Exercise effects on glucocorticoid-induced bone loss in adults: a systematic review and meta-analysis

Abstract

Objectives Due to their pronounced anti-inflammatory and immunosuppressive effects Glucocorticoids (GC) are widely used in the field of inflammatory conditions and organ transplants. Unfortunately, GC-induced osteoporosis is one of the most common causes of secondary osteoporosis. The aim of the present systematic review and meta-analysis was to determine the effect of exercise added to GC-therapy on bone mineral density (BMD) at the lumbar spine or femoral neck in people under GC-therapy. Methods A systematic literature search of five electronic databases included controlled trials with a duration of more than 6 months and at least two study arms: (a) Glucocorticoids (GC), (b) GC and exercise (GC+EX) were conducted up to 20/09/2022. Studies involving other pharmaceutical therapies with relevant effects on bone metabolism were excluded. We applied the inverse heterogeneity model. Outcome measures were standardized mean differences (SMD) with 95%-confidence intervals (95%-CI) for BMD changes at the lumbar spine (LS) and femoral neck (FN). Results We identified three eligible trials with 62 participants in total. In summary, the GC+EX intervention indicates statistically significantly higher SMD for LS- (SMD: 1.50; 95%-CI: 0.23 to 2.77), albeit not for FN-BMD (0.64; 95%-CI: -0.89 to 2.17), compared with GC-treatment alone. We observed substantial heterogeneity (LS-BMD: I2=71%, FN-BMD: I2=78%) between the study results. Conclusion Although more well-designed exercise studies are needed to address the issue of exercise effects on glucocorticoid-induced osteoporosis (GIOP) in more detail, upcoming guidelines should already pay more attention to the aspect of exercise for bone strengthening in GIOP. Registration number PROSPERO; ID: CRD42022308155 Lay summary What does this mean for patients ? Based on our research, we suggest that patients with glucocorticoid induced osteoporosis should participate in regular exercise programs for osteoporosis and fracture reduction. This not only helps to prevent fall-related fractures but also to increase bone mineral density, particularly at the lumbar spine and proximal femur, which are skeletal sites very prone to fragility fractures. Nevertheless, more well-designed exercise trials are needed to address the issue of exercise effects on glucocorticoid-induced osteoporosis in more detail, and to look at different groups of people on glucocorticoid therapy.