Exercise interventions to reduce fall-related fractures and their risk factors in individuals with low bone density: a systematic review of randomized controlled trials.
CONCLUSIONS
Exercise can reduce falls and fall-related fractures in healthy individuals; however, evidence for individuals with low BMD is limited. The results from this systematic review indicate that exercise interventions for individuals with low BMD to reduce falls and fractures should include balance, muscle strengthening, and weight-bearing exercises.


BACKGROUND
The purpose of this systematic review was to investigate which exercise interventions are effective in individuals with low bone mineral density (BMD; osteopenia or osteoporosis) in reducing (1) falls and fractures and (2) risk factors for falls and fractures.


METHODS
Databases were searched for relevant studies between 1996 and June 2008. Methodological quality was assessed with the Jadad score and the PEDro scale.


RESULTS
Of the 1,369 publications found, 23 met the inclusion criteria. Five additional articles were included after checking reference lists and searching author's names and related articles. Interventions with balance exercises reduced falls or fall-related fractures and improved balance in the majority of the studies. Muscle strengthening exercises were effective in improving lower extremity strength and back extensor strength; however, not all RCT's reported positive effects. Bone strength was improved by weight-bearing aerobic exercise with or without muscle strengthening exercise when the duration of the intervention was at least a year.


CONCLUSIONS
Exercise can reduce falls, fall-related fractures, and several risk factors for falls in individuals with low BMD. Exercise interventions for patients with osteoporosis should include weight-bearing activities, balance exercise, and strengthening exercises to reduce fall and fracture risk.
de Kam
D
D
Department of Rehabilitation, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Smulders
E
E
Weerdesteyn
V
V
Smits-Engelsman
B C M
BC
D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000502:physiology; D019317:Evidence-Based Medicine / Q000379:methods; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000503:physiopathology / Q000534:rehabilitation*; D058866:Osteoporotic Fractures / Q000209:etiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012107:Research Design; D012307:Risk Factors