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Abstract：
OBJECTIVE: Physical exercise has obvious effects on bone loss, pain relief, and improvement of bone metabolism indexes in patients with osteoporosis, but currently lacks sufficient evidence. The aim of this systematic review and meta-analysis was to synthesize and present the best available evidence on the effectiveness and safety of exercises in the treatment of primary osteoporosis.
METHODS: Publications pertaining to the effectiveness of exercise on bone mineral density (BMD), visual analog scores (VAS), and biochemical markers of bone metabolism in primary osteoporosis (POP) from PubMed, Cochrane Library, Embase, VIP, CNKI, and Wanfang Database were retrieved from their inception to April 2020.
RESULTS: A total of 20 studies with 1824 participants were included. The results of the meta-analysis revealed that exercise therapy for lumbar spine and femoral neck BMD is statistically different from conventional therapy (lumbar spine BMD: SMD = 0.78, 95%CI: 0.46, 1.10, P < 0.00001, I2 = 85%; femoral neck BMD (SMD = 0.80, 95%CI: 0.34, 1.27, P = 0.0007, I2 = 88%), exercise therapy can significantly increase the lumbar spine BMD of patients with OP, especially in lumbar spine2-4 BMD (SMD = 0.47; 95%CI: 0.20, 0.75; P = 0.0008; I2 = 69%). Compared with conventional treatment, kinesitherapy also has significant differences in alleviating the pain of POP patients (SMD = -1.39, 95%CI: -2.47,-0.31, P = 0.01, I2 = 97%). Compared with conventional therapy, kinesitherapy has no significant difference in improving biochemical markers of bone metabolism such as bone glaprotein (BGP) (SMD = 2.59, 95%CI:0.90, 4.28, P = 0.003, I2 = 98%), N-terminal pro peptide of type I procollagen (PINP) (SMD = 0.77, 95%CI: -0.44 to 1.98, P = 0.21, I2 = 95%), serum phosphorus (SMD = 0.04, 95%CI: -0.13, 0.22, P = 0.61, I2 = 30%), alkaline phosphatase (ALP) (SMD = -0.08, 95%CI: -0.44, 0.27, P = 0.64, I2 = 76%), and serum calcium (SMD = 0.12, 95%CI: -0.18, 0.43, P = 0.42, I2 = 63%) in POP patients.
CONCLUSIONS: Kinesitherapy significantly improved lumbar spine and femoral neck BMD, and relieve the pain of patients in the current low-quality evidence. Additional high-quality evidence is required to confirm the effect of exercise therapy on the biochemical markers of bone metabolism in POP patients.
METHODS: Publications pertaining to the effectiveness of exercise on bone mineral density (BMD), visual analog scores (VAS), and biochemical markers of bone metabolism in primary osteoporosis (POP) from PubMed, Cochrane Library, Embase, VIP, CNKI, and Wanfang Database were retrieved from their inception to April 2020.
RESULTS: A total of 20 studies with 1824 participants were included. The results of the meta-analysis revealed that exercise therapy for lumbar spine and femoral neck BMD is statistically different from conventional therapy (lumbar spine BMD: SMD = 0.78, 95%CI: 0.46, 1.10, P < 0.00001, I2 = 85%; femoral neck BMD (SMD = 0.80, 95%CI: 0.34, 1.27, P = 0.0007, I2 = 88%), exercise therapy can significantly increase the lumbar spine BMD of patients with OP, especially in lumbar spine2-4 BMD (SMD = 0.47; 95%CI: 0.20, 0.75; P = 0.0008; I2 = 69%). Compared with conventional treatment, kinesitherapy also has significant differences in alleviating the pain of POP patients (SMD = -1.39, 95%CI: -2.47,-0.31, P = 0.01, I2 = 97%). Compared with conventional therapy, kinesitherapy has no significant difference in improving biochemical markers of bone metabolism such as bone glaprotein (BGP) (SMD = 2.59, 95%CI:0.90, 4.28, P = 0.003, I2 = 98%), N-terminal pro peptide of type I procollagen (PINP) (SMD = 0.77, 95%CI: -0.44 to 1.98, P = 0.21, I2 = 95%), serum phosphorus (SMD = 0.04, 95%CI: -0.13, 0.22, P = 0.61, I2 = 30%), alkaline phosphatase (ALP) (SMD = -0.08, 95%CI: -0.44, 0.27, P = 0.64, I2 = 76%), and serum calcium (SMD = 0.12, 95%CI: -0.18, 0.43, P = 0.42, I2 = 63%) in POP patients.
