Rehabilitation Division, Tottori University Hospital, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
Department of Data Science, The Institute of Statistical Mathematics, 10-3 Midori-cho, Tachikawa, Tokyo, 190-8562, Japan.
J Bone Miner Metab. 2021 Sep;39(5):787-803. doi: 10.1007/s00774-021-01218-1. Epub 2021 Apr 13.
This study aimed to examine the effect of high-load resistance training (HLRT) on bone mineral density (BMD) in patients with osteoporosis and osteopenia using a meta-analysis.
We searched for randomized controlled trials (RCTs) on HLRT in patients with osteoporosis and osteopenia from medical databases. Our meta-analysis was performed with the primary endpoints being the standardized mean difference (SMD) of the change in BMD of the lumbar spine (LS), femoral neck (FN), and total hip (TH). The robustness of the results was assessed by subgroup analysis. Heterogeneity factors were examined by meta-regression. Publication bias was evaluated using a funnel plot.
We selected nine RCTs, with 259 patients in the HLRT group (women, 55.2%) and 236 patients in the control group (women, 62.7%). The HLRT group showed a significant increase in BMD in the LS [SMD = 1.40, 95% confidence interval (CI) = 0.68-2.12, p < 0.001, I = 90%], the FN (SMD = 0.86, 95% CI = 0.05-1.67, p = 0.04, I = 92%), and the TH (SMD = 1.26, 95% CI = 0.45-2.08, p = 0.002, I = 91%). Subgroup analysis confirmed the robustness of the results only in LS. Total sessions and a high risk of bias were identified as the factors of heterogeneity in FN and TH (p < 0.05). The funnel plot showed asymmetry in all measurement sites.
This study suggested that HLRT can be effective in increasing BMD, mainly of LS, in patients with osteoporosis and osteopenia. However, due to high heterogeneity and publication bias, additional studies with a low risk of bias should be conducted to generalize our findings.
本研究旨在通过荟萃分析探讨高强度负荷阻力训练（HLRT）对骨质疏松症和骨量减少患者骨密度（BMD）的影响。
我们从医学数据库中检索了针对骨质疏松症和骨量减少患者的 HLRT 的随机对照试验（RCT）。我们的荟萃分析主要终点是腰椎（LS）、股骨颈（FN）和全髋关节（TH）的 BMD 变化的标准化均数差（SMD）。通过亚组分析评估结果的稳健性。通过 meta 回归检查异质性因素。使用漏斗图评估发表偏倚。
我们选择了 9 项 RCT，HLRT 组有 259 例患者（女性，55.2%），对照组有 236 例患者（女性，62.7%）。HLRT 组 LS 的 BMD 显著增加[SMD=1.40，95%置信区间（CI）=0.68-2.12，p<0.001，I=90%]，FN（SMD=0.86，95%CI=0.05-1.67，p=0.04，I=92%）和 TH（SMD=1.26，95%CI=0.45-2.08，p=0.002，I=91%）。亚组分析仅在 LS 中证实了结果的稳健性。FN 和 TH 的异质性因素为总疗程和高偏倚风险（p<0.05）。漏斗图显示所有测量部位均存在不对称性。
本研究表明，HLRT 可有效增加骨质疏松症和骨量减少患者的 BMD，主要是 LS 的 BMD。然而，由于存在高度异质性和发表偏倚，应进行额外的低偏倚风险研究来推广我们的发现。
