Intervention Review

Exercise for preventing and treating osteoporosis in postmenopausal women

  1. Tracey E Howe1,*,
  2. Beverley Shea2,
  3. Lesley J Dawson3,
  4. Fiona Downie3,
  5. Ann Murray4,
  6. Craig Ross5,
  7. Robin T Harbour6,
  8. Lynn M Caldwell7,
  9. Gisela Creed8

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 6 JUL 2011

Assessed as up-to-date: 2 JAN 2011

DOI: 10.1002/14651858.CD000333.pub2

How to Cite

Howe TE, Shea B, Dawson LJ, Downie F, Murray A, Ross C, Harbour RT, Caldwell LM, Creed G. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD000333. DOI: 10.1002/14651858.CD000333.pub2.

Author Information

  1. 1

    Glasgow Caledonian University, School of Health & Life Sciences, Glasgow, Scotland, UK

  2. 2

    University of Ottawa, CIET, Institute of Population Health, Ottawa, Ontario, Canada

  3. 3

    NHS Forth Valley, Department of Physiotherapy, Stirling, Scotland, UK

  4. 4

    NHS Ayrshire and Arran, Kilmarnock, Ayrshire, UK

  5. 5

    NHS Greater Glasgow & Clyde, Physiotherapy Service for Osteoporosis, Glasgow, UK

  6. 6

    Scottish Intercollegiate Guidelines network (SIGN), Edinburgh, UK

  7. 7

    NHS Education for Scotland, Knowledge Services Group, Glasgow, UK

  8. 8

    Glasgow University, Academic Department of Geriatric Medicine, Glasgow, UK

*Tracey E Howe, School of Health & Life Sciences, Glasgow Caledonian University, Scottish Centre for Evidence Based Care of Older People, Glasgow, Scotland, G4 0BA, UK. tracey.howe@gcu.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 6 JUL 2011

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Background

Osteoporosis is a condition resulting in an increased risk of skeletal fractures due to a reduction in the density of bone tissue. Treatment of osteoporosis typically involves the use of pharmacological agents. In general it is thought that disuse (prolonged periods of inactivity) and unloading of the skeleton promotes reduced bone mass, whereas mechanical loading through exercise increases bone mass.

Objectives

To examine the effectiveness of exercise interventions in preventing bone loss and fractures in postmenopausal women.

Search methods

During the update of this review we updated the original search strategy by searching up to December 2010 the following electronic databases: the Cochrane Musculoskeletal Group's Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2010 Issue 12); MEDLINE; EMBASE; HealthSTAR; Sports Discus; CINAHL; PEDro; Web of Science; Controlled Clinical Trials; and AMED. We attempted to identify other studies by contacting experts, searching reference lists and searching trial registers.

Selection criteria

All randomised controlled trials (RCTs) that met our predetermined inclusion criteria.

Data collection and analysis

Pairs of members of the review team extracted the data and assessed trial quality using predetermined forms. For dichotomous outcomes (fractures), we calculated risk ratios (RRs) using a fixed-effect model. For continuous data, we calculated mean differences (MDs) of the percentage change from baseline. Where heterogeneity existed (determined by the I2 statistic), we used a random-effects model.

Main results

Forty-three RCTs (27 new in this update) with 4320 participants met the inclusion criteria. The most effective type of exercise intervention on bone mineral density (BMD) for the neck of femur appears to be non-weight bearing high force exercise such as progressive resistance strength training for the lower limbs (MD 1.03; 95% confidence interval (CI) 0.24 to 1.82). The most effective intervention for BMD at the spine was combination exercise programmes (MD 3.22; 95% CI 1.80 to 4.64) compared with control groups. Fractures and falls were reported as adverse events in some studies. There was no effect on numbers of fractures (odds ratio (OR) 0.61; 95% CI 0.23 to 1.64). Overall, the quality of the reporting of studies in the meta-analyses was low, in particular in the areas of sequence generation, allocation concealment, blinding and loss to follow-up.

Authors' conclusions

Our results suggest a relatively small statistically significant, but possibly important, effect of exercise on bone density compared with control groups. Exercise has the potential to be a safe and effective way to avert bone loss in postmenopausal women.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Exercise for preventing and treating osteoporosis in postmenopausal women

This summary of a Cochrane review presents what we know from research about the effect of exercise on bone mass in postmenopausal women.

The review shows that for postmenopausal women

-        Exercise will improve bone mineral density slightly.

-        Exercise will reduce the chances of having a fracture slightly.

These results might have happened by chance.