CONCLUSIONS: Kinesitherapy significantly improved lumbar spine and femoral neck BMD, and relieve the pain of patients in the current low-quality evidence. Additional high-quality evidence is required to confirm the effect of exercise therapy on the biochemical markers of bone metabolism in POP patients.
摘要：
目的：体育锻炼对骨质流失有明显的影响，疼痛缓解,骨质疏松患者骨代谢指标的改善,但目前缺乏足够的证据。本系统评价和荟萃分析的目的是综合并提供有关运动治疗原发性骨质疏松症的有效性和安全性的最佳证据。
方法：关于运动对骨矿物质密度（BMD）的有效性的出版物，视觉模拟评分(VAS)，和来自PubMed的原发性骨质疏松症（POP）的骨代谢生化标志物，科克伦图书馆,Embase,VIP,CNKI,和万方数据库从成立到2020年4月进行了检索。
结果：共纳入20项研究，共1824名参与者。荟萃分析结果显示，运动疗法对腰椎和股骨颈BMD的影响与常规疗法（腰椎BMD：SMD=0.78，95CI：0.46，1.10，P<0.00001，I2=85％；股骨颈BMD（SMD=0.80，95CI：0.34，1.27，P=0.0007，I2=88％），运动疗法能显著增加OP患者的腰椎BMD,尤其是腰椎2-4骨密度(SMD=0.47;95CI:0.20,0.75;P=0.0008;I2=69%)。与常规治疗相比,运动疗法在缓解POP患者疼痛方面也有显著差异(SMD=-1.39,95CI:-2.47,-0.31,P=0.01,I2=97%)。与常规治疗相比,运动疗法在改善骨代谢的生化标志物如骨glap(BGP)方面无显著差异(SMD=2.59,95CI:0.90,4.28,P=0.003,I2=98%),I型前胶原的N端前肽（PINP）（SMD=0.77，95CI：-0.44至1.98，P=0.21，I2=95％），血清磷（SMD=0.04，95CI：-0.13，0.22，P=0.61，I2=30％），碱性磷酸酶(ALP)(SMD=-0.08,95CI:-0.44,0.27,P=0.64,I2=76%),POP患者血清钙(SMD=0.12,95CI:-0.18,0.43,P=0.42,I2=63%)。
结论：运动疗法可显著改善腰椎和股骨颈BMD，并在当前低质量证据中缓解患者的痛苦。需要额外的高质量证据来证实运动疗法对POP患者骨代谢生化标志物的影响。
方法：关于运动对骨矿物质密度（BMD）的有效性的出版物，视觉模拟评分(VAS)，和来自PubMed的原发性骨质疏松症（POP）的骨代谢生化标志物，科克伦图书馆,Embase,VIP,CNKI,和万方数据库从成立到2020年4月进行了检索。
结果：共纳入20项研究，共1824名参与者。荟萃分析结果显示，运动疗法对腰椎和股骨颈BMD的影响与常规疗法（腰椎BMD：SMD=0.78，95CI：0.46，1.10，P<0.00001，I2=85％；股骨颈BMD（SMD=0.80，95CI：0.34，1.27，P=0.0007，I2=88％），运动疗法能显著增加OP患者的腰椎BMD,尤其是腰椎2-4骨密度(SMD=0.47;95CI:0.20,0.75;P=0.0008;I2=69%)。与常规治疗相比,运动疗法在缓解POP患者疼痛方面也有显著差异(SMD=-1.39,95CI:-2.47,-0.31,P=0.01,I2=97%)。与常规治疗相比,运动疗法在改善骨代谢的生化标志物如骨glap(BGP)方面无显著差异(SMD=2.59,95CI:0.90,4.28,P=0.003,I2=98%),I型前胶原的N端前肽（PINP）（SMD=0.77，95CI：-0.44至1.98，P=0.21，I2=95％），血清磷（SMD=0.04，95CI：-0.13，0.22，P=0.61，I2=30％），碱性磷酸酶(ALP)(SMD=-0.08,95CI:-0.44,0.27,P=0.64,I2=76%),POP患者血清钙(SMD=0.12,95CI:-0.18,0.43,P=0.42,I2=63%)。
结论：运动疗法可显著改善腰椎和股骨颈BMD，并在当前低质量证据中缓解患者的痛苦。需要额外的高质量证据来证实运动疗法对POP患者骨代谢生化标志物的影响。
