Jepsen Ditte Beck, Thomsen Katja, Hansen Stinus, Jørgensen Niklas Rye, Masud Tahir, Ryg Jesper
Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.
Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
BMJ Open. 2017 Dec 29;7(12):e018342. doi: 10.1136/bmjopen-2017-018342.
To investigate the effect of whole-body vibration exercise (WBV) on fracture risk in adults ≥50 years of age.
A systematic review and meta-analysis calculating relative risk ratios, fall rate ratio and absolute weighted mean difference using random effects models. Heterogeneity was estimated using I statistics, and the Cochrane Collaboration's risk of bias tool and the GRADE approach were used to evaluate quality of evidence and summarise conclusions.
The databases PubMed, Embase and the Cochrane Central Register from inception to April 2016 and reference lists of retrieved publications.
Randomised controlled trials examining the effect of WBV on fracture risk in adults ≥50 years of age. The primary outcomes were fractures, fall rates and the proportion of participants who fell. Secondary outcomes were bone mineral density (BMD), bone microarchitecture, bone turnover markers and calcaneal broadband attenuation (BUA).
15 papers (14 trials) met the inclusion criteria. Only one study had fracture data reporting a non-significant fracture reduction (risk ratio (RR)=0.47, 95% CI 0.14 to 1.57, P=0.22) (moderate quality of evidence). Four studies (n=746) showed that WBV reduced the rate of falls with a rate ratio of 0.67 (95% CI 0.50 to 0.89, P=0.0006; I=19%) (moderate quality of evidence). Furthermore, data from three studies (n=805) found a trend towards falls reduction (RR=0.76, 95% CI 0.48 to 1.20, P=0.24; I=24%) (low quality of evidence). Finally, moderate to low quality of evidence showed no overall effect on BMD and only sparse data were available regarding microarchitecture parameters, bone turnover markers and BUA.
WBV reduces fall rate but seems to have no overall effect on BMD or microarchitecture. The impact of WBV on fractures requires further larger adequately powered studies. This meta-analysis suggests that WBV may prevent fractures by reducing falls.
CRD42016036320; Pre-results.
探讨全身振动锻炼（WBV）对50岁及以上成年人骨折风险的影响。
一项系统评价和荟萃分析，使用随机效应模型计算相对风险比、跌倒率比和绝对加权平均差。使用I统计量估计异质性，并使用Cochrane协作网的偏倚风险工具和GRADE方法评估证据质量并总结结论。
从数据库建立至2016年4月的PubMed、Embase和Cochrane中心注册库，以及检索到的出版物的参考文献列表。
考察WBV对50岁及以上成年人骨折风险影响的随机对照试验。主要结局为骨折、跌倒率和跌倒参与者的比例。次要结局为骨密度（BMD）、骨微结构、骨转换标志物和跟骨宽带衰减（BUA）。
15篇论文（14项试验）符合纳入标准。只有一项研究有骨折数据，报告骨折减少不显著（风险比（RR）=0.47，95%可信区间0.14至1.57，P=0.22）（证据质量中等）。四项研究（n=746）表明，WBV降低了跌倒率，率比为0.67（95%可信区间0.50至0.89，P=0.0006；I=19%）（证据质量中等）。此外，三项研究（n=805）的数据发现有跌倒减少的趋势（RR=0.76，95%可信区间0.48至1.20，P=0.24；I=24%）（证据质量低）。最后，中低质量的证据表明对BMD无总体影响，关于微结构参数、骨转换标志物和BUA只有少量数据。
WBV降低跌倒率，但似乎对BMD或微结构无总体影响。WBV对骨折的影响需要进一步开展规模更大、有足够效力的研究。这项荟萃分析表明，WBV可能通过减少跌倒来预防骨折。
PROSPERO注册号：CRD42016036320；预结果。
