Effektivität eines körperlichen Trainings zur Reduktion niedrig-traumatischer und osteoporotischer Hauptfrakturen in Erwachsenen. Systematische Übersichtsarbeit und Meta-Analyse

Zusammenfassung

Ziel dieses systematischen Reviews mit Metaanalyse war es den Effekt körperlichen Trainings auf die Frakturinzidenz niedrig-traumatischer Gesamt- und osteoporotischer Hauptfrakturen zu erfassen. Eine systematische Literaturrecherche in sechs Literaturdatenbanken gemäß der PRISMA-Leitlinie wurde bis zum 22. Mai 2021 durchgeführt. Eingeschlossen wurden klinische Trainingsstudien mit (a) Personen≥45 Jahren, (b) Kohorten ohne relevante pharmakologische Therapie oder Behandlung mit Einfluss auf Knochenstoffwechsel oder Sturz, (c) einer Interventionsdauer von≥3 Monaten und (d) einer Erfassung der Anzahl niedrig-traumatischer Frakturen, die getrennt für die Trainings- (TG) und Kontrollgruppe (KG) aufgeführt wurden. Die Untersuchung wurde in PROSPERO registriert (ID: CRD42021250467). Für die Analyse wurde ein bedingtes Poisson-Regressionsmodell mit gemischten Effekten verwendet. Zwanzig Interventionsstudien mit 21 TG versus 20 KG und insgesamt 11,836 Teilnehmerjahren in der TG und 11,275 Teilnehmerjahren in der KG wurden eingeschlossen. Es zeigten sich statistisch signifikante Effekte für die Gesamtfraktur- (Inzidenzrate: 0.67, 95%-Konfidenz-Intervall: 0.51–0.87) und osteoporotischen Hauptfraktur-Rate (IR: 0.69, 95%-KI: 0.52–0.92). Die Heterogenität der Studienergebnisse (I²=40 und I²<1%) sowie wie die Evidenz eines Publikations-/small-study „Bias“ lag in einem insgesamt niedrig-moderaten Bereich. Trotz einiger biometrischer Limitationen zeigt die Arbeit die hohe Relevanz körperlichen Trainings im Rahmen der Frakturprophylaxe selbstständig lebender Menschen in mittleren-hohen Lebensalter deutlich auf. Die vorgelegten Daten für niedrig-traumatische Gesamt- und osteoporotischen Hauptfrakturen liegen dabei im Bereich moderner pharmakologischer Therapie.

Abstract

The aim of the present systematic review and meta-analysis was to determine the effects of exercise on low-trauma overall and major osteoporotic fractures in adults. Our systematic search of six literature databases according to the PRISMA guideline was conducted up to May 22, 2021, and included controlled clinical exercise trials with (a) individuals≥45 years, (b) cohorts without therapies/diseases related to bone metabolism or falls, (c) an intervention of≥3 months, and (d) the number of low-traumatic fractures listed separately for the exercise (EG) and control (CG) groups. The study was registered in PROSPERO (ID: CRD42021250467). We applied a mixed-effects conditional Poisson regression model for the analysis. A total of 20 intervention studies with 21 EGs and 20 CGs were included in the analysis. The studies comprising a pooled number of participant-years of n=11,836 in the EG and n=11,275 in the CG. The meta-analysis determined significant effects of exercise on low-trauma overall fracture incidence (rate) ratio (IR: 0.67, 95% confidence interval (95%-CI): 0.51–0.87) and major osteoporotic fractures IR (0.69, 95%-CI: 0.52–0.92). Heterogeneity between the trials was moderate for low-trauma overall (I²=40%), and negligible (I²<1%) for major osteoporotic fractures. Funnel plots suggest low to moderate evidence of publication/small-study bias in study outcomes for low-trauma overall fractures. Despite some biometric limitations the present study provides further evidence of the positive effect of exercise on low-trauma overall and major osteoporotic fractures in community dwelling middle aged to older adults. With respect to low-trauma overall and major osteoporotic fractures reduction, the study results are comparable to current pharmaceutical agents.

Schlüsselwörter

körperliches Training - niedrig-traumatische Fraktur - osteoporotische Hauptfraktur - Osteoporose - Sturzprophylaxe

Key words

Exercise - low-trauma fracture - major osteoporotic fracture - osteoporosis - fall reduction

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