Table 4

Characteristics of intervention studies and their main findings: non-pharmacological treatments provided to adults at high risk of primary osteoporotic fracture

Authors, country, setting if statedStudy designPopulation characteristics; number of participants for outcomes of interestIntervention; healthcare professional if statedMain findingsLoE
i) Exercise
de Kam et al53SRAdults with osteoporosis/osteopenia±a fracture
nine trials (n=974)
Exercise compared with inactive control group or sham interventionExercising <1 year had no effect on BMD (3/4 studies)
Exercising ≥1 year had positive effect on BMD/BMC (5/6 studies)
Luo et al30MAPostmenopausal women with osteoporosis
seven trials (n=287)
Whole body vibration therapy compared with usual careNo significant difference between groups in change in BMD (SMD=−0.06, 95% CI −0.22 to 0.11; p=0.05)1
Wei et al24MAPostmenopausal women with osteoporosis
two trials (n=116)
Wuqinxi exercise (mind/body conditioning) compared with usual careNo significant difference in lumbar spine BMD at 6 months between IG and CG (SMD 0.81, 95% CI −0.58 to 2.20, p=0.25)2
Varahra et al31MAAdults with osteoporosis/osteopenia±a fracture
seven trials (n=614); five trials (n=406)
Multicomponent exercise compared with non-exercise, usual physical activity and educationSMD favoured IG for mobility (−0.56, 95% CI −0.81 to 0.32) and balance (0.5, 95% CI 0.27 to 0.74)1
Korpelainen et al Finland, community54RCTWomen with osteopenia
1.Group 1 (n=84); 2.Group 2 (n=76)
  1. Multimodal exercise for 12 months

  2. General health information and usual care

17 fractures in the IG versus 23 fractures in CG at 7-year follow-up (IRR=0.68, 95% CI 0.34 to 1.32). Similar decrease in BMD in IG and CG2
Gianoudis et al Australia, community55RCTAdults with osteopenia/risk of falls
1.Group 1 (n=81); 2.Group 2 (n=81)
1.Multimodal exercise for 12 months+education
2.Usual care
Exercise trainers
No significant difference in falls incidence between IG and CG at 1 year (IRR 1.22, 95% CI 0.71 to 2.04), p=0.462
Kemmler et al Germany community56CCT
Women with osteopenia
1.Group 1 (n=59); 2.Group 2 (n=46)
1.Long-term multimodal exercise
2.Sedentary control group
Certified trainers
13 fractures in the IG versus 24 fractures in the CG at 16-year follow-up (rate ratio=0.42; 95% CI 0.20 to 0.86; p=0.018)3
ii) Nutrients including vitamin D plus calcium and oral nutritional supplements
Porter et al58SRPostmenopausal women with osteopenia
three trials (n=254)
Supplementation with vitamin D analogues compared with placeboNo significant difference in mean % change in BMD in IG or CG when assessed between 6 and 12 months1
Koutsofta et al59SRPostmenopausal women with osteoporosis
five studies (n=677)
Non-soy protein (diet and/or supplement) compared with a control group.The effect of non-soy protein on BMD at different sites was mixed.2
Cheung et al Canada, community60RCTPostmenopausal women with osteopenia
1.Group 1 (n=217); 2.Group 2 (n=223)
  1. Vitamin K (5 mg) daily

  2. Placebo

No significant difference in BMD decrease at the LS or total hip between IG and CG at 2 years. IG, 6 fractures; CG, 11 fractures1
iii) Falls prevention programmes
Smulders et al The Netherlands, community36RCTAdults with osteoporosis +falls history
1.Group 1 (n=50); 2.Group 2 (n=46)
  1. Falls prevention programme lasting 5.5 weeks.

  2. Usual care

Physical therapists, occupational therapists
Fall rate at 12 months was 39% lower in the IG compared with the CG (IRR 0.61, 95% CI 0.40 to 0.94)2
Palvanen et al Finland community57RCTOlder adults at high risk of fracture
1.Group 1 (n=661); 2.Group 2 (n=653)
  1. Individualised falls prevention programme

  2. Brochure

Nurse, physiotherapist, physician
Significantly lower rate of falls at 12 months (IRR 0.72, 95% CI 0.61 to 0.86; p<0.001, NNT=3). Total number of fractures 33 (IG) versus 42 (CG) (IRR 0.77, 95% CI 0.48 to 1.23; p=0.276)2
iv) Education
Morfeld et al61SRPatients with low bone mass
four studies (n=2877)
Face-to-face patient education compared with no education or usual care1/4 trials showed a significant between group difference in hip fracture incidence at 10-year follow-up.2
  • BMC, bone mineral content; BMD, bone mineral density; CCT, controlled clinical trial; CG, control group; IG, intervention group; IRR, incidence rate ratio; LoE, level of evidence; LS, lumbar spine; MA, meta-analysis; NNT, number needed to treat; NR, non-randomised; RCT, randomised controlled trial; RR, relative risk; SMD, standardised mean difference; SR, systematic review.