Effektivität eines körperlichen Trainings zur Reduktion niedrig-traumatischer und osteoporotischer Hauptfrakturen in Erwachsenen. Systematische Übersichtsarbeit und Meta-Analyse

 

 Buy Article Permissions and Reprints

Zusammenfassung

Ziel dieses systematischen Reviews mit Metaanalyse war es den Effekt körperlichen Trainings auf die Frakturinzidenz niedrig-traumatischer Gesamt- und osteoporotischer Hauptfrakturen zu erfassen. Eine systematische Literaturrecherche in sechs Literaturdatenbanken gemäß der PRISMA-Leitlinie wurde bis zum 22. Mai 2021 durchgeführt. Eingeschlossen wurden klinische Trainingsstudien mit (a) Personen≥45 Jahren, (b) Kohorten ohne relevante pharmakologische Therapie oder Behandlung mit Einfluss auf Knochenstoffwechsel oder Sturz, (c) einer Interventionsdauer von≥3 Monaten und (d) einer Erfassung der Anzahl niedrig-traumatischer Frakturen, die getrennt für die Trainings- (TG) und Kontrollgruppe (KG) aufgeführt wurden. Die Untersuchung wurde in PROSPERO registriert (ID: CRD42021250467). Für die Analyse wurde ein bedingtes Poisson-Regressionsmodell mit gemischten Effekten verwendet. Zwanzig Interventionsstudien mit 21 TG versus 20 KG und insgesamt 11,836 Teilnehmerjahren in der TG und 11,275 Teilnehmerjahren in der KG wurden eingeschlossen. Es zeigten sich statistisch signifikante Effekte für die Gesamtfraktur- (Inzidenzrate: 0.67, 95%-Konfidenz-Intervall: 0.51–0.87) und osteoporotischen Hauptfraktur-Rate (IR: 0.69, 95%-KI: 0.52–0.92). Die Heterogenität der Studienergebnisse (I²=40 und I²<1%) sowie wie die Evidenz eines Publikations-/small-study „Bias“ lag in einem insgesamt niedrig-moderaten Bereich. Trotz einiger biometrischer Limitationen zeigt die Arbeit die hohe Relevanz körperlichen Trainings im Rahmen der Frakturprophylaxe selbstständig lebender Menschen in mittleren-hohen Lebensalter deutlich auf. Die vorgelegten Daten für niedrig-traumatische Gesamt- und osteoporotischen Hauptfrakturen liegen dabei im Bereich moderner pharmakologischer Therapie.

Abstract

The aim of the present systematic review and meta-analysis was to determine the effects of exercise on low-trauma overall and major osteoporotic fractures in adults. Our systematic search of six literature databases according to the PRISMA guideline was conducted up to May 22, 2021, and included controlled clinical exercise trials with (a) individuals≥45 years, (b) cohorts without therapies/diseases related to bone metabolism or falls, (c) an intervention of≥3 months, and (d) the number of low-traumatic fractures listed separately for the exercise (EG) and control (CG) groups. The study was registered in PROSPERO (ID: CRD42021250467). We applied a mixed-effects conditional Poisson regression model for the analysis. A total of 20 intervention studies with 21 EGs and 20 CGs were included in the analysis. The studies comprising a pooled number of participant-years of n=11,836 in the EG and n=11,275 in the CG. The meta-analysis determined significant effects of exercise on low-trauma overall fracture incidence (rate) ratio (IR: 0.67, 95% confidence interval (95%-CI): 0.51–0.87) and major osteoporotic fractures IR (0.69, 95%-CI: 0.52–0.92). Heterogeneity between the trials was moderate for low-trauma overall (I²=40%), and negligible (I²<1%) for major osteoporotic fractures. Funnel plots suggest low to moderate evidence of publication/small-study bias in study outcomes for low-trauma overall fractures. Despite some biometric limitations the present study provides further evidence of the positive effect of exercise on low-trauma overall and major osteoporotic fractures in community dwelling middle aged to older adults. With respect to low-trauma overall and major osteoporotic fractures reduction, the study results are comparable to current pharmaceutical agents.

Publication History

Received: 25 January 2023

Accepted: 29 March 2023

Article published online:
10 May 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• Literatur