What is osteoporosis and exercise

Bone is a living, growing part of your body. Throughout your lifetime, new bone cells grow and old bone cells break down to make room for the new, stronger bone. When you have osteoporosis, the old bone breaks down faster than the new bone can replace it. As this happens, the bones lose minerals (such as calcium). This makes bones weaker and more likely to break even after a minor injury, like a little bump or fall.

Exercise interventions are typically those that stress or mechanically load bones (when bones support the weight of the body or when movement is resisted for example when using weights) and include aerobics, strength training, walking and tai chi.

Best estimate of what happens to postmenopausal women who exercise

Bone mineral density at the spine

People who exercised had on average 0.85% less bone loss than those who didn't exercise.

People who engaged in combinations of exercise types had on average 3.2% less bone loss than those who did not exercise.

Bone mineral density at the hip

People who exercised had on average 1.03% less bone loss than those who didn't exercise.

People who exercised by strength training had on average 1.03% less bone loss.

Fractures

4 less women out of 100 who did exercise had a fracture.  (Absolute difference 4%).

7 women out of 100 who exercised had a fracture.

11 women out of 100 who did not exercise had a fracture.

 

Resumen

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Antecedentes

Ejercicios para la prevención y el tratamiento de la osteoporosis en mujeres posmenopáusicas

La osteoporosis es una enfermedad que produce un riesgo elevado de fracturas esqueléticas debido a una reducción en la densidad del tejido óseo. Habitualmente el tratamiento de la osteoporosis incluye el uso de agentes farmacológicos. En general se considera que el desuso (períodos prolongados de inactividad) y la disminución de la carga sobre el esqueleto promueven la reducción de la masa ósea, mientras que la carga mecánica lograda a través del ejercicio aumenta la masa ósea.

Objetivos

Examinar la efectividad de las intervenciones con ejercicios en la prevención de la pérdida ósea y las fracturas en pacientes posmenopáusicas.

Estrategia de búsqueda

Durante la actualización de esta revisión se actualizó la estrategia original de búsqueda al buscar hasta diciembre de 2010 en las bases de datos electrónicas siguientes: Registro Especializado de Ensayos Controlados del Grupo Cochrane de Enfermedades Musculoesqueléticas (Cochrane Musculoskeletal Group); Registro Cochrane Central de Ensayos Controlados (Cochrane Central Register of Controlled Trials, CENTRAL) (Cochrane Library, 2010, número 12); MEDLINE; EMBASE; HealthSTAR; Sports Discus; CINAHL; PEDro; Web of Science; Controlled Clinical Trials; y AMED. Se intentó identificar otros estudios mediante el contacto con expertos, y a través de las búsquedas en las listas de referencias y en los registros de ensayos.

Criterios de selección

Todos los los ensayos controlados con asignación aleatoria (ECAs) que cumplieron con los criterios de inclusión predeterminados.

Obtención y análisis de los datos

Pares de miembros del equipo de revisión extrajeron los datos y evaluaron la calidad del ensayo mediante formularios predeterminados. Para los resultados dicotómicos (fracturas) se calcularon los cocientes de riesgos (CR) mediante un modelo de efectos fijos. Para los datos continuos se calcularon las diferencias de medias (DM) del cambio con respecto al valor inicial. Cuando hubo heterogeneidad (determinada por la estadística I2) se utilizó un modelo de efectos aleatorios.

Resultados principales

Cuarenta y tres ECsA (27 nuevos en esta actualización) con 4 320 participantes cumplieron los criterios de inclusión. Las intervenciones con el tipo de ejercicio más efectivo sobre la densidad mineral ósea (DMO) para el cuello del fémur parecen ser los ejercicios de fuerza intensa sin peso como el entrenamiento progresivo de fuerza de resistencia para los miembros inferiores (DM 1,03; intervalo de confianza [IC] del 95%: 0,24 a 1,82). Las intervenciones más efectivas para la DMO de la columna fueron los programas de ejercicios de combinación (DM 3,22; IC del 95%: 1,80 a 4,64) en comparación con los grupos control. Las fracturas y las caídas se informaron como eventos adversos en algunos estudios. No hubo efectos sobre la cantidad de fracturas (odds ratio [OR] 0,61; IC del 95%: 0,23 a 1,64). En general la calidad del informe de los estudios en los metanálisis fue deficiente, particularmente en las áreas de generación de la secuencia, la ocultación de la asignación, el cegamiento y las pérdidas durante el seguimiento.

Conclusiones de los autores

Estos resultados indican un efecto significativo relativamente pequeño pero posiblemente importante de los ejercicios sobre la densidad ósea en comparación con los grupos control. El ejercicio tiene la posibilidad de ser una manera segura y efectiva de evitar la pérdida ósea en las pacientes postmenopáusicas.

Traducción

Traducción realizada por el Centro Cochrane Iberoamericano