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Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture

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Abstract

Summary

A consensus process was conducted to develop exercise recommendations for individuals with osteoporosis or vertebral fractures. A multicomponent exercise program that includes balance and resistance training is recommended.

Introduction

The aim was to develop consensus on exercise recommendations for older adults: (1) with osteoporosis and (2) with osteoporotic vertebral fracture(s).

Methods

The Grading of Recommendations Assessment, Development, and Evaluation method was used to evaluate the quality of evidence and develop recommendations. Outcomes important for decision making were nominated by an expert panel and patient advocates. They included falls, fractures, bone mineral density (BMD), and adverse events for individuals with osteoporosis/vertebral fractures, and pain, quality of life, and function for those with vertebral fracture. Meta-analyses evaluating the effects of exercise on the outcomes were reviewed. Observational studies or clinical trials were reviewed when meta-analyses were not available. Quality ratings were generated, and informed the recommendations.

Results

The outcome for which evidence is strongest is falls. Point estimates of the effects of exercise on falls, fractures, and BMD vary according to exercise type. There is not enough evidence to quantify the risks of exercise in those with osteoporosis or vertebral fracture. Few trials of exercise exist in those with vertebral fracture. The exercise recommendations for exercise in individuals with osteoporosis or osteoporotic vertebral fracture are conditional. The panel strongly recommends a multicomponent exercise program including resistance and balance training for individuals with osteoporosis or osteoporotic vertebral fracture. The panel recommends that older adults with osteoporosis or vertebral fracture do not engage in aerobic training to the exclusion of resistance or balance training.

Conclusions

The consensus of our international panel is that exercise is recommended for older adults with osteoporosis or vertebral fracture, but our recommendations are conditional.

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Acknowledgments

These recommendations were reviewed and endorsed by Osteoporosis Canada, by the National Osteoporosis Foundation, and by Osteoporosis Australia's Medical and Scientific Advisory Committee. We are grateful for the International Osteoporosis Foundation’s contribution and review of this document, as well as reviews by Dr. Susan Muir and Bonny O’Hare representing the Canadian Physiotherapy Association, and reviews by Dr. Harri Sievänen and Dr. Maarit Piirtola representing the Finnish Osteoporosis Association. We would like to acknowledge financial support from the University of Waterloo, Osteoporosis Canada, and the Ontario Osteoporosis Strategy and the Schlegel-University of Waterloo Research Institute for Aging. We would like to thank Celina Lin, Michael McLeod and Caroline Jeon for their assistance with the literature review process. L.M. Giangregorio is a CIHR. New investigator Award Recipient, and holds an Early Researcher Award from the Ontario Ministry of Research and Innovation.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Kinesiology, University of Waterloo, 200 University Ave, Waterloo, ON, N2L 3G1, Canada

    L. M. Giangregorio, S. McGill & H. Keller

  2. University Health Network, Toronto Rehabilitation Institute, Toronto, Canada

    L. M. Giangregorio

  3. Schlegel-UW Research Institute for Aging, Kitchener, Canada

    L. M. Giangregorio & H. Keller

  4. Department of Medicine, McMaster University, Hamilton, Canada

    A. Papaioannou

  5. School of Rehabilitation Science, McMaster University, Hamilton, Canada

    N. J. MacIntyre

  6. Department of Family Practice, University of British Columbia, Vancouver, Canada

    M. C. Ashe

  7. Department of Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland

    A. Heinonen

  8. Department of Community and Family Medicine, Duke University, Durham, NC, USA

    K. Shipp

  9. Department of Medicine, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia

    J. Wark

  10. Osteoporosis Canada, Toronto, Canada

    R. Jain & J. Laprade

  11. Division of Anatomy, University of Toronto, Toronto, Canada

    J. Laprade

  12. Department of Medicine, University Health Network, University of Toronto, Toronto, Canada

    A. M. Cheung

Authors
  1. L. M. Giangregorio
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  2. A. Papaioannou
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  3. N. J. MacIntyre
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  4. M. C. Ashe
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  5. A. Heinonen
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  6. K. Shipp
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  7. J. Wark
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  8. S. McGill
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  9. H. Keller
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  10. R. Jain
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  11. J. Laprade
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  12. A. M. Cheung
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Corresponding author

Correspondence to L. M. Giangregorio.

Appendix A: Members of the expert panel for GRADE recommendations process

Appendix A: Members of the expert panel for GRADE recommendations process

Member name, title, affiliation

 Lora Giangregorio, Associate Professor, Department of Kinesiology, University Health Network, University of Waterloo, Canada, Research Scientist, Schlegel-UW Research Institute for Aging

 Alexandra Papaioannou, Professor, Department of Medicine, McMaster University, Canada

 Angela Cheung, Professor, Department of Medicine, University Health Network, University of Toronto, Canada

 Ari Heinonen, Professor, Department of Health Sciences, University of Jyvaskyla, Finland

 John Wark, Professor of Medicine, University of Melbourne, Australia

 Kathy Shipp, Assistant Professor, Department of Medicine, Duke University, United States of America

 Maureen Ashe, Assistant Professor, Dept. of Family Practice, University of British Columbia, Canada

 Norma MacIntyre, Associate Professor, School of Rehabilitation Science, McMaster University, Canada

 Stuart McGill, Professor, Department of Kinesiology, University of Waterloo, Canada

 Heather Keller, Professor, Department of Kinesiology, University of Waterloo, Canada, Schlegel Research Chair, Schlegel-UW Research Institute for Aging

Osteoporosis Canada partners

 Ravi Jain, Director, Ontario Osteoporosis Strategy & Osteoporosis Canada

 Judi Laprade, Lecturer, Division of Anatomy, University of Toronto, Lead Consultant, Bone FitTM Training Program, Osteoporosis Canada

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Giangregorio, L.M., Papaioannou, A., MacIntyre, N.J. et al. Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Osteoporos Int 25, 821–835 (2014). https://doi.org/10.1007/s00198-013-2523-2

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