• 1 Kemmler W, Bebenek M, Kohl M. et al. Exercise and fractures in postmenopausal women. Final results of the controlled Erlangen Fitness and Osteoporosis Prevention Study (EFOPS). Osteoporos Int 2015; 26: 2491-2499 DOI: 10.1007/s00198-015-3165-3.
  CrossrefPubMedGoogle Scholar
• 2 Kemmler W, Haberle L, von Stengel S. Effects of exercise on fracture reduction in older adults : A systematic review and meta-analysis. Osteoporos Int 2013; 24: 1937-1950 DOI: 10.1007/s00198-012-2248-7.
  CrossrefPubMedGoogle Scholar
• 3 Sherrington C, Herbert RD, Maher CG. et al. PEDro. A database of randomized trials and systematic reviews in physiotherapy. Man Ther 2000; 5: 223-226 DOI: 10.1054/math.2000.0372.
  CrossrefPubMedGoogle Scholar
• 4 Kanis JA, Johnell O, Oden A. et al. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 2008; 19: 385-397 DOI: 10.1007/s00198-007-0543-5.
  CrossrefPubMedGoogle Scholar
• 5 Karinkanta S, Heinonen A, Sievanen H. et al. A multi-component exercise regimen to prevent functional decline and bone fragility in home-dwelling elderly women: randomized, controlled trial. Osteoporos Int 2007; 18: 453-462
  CrossrefPubMedGoogle Scholar
• 6 Iliffe S, Kendrick D, Morris R. et al. Multicentre cluster randomised trial comparing a community group exercise programme and home-based exercise with usual care for people aged 65 years and over in primary care. Health Technol Assess 2014; 18: vii-xxvii 1-105 DOI: 10.3310/hta18490.
  CrossrefPubMedGoogle Scholar
• 7 Higgins J, Thomas J, Chandler J et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021)
• 8 R-Core-Team. R. A language and environment for statistical computing. In: R Foundation for Statistical Computing ed stij ed. Vienna, Austria: https://www.R-project.org/. 2021
• 9 Ashburn A, Fazakarley L, Ballinger C. et al. A randomised controlled trial of a home based exercise programme to reduce the risk of falling among people with Parkinson’s disease. J Neurol Neurosurg Psychiatry 2007; 78: 678-684
  CrossrefPubMedGoogle Scholar
• 10 Bischoff-Ferrari HA, Vellas B, Rizzoli R. et al. Effect of Vitamin D Supplementation, Omega-3 Fatty Acid Supplementation, or a Strength-Training Exercise Program on Clinical Outcomes in Older Adults: The DO-HEALTH Randomized Clinical Trial. JAMA 2020; 324: 1855-1868 DOI: 10.1001/jama.2020.16909.
  CrossrefPubMedGoogle Scholar
• 11 Chan K, Qin L, Lau M. et al. A randomized, prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women. Arch Phys Med Rehabil 2004; 85: 717-722
  PubMedGoogle Scholar
• 12 Ebrahim SB, Thompson PW, Baskaran V. et al. Randomized placebo controlled trial of brisk walking in the prevention of postmenopausal osteoporosis. Age and Aging 1997; 26: 252-260
  CrossrefPubMedGoogle Scholar
• 13 Gianoudis J, Bailey CA, Ebeling PR. et al. Effects of a targeted multimodal exercise program incorporating high-speed power training on falls and fracture risk factors in older adults: a community-based randomized controlled trial. J Bone Miner Res 2014; 29: 182-191 DOI: 10.1002/jbmr.2014.
  CrossrefPubMedGoogle Scholar
• 14 Gill TM, Pahor M, Guralnik JM. et al. Effect of structured physical activity on prevention of serious fall injuries in adults aged 70-89: randomized clinical trial (LIFE Study). BMJ 2016; 352: i245 DOI: 10.1136/bmj.i245.
  CrossrefPubMedGoogle Scholar
• 15 Karinkanta S, Kannus P, Uusi-Rasi K. et al. Combined resistance and balance-jumping exercise reduces older women’s injurious falls and fractures: 5-year follow-up study. Age Ageing 2015; 44: 784-789 DOI: 10.1093/ageing/afv064.
  CrossrefPubMedGoogle Scholar
• 16 Kemmler W, von Stengel S, Engelke K. et al. Exercise effects on bone mineral density, falls, coronary risk factors, and health care costs in older women: the randomized controlled senior fitness and prevention (SEFIP) study. Arch Intern Med 2010; 170: 179-185 DOI: 10.1001/archinternmed.2009.499.
  CrossrefPubMedGoogle Scholar
• 17 Korpelainen R, Keinanen-Kiukaanniemi S, Heikkinen J. et al. Effect of exercise on extraskeletal risk factors for hip fractures in elderly women with low BMD: a population-based randomized controlled trial. J Bone Miner Res 2006; 21: 772-779
  CrossrefPubMedGoogle Scholar
• 18 Korpelainen R, Keinanen-Kiukaanniemi S, Nieminen P. et al. Long-term outcomes of exercise: follow-up of a randomized trial in older women with osteopenia. Arch Intern Med 2010; 170: 1548-1556 DOI: 10.1001/archinternmed.2010.311.
