Impact of Exercise-Induced Strains and Nutrition on Bone Mineral Density in Spaceflight and on the Ground

John Caruso, Neel Patel, Joseph Wellwood, Lance Bollinger

Research output: Contribution to journalReview articlepeer-review


BACKGROUND: Bone mineral density (BMD) is a measure of skeletal health that may foretell disorders like osteoporosis. METHODS: To reduce bone losses on Earth, treatments include exercise, diet, and drugs. Each impact osteoblast and osteoclast activity dictates skeletal remodeling and subsequent BMD changes. BMD loss is a concern during spaceflight. For astronauts, low BMD undermines in-flight tasks and compromises their postflight health. RESULTS: While bisphosphonates exhibited promise as an in-flight bone loss treatment, study results are mixed, and this class of drugs has numerous side-effects. While the role antiresorptive agents play in reducing BMD loss is discussed, this review focuses on exercise-induced strains and nutrition, two in-flight treatments without bisphosphonates’ side-effects. DISCUSSION: Evidence supports in-flight exercise and a healthy diet with vitamin D and Ca+2 supplementation to limit BMD loss. This review suggests how exercise and nutrition may limit BMD loss during spaceflight. Also discussed is an in-flight version of the inertial exercise trainer (IET; Impulse Technologies, Knoxville TN). By imparting high bone-strain magnitudes, rates, and frequencies with less mass, footprint, and power needs than other forms of in-flight resistance exercise hardware, the IET warrants inquiry for use aboard future long-term spaceflights.

Original languageEnglish
Pages (from-to)923-933
Number of pages11
JournalAerospace medicine and human performance
Issue number12
StatePublished - 2023

Bibliographical note

Publisher Copyright:
© By the Aerospace Medical Association, Alexandria, VA.


  • Ca
  • advanced resistive exercise device
  • frequency
  • inertial exercise trainer
  • magnitude
  • mechanotransduction
  • rate
  • strain
  • vitamin D

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Public Health, Environmental and Occupational Health


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