The efficacy of exercise prescription in patients with osteoporotic fractures: a systematic review and meta-analysis.

Background: Patients with osteoporotic fractures will further lose bone mineral density and the incidence of refractures will be greatly increased, which is one of the leading causes of death and disability in the elderly. Exercise prescription is effective in enhancing bone strength in patients with osteoporosis, but its effects on patients with osteoporotic fractures have not been systematically reviewed. The purpose of this study is to retrospectively analyze the effect of exercise prescription on bone mineral density in patients with osteoporotic fractures, so as to provide a basis for clinicians to provide postoperative guidance for fracture patients.

Method: We searched online databases for published studies on exercise prescription for people with osteoporotic fractures up to September 2024. We included 11 randomized controlled trials that reported the effect of exercise prescription on bone mineral density in people with osteoporotic fractures, and four of these studies reported the effect of exercise prescription on the incidence of refracture in people with osteoporotic fractures. We analysed changes in bone mineral density and incidence of refractures using a fixed-effect model, and meta-regression analyses were performed for subgroups.

Results: Of the 701 articles reviewed, we included 11 randomized controlled trials in the meta-analysis. A total of 1101 samples were pooled, including 357 males and 744 females. This study found that exercise prescription was effective in increasing bone mineral density in patients with osteoporotic fractures (MD: 0.07; 95%CI: 0.06 to 0.09), reducing the incidence of refracture by about 3.67 times (OR: 3.67; 95%CI: 1.74 to 7.72). Both whole-body exercise (MD: 0.09; 95% CI: 0.06 to 0.11) and local exercise of the affected limb (MD: 0.06; 95%CI: 0.04 to 0.09) can effectively improve the patient's bone mineral density, and more than 1 year of exercise may be better (MD: 0.10; 95%CI: 0.07 to 0.14).

Conclusion: Reasonable exercise prescription can effectively improve bone mineral density and reduce the incidence of refracture in patients with osteoporotic fractures.