  CrossrefPubMedGoogle Scholar
• 19 Lamb SE, Bruce J, Hossain A. et al. Screening and Intervention to Prevent Falls and Fractures in Older People. N Engl J Med 2020; 383: 1848-1859 DOI: 10.1056/NEJMoa2001500.
  CrossrefPubMedGoogle Scholar
• 20 McMurdo ME, Mole PA, Paterson CR. Controlled trial of weight bearing exercise in older women in relation to bone density and falls. BMJ 1997; 314: 569
  CrossrefPubMedGoogle Scholar
• 21 Liu-Ambrose T, Davis JC, Best JR. et al. Effect of a Home-Based Exercise Program on Subsequent Falls Among Community-Dwelling High-Risk Older Adults After a Fall: A Randomized Clinical Trial. JAMA 2019; 321: 2092-2100 DOI: 10.1001/jama.2019.5795.
  CrossrefPubMedGoogle Scholar
• 22 Preisinger E, Alacamlioglu Y, Pils K. et al. Exercise therapy for osteoporosis: results of a randomised controlled trial. Br J Sports Med 1996; 30: 209-212
  CrossrefPubMedGoogle Scholar
• 23 Robertson MC, Devlin N, Gardner MM. et al. Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: Randomised controlled trial. BMJ 2001; 322: 697-701
  CrossrefPubMedGoogle Scholar
• 24 Sakamoto K, Endo N, Harada A. et al. Why not use your own body weight to prevent falls? A randomized, controlled trial of balance therapy to prevent falls and fractures for elderly people who can stand on one leg for</=15 s. J Orthop Sci 2013; 18: 110-120 DOI: 10.1007/s00776-012-0328-3.
  CrossrefPubMedGoogle Scholar
• 25 Sinaki M, Itoi E, Wahner HW. et al. Stronger back muscles reduce the incidence of vertebral fractures: a prospective 10 year follow-up of postmenopausal women. Bone 2002; 30: 836-841
  CrossrefPubMedGoogle Scholar
• 26 Maher CG, Sherrington C, Herbert RD. et al. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 2003; 83: 713-721
  CrossrefPubMedGoogle Scholar
• 27 Smart NA, Waldron M, Ismail H. et al. Validation of a new tool for the assessment of study quality and reporting in exercise training studies: TESTEX. Int J Evid Based Healthc 2015; 13: 9-18 DOI: 10.1097/XEB.0000000000000020.
  CrossrefPubMedGoogle Scholar
• 28 Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50: 1088-1101
  CrossrefPubMedGoogle Scholar
• 29 de Souto Barreto P, Rolland Y, Vellas B. et al. Association of Long-term Exercise Training With Risk of Falls, Fractures, Hospitalizations, and Mortality in Older Adults: A Systematic Review and Meta-analysis. JAMA Intern Med 2019; 179: 394-405 DOI: 10.1001/jamainternmed.2018.5406.
  CrossrefPubMedGoogle Scholar
• 30 Wang Q, Jiang X, Shen Y. et al. Effectiveness of exercise intervention on fall-related fractures in older adults: a systematic review and meta-analysis of randomized controlled trials. BMC Geriatr 2020; 20: 322 DOI: 10.1186/s12877-020-01721-6.
  CrossrefPubMedGoogle Scholar
• 31 Wells GA, Hsieh SC, Zheng C. et al. Risedronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev 2022; 5: CD004523 DOI: 10.1002/14651858.CD004523.pub4.
  CrossrefPubMedGoogle Scholar
• 32 Black DM, Delmas PD, Eastell R. et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 2007; 356: 1809-1822 DOI: 10.1056/NEJMoa067312.
  CrossrefPubMedGoogle Scholar
• 33 McCloskey EV, Johansson H, Oden A. et al. Denosumab reduces the risk of osteoporotic fractures in postmenopausal women, particularly in those with moderate to high fracture risk as assessed with FRAX. J Bone Miner Res 2012; 27: 1480-1486 DOI: 10.1002/jbmr.1606.
  CrossrefPubMedGoogle Scholar
• 34 Neer RM, Arnaud CD, Zanchetta JR. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001; 344: 1434-1441
  CrossrefPubMedGoogle Scholar
• 35 Wells G, Cranney A, Peterson J. et al. Risedronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev 2008; CD004523 DOI: 10.1002/14651858.CD004523.pub3.
  CrossrefPubMedGoogle Scholar
• 36 Sterne JA, Sutton AJ, Ioannidis JP. et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ 2011; 343: d4002 DOI: 10.1136/bmj.d4002.
  CrossrefPubMedGoogle Scholar
• 37 Gentil P, Arruda A, Souza D. et al. Is There Any Practical Application of Meta-Analytical Results in Strength Training?. Front Physiol 2017; 8: 1 DOI: 10.3389/fphys.2017.00001.
  CrossrefPubMedGoogle Scholar
• 38 Karinkanta S, Heinonen A, Sievanen H. et al. Maintenance of exercise-induced benefits in physical functioning and bone among elderly women. Osteoporos Int 2009; 20: 665-674 DOI: 10.1007/s00198-008-0703-2.
  CrossrefPubMedGoogle Scholar