Effects of exercise on bone metabolism in postmenopausal women: a systematic review and meta-analysis of randomized controlled trials.

IF 4.6 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Frontiers in Endocrinology Pub Date : 2025-09-15 eCollection Date: 2025-01-01 DOI:10.3389/fendo.2025.1597046

Wenhua Zhang, Xun Li, Qiang He, Xiaoqiang Wang

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Abstract

Objective: To assess the impact of exercise on bone metabolism in postmenopausal women through meta-analysis, and to offer evidence-based guidance for preventing and managing osteoporosis in this population.

Methods: We searched PubMed, Embase, and other databases using keywords such as "exercise," "postmenopausal women," and "bone metabolism" to identify randomized controlled trials published up to 2024 on the effect of exercise on bone metabolism in postmenopausal women. Studies were selected according to predefined inclusion and exclusion criteria. Data were analyzed using Review Manager 5.4 and Stata17. Study quality was assessed with the Cochrane risk-of-bias tool. Effect sizes were pooled as standardized mean differences(SMDs)with 95% confidence intervals(CIs), and heterogeneity was evaluated with the I²statistic. A fixed-effects model was used when I²≤50%; otherwise, a random-effects model was applied. The overall evidence certainty was rated using the Grading of recommendations assessment, development, and evaluation(GRADE)system.

Results: A meta-analysis of 24 studies(1067 subjects total)showed that exercise significantly elevated the levels of alkaline phosphatase(ALP)(SMD = 0.49, 95%CI: 0.21-0.77, P = 0.0006), N-terminal propeptide of type I procollagen(P1NP)(SMD = 0.62, 95% CI: 0.24 to 1.01, P = 0.002)and osteocalcin(OC)(SMD = 0.21, 95% CI: 0.05 to 0.37, P = 0.01); exercise significantly reduced the levels of parathyroid hormone(PTH)(SMD=-0.51, 95% CI: -0.77 to -0.25, P = 0.0001)and type I collagen cross-linked C-terminal peptide(CTX)(SMD=-0.32, 95% CI: -0.51to-0.12, P = 0.001). Subgroup analyses showed that aerobic exercise(SMD=-0.35, 95% CI: -0.65 to -0.06, P = 0.02) significantly reduced CTX levels, while both aerobic exercise(SMD = 0.23, 95% CI: 0.01 to 0.44, P = 0.04)and resistance exercise(SMD = 0.65, 95% CI: 0.10 to 1.20, P = 0.02)significantly increased OC levels. Exercise interventions lasting ≤6 months(SMD=-0.45, 95% CI: -0.72 to -0.18, P = 0.001)and sessions of ≤60 min(SMD=-0.48, 95% CI: -0.80 to -0.17, P = 0.003)both significantly reduced CTX levels, exercise interventions lasting ≤6 months(SMD = 0.35, 95% CI: 0.13 to 0.57, P = 0.002)and sessions of ≤60 min(SMD = 0.20, 95% CI: 0.01 to 0.39, P = 0.04)can significantly both increase OC levels.

Conclusion: Exercise significantly improves bone metabolism in postmenopausal women by reducing bone resorption and promoting bone formation. Aerobic exercise lowers CTX levels, while both aerobic and resistance exercise increase OC levels. Short-term (≤6 months) and moderate-length (≤60 minutes/session) interventions are particularly effective. However, more high-quality randomized controlled trials are needed to confirm these benefits.

Systematic review registration: https://www.crd.york.ac.uk/, identifier CRD42024610810.

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运动对绝经后妇女骨代谢的影响：随机对照试验的系统回顾和荟萃分析。

目的：通过荟萃分析评估运动对绝经后妇女骨代谢的影响，为绝经后妇女骨质疏松症的预防和管理提供循证指导。方法：我们使用“运动”、“绝经后妇女”和“骨代谢”等关键词搜索PubMed、Embase和其他数据库，以确定截至2024年发表的关于运动对绝经后妇女骨代谢影响的随机对照试验。根据预先确定的纳入和排除标准选择研究。使用Review Manager 5.4和Stata17对数据进行分析。采用Cochrane风险偏倚工具评估研究质量。效应量以95%置信区间（ci）的标准化平均差（SMDs）合并，并用I²统计量评估异质性。当I²≤50%时采用固定效应模型；否则，采用随机效应模型。使用建议评估、发展和评价分级（GRADE）系统对总体证据确定性进行评级。结果：24项研究（共1067名受试者）的荟萃分析显示，运动显著提高了碱性磷酸酶（ALP）（SMD = 0.49, 95%CI: 0.21 ~ 0.77, P = 0.0006）、I型前胶原n端前肽（P1NP）（SMD = 0.62, 95%CI: 0.24 ~ 1.01, P = 0.002）和骨钙素（OC）（SMD = 0.21, 95%CI: 0.05 ~ 0.37, P = 0.01）的水平；运动显著降低甲状旁腺激素（PTH）水平（SMD=-0.51, 95% CI: -0.77 ~ -0.25, P = 0.0001）和I型胶原交联c端肽（CTX）水平（SMD=-0.32, 95% CI: -0.51 ~ 0.12, P = 0.001）。亚组分析显示，有氧运动（SMD=-0.35, 95% CI: -0.65 ~ -0.06, P = 0.02）显著降低CTX水平，而有氧运动（SMD= 0.23, 95% CI: 0.01 ~ 0.44, P = 0.04）和阻力运动（SMD= 0.65, 95% CI: 0.10 ~ 1.20, P = 0.02）均显著增加OC水平。运动干预时间≤6个月（SMD=-0.45, 95% CI: -0.72 ~ -0.18, P = 0.001）和运动干预时间≤60分钟（SMD=-0.48, 95% CI: -0.80 ~ -0.17, P = 0.003）均可显著降低CTX水平，运动干预时间≤6个月（SMD= 0.35, 95% CI: 0.13 ~ 0.57, P = 0.002）和运动干预时间≤60分钟（SMD= 0.20, 95% CI: 0.01 ~ 0.39, P = 0.04）均可显著增加OC水平。结论：运动通过减少骨吸收和促进骨形成，显著改善绝经后妇女的骨代谢。有氧运动降低CTX水平，而有氧运动和抗阻运动都增加OC水平。短期（≤6个月）和中等长度（≤60分钟/次）干预特别有效。然而，需要更多高质量的随机对照试验来证实这些益处。系统综述注册：https://www.crd.york.ac.uk/，标识符CRD42024610810。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Endocrinology Medicine-Endocrinology, Diabetes and Metabolism

CiteScore

5.70

自引率

9.60%

发文量

3023

审稿时长

14 weeks

期刊介绍： Frontiers in Endocrinology is a field journal of the "Frontiers in" journal series. In today’s world, endocrinology is becoming increasingly important as it underlies many of the challenges societies face - from obesity and diabetes to reproduction, population control and aging. Endocrinology covers a broad field from basic molecular and cellular communication through to clinical care and some of the most crucial public health issues. The journal, thus, welcomes outstanding contributions in any domain of endocrinology. Frontiers in Endocrinology publishes articles on the most outstanding discoveries across a wide research spectrum of Endocrinology. The mission of Frontiers in Endocrinology is to bring all relevant Endocrinology areas together on a single platform.