Does adding exercise or physical activity to pharmacological osteoporosis therapy in patients with increased fracture risk improve bone mineral density and lower fracture risk? A systematic review and meta-analysis
Authors' conclusion
It remains unclear whether EX has an additive impact to PT in people with osteoporosis.
Study context
- Population
- People with osteoporosis on osteoanabolic and/or antiresorptive pharmacological therapy
- Participants
- 530 people5 RCTs
- Comparison
- Exercise plus pharmacological therapy vs pharmacological therapy alone
- Outcome
- Bone mineral density (BMD), BTMs, fracture healing and fractures
Methodological detailsprospectively registered, random-effects meta-analysis with Hartung-Knapp-Sidik-Jonkman adjustment, Cochrane RoB2, GRADE, Four databases (inception to 6 May 2022), 5 trial registries and reference lists searched; 2593 records, Three potentially relevant ongoing trials identified via registries
- Prospectively registered
- Random-effects meta-analysis with Hartung-Knapp-Sidik-Jonkman adjustment
- Cochrane RoB2
- GRADE
- Four databases (inception to 6 May 2022), 5 trial registries and reference lists searched; 2593 records
- Three potentially relevant ongoing trials identified via registries
Pooled result
As reported in the abstract
BMD at 12 months (SMD; very low certainty evidence)
- Hip, n = 3 studies
- SMD 0.18 (95% CI - 1.71; 2.06)
- Tibia, n = 2
- SMD 0.25 (95% CI - 4.85; 5.34)
- Lumbar spine, n = 4
- SMD 0.20 (95% CI - 1.15; 1.55)
- Forearm, n = 3
- SMD 0.05 (95% CI - 0.35; 0.46)
- Femoral neck, n = 3
- SMD - 0.03 (95% CI - 1.80; 1.75)
Further pooled results
Bone turnover markers (BTMs): no improvement (very wide CIs)
- Bone ALP, SMD [95%CI] (n = 3 studies)
- - 0.68 [- 5.88; 4.53]
- PINP, SMD [95%CI] (n = 2 studies)
- - 0.74 [- 10.42; 8.93]
- CTX-I, SMD [95%CI] (n = 2 studies)
- - 0.69 [- 9.61; 8.23]
- Very wide confidence intervals
Fracture healing and fractures
- No data were found for fracture healing or fracture outcomes
Original publication
Does adding exercise or physical activity to pharmacological osteoporosis therapy in patients with increased fracture risk improve bone mineral density and lower fracture risk? A systematic review and meta-analysis. Osteoporos Int. Published 11 July 2023. doi:10.
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