Adverse events and safety issues associated with physical activity and exercise for adults with osteoporosis and osteopenia: A systematic review of observational studies and an updated review of interventional studies

Abstract

Objectives: We conducted a systematic review to identify adverse effects of physical activity and/or exercise for adults with osteoporosis/osteopenia. We synthesised evidence from observational studies, and updated three previously published systematic reviews. Methods: We searched MEDLINE, EMBASE, CINAHL, Web of Science, grey literature and reference lists of relevant studies. Selection criteria were: (1) observational studies in patients with osteoporosis/osteopenia; and (2) in accordance with the criteria used in the previous reviews. A narrative synthesis was conducted for the observational data. Random effects meta-analysis was undertaken for the review updates. Results: For the observational synthesis 14 studies were included. The majority of studies reported no adverse events, reduced incidence/improvement, or no significant change after physical activity or exercise. Activities that involved spinal flexion (certain yoga moves and sit-ups) were associated with a greater risk of vertebral fractures but these events were rare. For the update of reviews, 57 additional studies were identified. Exercise was generally associated with a greater number of minor adverse events including mild muscle/joint pain. Serious adverse events were rare and could not be attributed to the intervention. Conclusion: Patients with osteoporosis/osteopenia can safely participate in structured exercise programmes, whether at home or in supervised facilities. Systematic review registration for observational studies: PROSPERO 2017: CRD42017070551

Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis

“…A few case studies described instances of vertebral fractures during horse riding or during a golfing mid-swing stroke 48. However, the majority of observational or non-randomised studies in people with osteoporosis did not report adverse events, apart from muscle soreness and joint discomfort 44 48.…”

Effect of kettlebell training on bone mineral density in two older adults with osteoporosis: a multiple-case study from the BELL trial

“…Due to their fear of fracture, older adults diagnosed with osteoporosis are often overly cautious and risk-averse towards engaging in impact and resistance exercise (6) . This fear and anxiety can be compounded by inappropriate messages from healthcare providers where uncertainty exists around what is appropriate and safe (5) .…”

“…Currently, approximately two thirds of Australians over 50 years of age have low bone mass (3) , with 500 daily osteoporotic fractures projected to occur in Australia by 2022 (4) . More than one in three women and one in five men are likely to sustain at least one fragility fracture in their lifetime (5, 6) with the cumulative risk of fracture for postmenopausal women as high as 60% (7) . More than 50% of older adults who fracture a hip are no longer able to live independently and almost one in three can die within 12 months of the fracture (5, 8) .…”

“…Hip fractures account for the largest proportion of this increase (43%), with 74% of the fractures occurring in people over 70 years of age (10) , with direct and indirect costs of osteoporosis projected to be $3.84 billion by 2022 in Australia (5) . In addition to the financial cost, the social burden is considerable, with fragility fractures, especially in the hip and spine, causing severe pain, disability, loss of independence, and decreased quality of life (7) . Up to 70% of the variance in fracture from loading is explained by BMD (11) with each 1 SD reduction in BMD representing a 1.5 to 3-fold increase in risk of fracture (2,6) .…”

Higher-Impact Physical Activity Is Associated With Maintenance of Bone Mineral Density But Not Reduced Incident Falls or Fractures in Older Men: The Concord Health and Aging in Men Project

“…When determining the skeletal benefits of physical activity, studies have commonly compared specific exercise modes ( 10,11 ) or utilized traditional physical activity measurement instruments like pedometers or questionnaires that fail to capture mechanical loading intensity or rate, possibly explaining their inconsistent associations with bone mineral density (BMD). ( 12,13 ) Accelerometers capture habitual physical activity loading via impact counts per unit of time and have demonstrated positive associations between moderate to vigorous physical activity and tibial microarchitecture and bone mass in older men.…”