title: Additive effects of antiresorptive agents and exercise on lumbar spine bone mineral density in adults with low bone mass: a meta-analysis.
abstract: BACKGROUND
  Exercise has been recommended to increase bone mass and prevent osteoporosis. While current treatment of osteoporosis mainly involves the use of antiresorptive agents, it is unclear whether there are any additive effects in improving bone mass when antiresorptive agents and exercise are jointly used.
  
  
  METHODS
  A structured and comprehensive search of databases was undertaken along with hand searching of key journals and reference lists. The combined interventions of antiresorptive agents and exercise were examined for their additive effects on lumbar spine bone mineral density (BMD) among adults with low bone mass. Trial quality was assessed using the Jadad quality score. Study outcomes for analysis, absolute change (grams per square centimeter) or relative change (in percent) in BMD, at the lumbar spine were compared by calculating standardized mean difference (SMD) using fixed and random effect models.
  
  
  RESULTS
  Seven randomized controlled trials (RCT) met the predetermined inclusion criteria. The increase in lumbar spine BMD of the combined-intervention group was significantly greater than that of the antiresorptive agent-alone group (fixed effect model: SMD = 0.55; 95% confidence interval (CI) = 0.36, 0.75; overall effect Z-value = 5.51; p < 0.00001). Subgroup analyses also showed consistent results. Methodological quality of most included studies was scored 3 by the Jadad criterion, and publication bias was slight according to funnel plots.
  
  
  CONCLUSIONS
  It was found that combining antiresorptive agents with exercise had additive effects on improving lumbar spine bone mass gains in adults with low bone mass. To verify the additive effects further, more RCTs with longer duration and larger sample sizes are needed.
authors.affiliation: Evidence-Based Medicine Group, Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
authors.forename: J
authors.initials: J
authors.lastname: Zhang
authors.forename: R
authors.initials: R
authors.lastname: Gao
authors.forename: P
authors.initials: P
authors.lastname: Cao
authors.forename: W
authors.initials: W
authors.lastname: Yuan
mesh_terms: D015519:Bone Density / Q000187:drug effects* / Q000502:physiology; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology*; D010024:Osteoporosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D010349:Patient Compliance
chemical_list: D050071:Bone Density Conservation Agents