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JFSF Vol 3, No 4, December 2018, p.155-178

doi: 10.22540/JFSF-03-155


Review Article

Adverse events and safety issues associated with physical activity and exercise for adults with osteoporosis and osteopenia: A systematic review of observational studies and an updated review of interventional studies

Setor K. Kunutsor1,2, Sarah Leyland3, Dawn A. Skelton4, Laura James5, Matthew Cox5, Nicola Gibbons5, Julie Whitney5, Emma M. Clark6

  1. National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, UK
  2. Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK
  3. National Osteoporosis Society, Camerton, Bath, UK
  4. School of Health & Life Sciences, Centre for Living, Glasgow Caledonian University, Glasgow
  5. Department of Academic Physiotherapy, King’s College London, London, UK
  6. Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, UK

Keywords: Osteoporosis, Physical activity, Exercise, Adverse events, Systematic review


Objectives: We conducted a systematic review to identify adverse effects of physical activity and/or exercise for adults with osteoporosis/osteopenia. We synthesised evidence from observational studies, and updated three previously published systematic reviews. Methods: We searched MEDLINE, EMBASE, CINAHL, Web of Science, grey literature and reference lists of relevant studies. Selection criteria were: (1) observational studies in patients with osteoporosis/osteopenia; and (2) in accordance with the criteria used in the previous reviews. A narrative synthesis was conducted for the observational data. Random effects meta-analysis was undertaken for the review updates. Results: For the observational synthesis 14 studies were included. The majority of studies reported no adverse events, reduced incidence/improvement, or no significant change after physical activity or exercise. Activities that involved spinal flexion (certain yoga moves and sit-ups) were associated with a greater risk of vertebral fractures but these events were rare. For the update of reviews, 57 additional studies were identified. Exercise was generally associated with a greater number of minor adverse events including mild muscle/joint pain. Serious adverse events were rare and could not be attributed to the intervention. Conclusion: Patients with osteoporosis/osteopenia can safely participate in structured exercise programmes, whether at home or in supervised facilities. Systematic review registration for observational studies: PROSPERO 2017: CRD42017070551