Exercise for preventing and treating osteoporosis in postmenopausal women.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 21735380 · doi:10.1002/14651858.CD000333.pub2
What was done
This Cochrane systematic review searched major biomedical databases through December 2010 to identify randomized controlled trials evaluating exercise interventions for preventing bone loss and fractures in postmenopausal women. Forty-three randomized trials including 4,320 participants met inclusion criteria. Reviewers extracted data in duplicate, using fixed- or random-effects models to pool mean differences in percentage change from baseline for bone mineral density and odds ratios for fracture outcomes.
What was found
For the femoral neck, non-weight bearing high-force exercise (such as progressive resistance training of the lower limbs) was the most effective intervention (MD 1.03%, 95% CI 0.24 to 1.82). For the spine, combination exercise programs yielded the largest benefit compared with controls (MD 3.22%, 95% CI 1.80 to 4.64). Exercise showed no statistically significant effect on fracture incidence (OR 0.61, 95% CI 0.23 to 1.64).
Why it matters
Targeted exercise programs provide small, statistically significant site-specific increases in bone mineral density in postmenopausal women. However, existing trial evidence is not sufficiently powered to confirm whether these density improvements translate into reduced clinical fractures.
Limits
The overall quality of trial reporting was low, with widespread deficiencies or missing details regarding sequence generation, allocation concealment, blinding, and handling of loss to follow-up. Fracture data were reported in only a subset of trials and were characterized by wide confidence intervals.
Cited by
- partial Weight-bearing resistance training reverses osteoporosis in women.