Effectiveness of different exercise types for improving bone mineral density in adults: A pairwise, network, and dose-response meta-analysis of 162 randomized controlled trials
Abstract
BACKGROUND
Comparative effectiveness of exercise modalities across skeletal sites and the dose-response pattern for bone mineral density (BMD) remain incompletely characterized. This review aimed to compare exercise modalities across six skeletal sites and to explore whether MET-min/week could describe a dose-response relationship between exercise exposure and BMD change.
METHODS
We conducted a systematic review and meta-analysis of RCTs (PROSPERO: CRD420261345811), searching four databases to March 2026. Three complementary frameworks were applied: three-level pairwise meta-analysis with robust variance estimation, Bayesian network meta-analysis (NMA) with prespecified vague priors and SUCRA rankings, and exploratory dose-response model-based NMA using restricted cubic spline modelling of MET-min/week. Methodological quality was assessed using ROBUST-RCT, GRADE, and an NMA-specific certainty assessment considering intransitivity and incoherence.
RESULTS
We included 162 RCTs (10,475 participants; age range, 18-81.6 years). Pairwise GRADE certainty ranged from high (femoral neck) to very low (total hip). Significant pooled effects were observed at five of six sites: lumbar spine (Hedges' g = 0.22), femoral neck (g = 0.28), Ward's triangle (g = 0.23), trochanter (g = 0.15), and total body (g = 0.26). NMA suggested site-specific ranking patterns, but credible intervals were often wide and NMA certainty was commonly limited by imprecision, heterogeneity, and sparse direct…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 10,475 participants or records.
Read the paper
Related studies
- Erratum to: The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations
- Association between obesity and risk of fracture, bone mineral density and bone quality in adults: A systematic review and meta-analysis
- Dietary Patterns in Relation to Low Bone Mineral Density and Fracture Risk: A Systematic Review and Meta-Analysis
- Association of obesity with bone mineral density and osteoporosis in adults: a systematic review and meta-analysis
- Falls, fractures, and areal bone mineral density in older adults with sarcopenic obesity: A systematic review and meta‐analysis
- Exercise training and bone mineral density in postmenopausal women: an updated systematic review and meta-analysis of intervention studies with emphasis on potential moderators
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.