Effect of different types of exercise on bone mineral density in postmenopausal women: A systematic review and meta-analysis

Abstract

Postmenopausal women face a high risk of bone loss. Exercise has a beneficial effect to prevent bone deterioration in elderly women. This study was conducted to investigate the effect of different types of exercise on bone mineral density at the lumbar spine and femoral neck in postmenopausal women.This review followed the guidelines recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was registered in advance in the International prospective register of systematic reviews (PROSPERO) (ID: CRD42018095097). Literature searches with no language restriction were conducted through PubMed, Scopus, Web of Science, Cochrane, Science Direct, Eric, ProQuest, and Primo up to March 1 2019 using related MeSH terms and key words. Controlled trials with ≥ 6 months intervention duration among postmenopausal women that comprised at least one exercise and one control group were included in this study. Meta-analyses were performed using random-effects models and effect sizes calculated using the standardised mean difference (SMD). Seven categories of exercise were classified and used in sub-group analyses. P-values < 0.05 were considered statistically significant.Seventy-five studies were included, assessing the bone mineral density of 5300 (range of mean age: 50–79) postmenopausal women who performed exercise or control protocols. Interventions ranged from six to 30 months and the most common exercise frequency was three sessions per week. The majority of studies employed multicomponent exercise interventions. Results of the meta-analyses showed a significant effect (SMD = 0.37, 95%-CI: 0.25–0.50) for lumbar spine and femoral neck (SMD = 0.33, 0.23–0.43) (all P < 0.0001).Sub-group analysis revealed large heterogeneity and no significant differences in exercise categories at the lumbar spine (P = 0.36) and femoral neck (P = 0.43). However, weight-bearing exercise + jumping + resistance training exhibited the largest effect (SMD = 0.71, 0.33–1.10) at the lumbar spine. Moreover, non-weight-bearing combined + resistance exercise revealed the largest effect (SMD = 0.68, 0.16–1.19) at the femoral neck. Contrary to our expectation, jumping alone indicated a greater decrease in bone mineral density compared to the control group at both the lumbar spine (−0.07, −0.46–0.32) and femoral neck (−0.12, −0.62–0.37).In conclusion, the current study provided a positive small effect of exercise on bone mineral density at the lumbar spine and femoral neck. Findings from sub-group analyses suggest larger benefits in multicomponent interventions that include weight-bearing and resistance training exercises compared to them as a single mode of exercise. Unequal numbers of studies were found for each category (e. g. jumping: two trials; dynamic resistance training: 15 trials), affecting the comparison between them. Therefore, findings should be interpreted with caution; they are not yet generalizable to specific types of exercise.

Exercise Effects on Bone Mineral Density in Men

“…However, three out of five WB-protocols scheduled low intensity exercise such as brisk walking or Tai Chi [17,20,22]. Nevertheless, this result confirmed the results of a recent meta-analysis with 84 included trials that did not observe relevant differences on BMD at LS and FN after resistance vs. weight bearing vs. combined exercise protocols in postmenopausal women [45]. We thus conclude that the ability of comprehensive meta-analyses to derive even raw exercise recommendations is rather limited [46,47], independently of the outcome.…”

Effekt von additivem körperlichem Training zur Bisphosphonat-Therapie auf die Knochendichte: Eine systematische Übersichtsarbeit und Meta-Analyse

“…Fehlende Standardabweichungen (SD) wurden nach der Methode berechnet, die in der kürzlich veröffentlichten umfassenden Metaanalyse von Shojaa et al 11 ausführlich beschrieben wurde. Zusammengefasst wurden Konfidenzintervall (KI) oder Standardfehler (SE) in SD umgerechnet 15 .…”

“…Die Aussteiger- bzw. „Loss to follow-up“-Rate lag mit 0% bei 6-monatiger 23 bis 25% bei 24-monatiger Studiendauer in einem unauffälligen Bereich 11 .…”

“…Während Bisphosphonate effektive Wirkstoffe zur Erhöhung der Knochenfestigkeit darstellen, werden nennenswerte Effekte auf Sturzrisikofaktoren kaum berichtet 27 28 . Im Gegensatz dazu ist ein körperliches Training wie keine andere Therapieform geeignet, Einfluss auf Sturzhäufigkeit und Sturzergebnis zu nehmen 29 30 31 , während der Einfluss zumindest auf die Knochendichte (BMD) geringer 10 11 als nach Bisphosphonatgabe ist 32 33 . Wenigstens bei Menschen mit erhöhtem Sturzrisiko ist also ein adjuvantes körperliches Training mit Ausrichtung auf das Sturzrisiko essentiell 25 .…”

“…Antiresorptiva haben dem gemäß einen hemmenden Einfluss auf das Remodeling, nicht aber auf die Mechanotransduktion und die Knochenformation generell 8 9 . Daneben wird körperliches Training als kostengünstige und effektive Option zur Prävention und Behandlung von Osteoporose angesehen 10 11 . Inwieweit eine kombinierte Intervention aus Bisphosphonat- und Körpertraining die Effekte isolierter Bisphosphonat-Therapie übersteigt, wurde nur von wenigen Studien (u. a.…”