Exercise training and bone mineral density in postmenopausal women: an updated systematic review and meta-analysis of intervention studies with emphasis on potential moderators.

Ramin Mohebbi, Mahdieh Shojaa, Matthias Kohl, Simon von Stengel, Franz Jakob, Katharina Kerschan-Schindl, Uwe Lange, Stefan Peters, Friederike Thomasius, Michael Uder, Wolfgang Kemmler

Journal: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 2023;34(7):1145-1178

PMID: 36749350

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Plain Language Summary

Postmenopausal women often experience a decline in bone mineral density (BMD), which can lead to osteoporosis. Exercise training is considered a potential non-pharmacological intervention to mitigate this decline. The aim of this study was to evaluate the effects of exercise training on BMD in postmenopausal women and to explore the role of potential moderators such as bone and menopausal status or supervision in these interventions. This study was an updated systematic review and meta-analysis that included 80 studies with a pooled number of 5581 participants, focusing on BMD changes at the lumbar spine, femoral neck, and total hip. Results showed that exercise had a positive effect on BMD at all measured sites, with standardised mean differences indicating moderate effect sizes. However, differences in bone status, menopausal status, and supervision did not significantly affect the exercise outcomes. Authors concluded that exercise training is beneficial for improving BMD in postmenopausal women. The lack of significant differences based on moderators suggests that exercise benefits are consistent across various subgroups.

Abstract

The aim of this systematic review and meta-analysis was (1) to determine exercise effects on bone mineral density (BMD) in postmenopausal women and (2) to address the corresponding implication of bone and menopausal status or supervision in postmenopausal women. A comprehensive search of eight electronic databases according to the PRISMA statement up to August 9, 2022, included controlled exercise trials ≥ 6 months. BMD changes (standardized mean differences: SMD) at the lumbar spine (LS), femoral neck (FN), and total hip (TH) were considered as outcomes. Study group comparisons were conducted for osteopenia/osteoporosis versus normal BMD, early versus late postmenopausal women, and predominantly supervised versus predominantly non-supervised study arms. We applied an inverse heterogeneity (IVhet) model. In summary, 80 studies involving 94 training and 80 control groups with a pooled number of 5581 participants were eligible. The IVhet model determined SMDs of 0.29 (95% CI: 0.16-0.42), 0.27 (95% CI: 0.16-0.39), and 0.41 (95% CI: 0.30-0.52) for LS, FN, and THBMD, respectively. Heterogeneity between the trial results varied from low (I = 20%, TH BMD) to substantial (I = 68%, LS-BMD). Evidence for publication bias/small study effects was negligibly low (FN-, TH-BMD) to high (LSBMD). We observed no significant differences (p > .09) for exercise effects on LS-, FN-, or TH-BMD-LS between studies/study arms with or without osteopenia/osteoporosis, early versus late postmenopausal women, or predominantly supervised versus non-supervised exercise programs. Using robust statistical methods, the present work provides further evidence for a positive effect of exercise on BMD in postmenopausal women. Differences in bone status (osteopenia/osteoporosis versus normal bone), menopausal status (early versus late postmenopausal), and supervision (yes versus no) did not significantly affect the exercise effects on BMD at LS or proximal femur.

Address: Institute of Medical Physics, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany.; Department Population-Based Medicine, Institute of Health Science, University Hospital Tübingen, Tübingen, Germany.; Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany.; Department of Medical and Life Sciences, University of Furtwangen, Schwenningen, Germany.; Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany.; Institute of Radiology, University Hospital Erlangen, Erlangen, Germany.; Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany.; Bernhard-Heine-Centrum Für Bewegungsforschung, University of Würzburg, Würzburg, Germany.; Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany.; Austrian Society for Bone and Mineral Research, Vienna, Austria.; Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany.; German Society for Physical and Rehabilitative Medicine, Dresden, Germany.; Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany.; German Association for Health-Related Fitness and Exercise Therapy (DVGS), Hürth-Efferen, Germany.; Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany.; Osteology Umbrella Association Germany, Austria, Switzerland.; Frankfurt Center of Bone Health, Frankfurt, Germany.; Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany.; Institute of Medical Physics, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany. [email protected].; Institute of Radiology, University Hospital Erlangen, Erlangen, Germany. [email protected].; Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany. [email protected].

DOI: 10.1007/s00198-023-06682-1