Benefits and harms of non-surgical and non-pharmacological management of osteoporotic vertebral fractures: A systematic review and meta-analysis.

BACKGROUND: Osteoporotic vertebral fractures affect a large number of older adults OBJECTIVES: Systematically review evidence of the benefits and harms of non-surgical and non-pharmacological management of people with osteoporotic vertebral fractures compared with standard care (control); and evaluate the benefits and harms of non-surgical and non-pharmacological management of people with osteoporotic vertebral fractures compared with an alternative non-pharmacological, non-invasive intervention. DESIGN: Systematic review and meta-analysis of randomized controlled trials. Five electronic databases (CINAHL, EMBASE, MEDLINE, PUBMED, and COCHRANE) were searched. Eligible trials included participants with primary osteoporosis and at least one vertebral fracture diagnosed on radiographs, with treatment that was non-surgical and non-pharmacological involving more than one session. RESULTS: Twenty randomized controlled trials were included with 2083 participants with osteoporotic vertebral fractures. Exercise, bracing, multimodal therapy, electrotherapy, and taping were investigated interventions. Meta-analyses provided low certainty evidence that exercise interventions compared to no exercise were effective in reducing pain in patients with osteoporotic vertebral fractures (mean difference (MD)= 1.01; 95% confidence interval (CI): 0.08, 1.93), and low certainty evidence that rigid bracing intervention compared with no bracing was effective in reducing pain in patients with osteoporotic vertebral fractures (MD= 2.61; 95%CI: 0.95, 4.27). Meta-analyses showed no differences in harms between exercise and no exercise groups. No health-related quality of life or activity improvements were demonstrated for exercise interventions, bracing, electrotherapy, or multimodal interventions. CONCLUSIONS: Exercise and rigid bracing as management for patients with osteoporotic vertebral fractures may have a small benefit for pain without increasing risk of harm. TRIAL REGISTRATION: PROSPERO registration number CRD42012002936.

Effects of exercise on bone density and falls risk factors in post-menopausal women with osteopenia: a randomised controlled trial.

OBJECTIVES: This study aimed to determine the efficacy of an exercise program for post-menopausal women with osteopenia undertaken in community exercise facilities. DESIGN: Randomised, single-blind controlled trial. METHODS: Thirty-nine community volunteers with hip osteopenia and not taking bone-enhancing medication were randomly allocated to an exercise (EX) or control (CON) group. EX participants attended an exercise facility in Melbourne, Australia, three times/week for 52 weeks (with a 2 week break) for partially supervised exercises targeting hip bone strength, muscle strength and balance. They also performed daily jumping exercises at home. CON participants continued with their usual care. All participants were given calcium supplementation. Assessment at baseline and 52 weeks measured bone mineral density (BMD) at the proximal femur and lumbar spine. Health-related quality of life (QOL) and objective measures of strength and balance were also collected. RESULTS: ANCOVA adjusting for baseline values revealed a small benefit of exercise in mean total hip BMD (the primary outcome) with a significant mean difference in change between groups of -0.012 g/cm(2) (95% CI -0.022 to -0.002 g/cm(2)). EX participants improved 0.5% compared with a 0.9% loss for CON participants. The only other between-group differences were in QOL and a test of trunk and upper limb endurance, which both favoured the EX group. CONCLUSIONS: This exercise program appears to have modest benefits for post-menopausal women with osteopenia who are not taking bone-enhancing medication. This mode of exercise delivery has adherence and progression limitations but may be appropriate to recommend for some people.