Nutrient Intake Prior to Exercise Is Necessary for Increased Osteogenic Marker Response in Diabetic Postmenopausal Women

Nutrients. 2019 Jun 30;11(7):1494. doi: 10.3390/nu11071494.


Type 2 diabetes increases bone fracture risk in postmenopausal women. Usual treatment with anti-resorptive bisphosphonate drugs has some undesirable side effects, which justified our interest in the osteogenic potential of nutrition and exercise. Since meal eating reduces bone resorption, downhill locomotion increases mechanical stress, and brief osteogenic responsiveness to mechanical stress is followed by several hours of refractoriness, we designed a study where 40-min of mechanical stress was manipulated by treadmill walking uphill or downhill. Exercise preceded or followed two daily meals by one hour, and the meals and exercise bouts were 7 hours apart. Fifteen subjects each performed two of five trials: No exercise (SED), uphill exercise before (UBM) or after meals (UAM), and downhill exercise before (DBM) or after meals (DAM). Relative to SED trial, osteogenic response, defined as the ratio of osteogenic C-terminal propeptide of type I collagen (CICP) over bone-resorptive C-terminal telopeptide of type-I collagen (CTX) markers, increased in exercise-after-meal trials, but not in exercise-before-meal trials. CICP/CTX response rose significantly after the first exercise-after-meal bout in DAM, and after the second one in UAM, due to a greater CICP rise, and not a decline in CTX. Post-meal exercise, but not the pre-meal exercise, also significantly lowered serum insulin response and homeostatic model (HOMA-IR) assessment of insulin resistance.

Keywords: HOMA-IR; cortisol; exercise and meal timing; markers of bone formation and resorption; nutrient intake; osteogenesis; parathyroid hormone.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Aged
  • Biomarkers / blood
  • Bone Remodeling*
  • Collagen Type I / blood
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / therapy*
  • Exercise Therapy*
  • Female
  • Fractures, Bone / blood
  • Fractures, Bone / etiology
  • Fractures, Bone / physiopathology
  • Fractures, Bone / prevention & control*
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Insulin / blood
  • Insulin Resistance
  • Meals*
  • Middle Aged
  • Nutritive Value
  • Osteogenesis*
  • Peptide Fragments / blood
  • Peptides / blood
  • Postmenopause / blood
  • Postprandial Period
  • Procollagen / blood
  • Time Factors
  • Treatment Outcome


  • Biomarkers
  • Collagen Type I
  • Hypoglycemic Agents
  • Insulin
  • Peptide Fragments
  • Peptides
  • Procollagen
  • collagen type I trimeric cross-linked peptide
  • procollagen type I carboxy terminal peptide