years (IQR: 3.6–17.4). Overall, 63% of patients exercised regularly, with 59% performing low-impact exercises, 52% engaging in weight-bearing activities, 34% participating in aerobic exercises, 23% in strength training, and 18% in high-impact exercises. Weight-bearing (regression coefficient [95% CI]: +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 exercises (+0.002 [0.00;0.04], p=0.013) were positively associated with lumbar spine T-Score, while only high-impact exercises (+0.16 [0.03;0.28], p=0.017) showed a positive association with femoral T-Score. Low-impact exercise did not signal a significant relation. TBS at the lumbar spine was positively influenced by weight-bearing activities (+0.018 [0.003;0.033], p=0.022) only. At the femur, trabecular parameters were associated with high-impact exercise (+4.62 [0.22;9.02], p=0.040), while cortical parameters benefited from endurance training (0.01 [0.00;0.03], p=0.049). Trends were observed for strength, weight-bearing, and low-impact exercises for cortical structure parameters. There was no negative association of any physical activity category with the outcome parameters.

Conclusion: Our findings confirm that in patients with inflammatory rheumatic disease, mechanical loading exercises are best suited in promoting bone health, particularly in enhancing BMD and TBS. These insights support the development of tailored exercise recommendations based on individual functional capacities, empowering patients with rheumatic diseases to improve bone health. Future longitudinal analyses, incorporating fracture outcomes, will provide further clarity on the long-term benefits of specific exercise types.

REFERENCES: [1] Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. J Bone Miner Res. 2018;33(2):211-20.

Funding: Rh-GIOP is or was supported by a joint funding of Abbvie, Amgen, Alfasigma, Almirall, Biogen, BMS, Chugai, Galapagos, GA Generic Assays, GSK, Hexal, Horizon Therapeutics, Lilly, Medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi-Genzyme.

Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.