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. 2019 Jul 5;7(7):CD008618.
doi: 10.1002/14651858.CD008618.pub3.

Exercise for improving outcomes after osteoporotic vertebral fracture

Jenna C Gibbs  1 , Norma J MacIntyre, Matteo Ponzano, Jeffrey Alan Templeton, Lehana Thabane, Alexandra Papaioannou, Lora M Giangregorio
Affiliations

Exercise for improving outcomes after osteoporotic vertebral fracture

Jenna C Gibbs et al. Cochrane Database Syst Rev. .

Abstract

Background: Vertebral fractures are associated with increased morbidity (e.g. pain, reduced quality of life) and mortality. Therapeutic exercise is a non-pharmacological conservative treatment that is often recommended for patients with vertebral fractures to reduce pain and restore functional movement. This is an update of a Cochrane Review first published in 2013.

Objectives: To assess the effects (benefits and harms) of exercise intervention of four weeks or greater (alone or as part of a physical therapy intervention) versus non-exercise/non-active physical therapy intervention, no intervention or placebo among adults with a history of vertebral fractures on incident fragility fractures of the hip, vertebra or other sites. Our secondary objectives were to evaluate the effects of exercise on the following outcomes: falls, pain, physical performance, health-related quality of life (disease-specific and generic), and adverse events.

Search methods: We searched the following databases until November 2017: the Cochrane Library (Issue 11 of 12), MEDLINE (from 2005), Embase (from 1988), CINAHL (Cumulative Index to Nursing and Allied Health Literature, from 1982), AMED (from 1985), and PEDro (Physiotherapy Evidence Database, from 1929). Ongoing/recently completed trials were identified by searching the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov. Conference proceedings were searched via ISI and SCOPUS, and targeted searches of proceedings of the American Congress of Rehabilitation Medicine and American Society for Bone and Mineral Research. Search terms or MeSH headings included terms such as vertebral fracture AND exercise OR physical therapy. For this update, the search results were limited from 2011 onward.

Selection criteria: We included all randomized controlled trials and quasi-randomized trials comparing exercise or active physical therapy interventions with placebo/non-exercise/non-active physical therapy interventions or no intervention implemented in individuals with a history of vertebral fracture.

Data collection and analysis: Two review authors independently selected trials and extracted data using a pre-tested data extraction form. Disagreements were resolved by consensus, or third-party adjudication. We used Cochrane's tool for assessing risk of bias to evaluate each study. Studies were grouped according to duration of follow-up (i.e. a) 4-12 weeks; b) 16-24 weeks; c) 52 weeks); a study could be represented in more than one group depending on the number of follow-up assessments. For dichotomous data, we reported risk ratios (RR) and corresponding 95% confidence intervals (95% CI). For continuous data, we reported mean differences (MD) of the change from baseline and 95% CI. Data were pooled for Timed Up and Go test, self-reported physical function measured by the QUALEFFO-41 physical function subscale score (scale of zero to 100; lower scores indicate better self-reported physical function), and disease-specific quality of life measured by the QUALEFFO-41 total score (scale of zero to 100; lower scores indicate better quality of life) at 12 weeks using a fixed-effect model.

Main results: Nine trials (n = 749, 68 male participants; two new trials in this review update) were included. Substantial variability across the trials prevented any meaningful pooling of data for most outcomes. Risk of bias across all studies was variable; low risk across most domains in four studies, and unclear/high risk in most domains for five studies. Performance bias and blinding of subjective outcome assessment were almost all high risk of bias.One trial reported no between-group difference in favor of the effect of exercise on incident fragility fractures after 52 weeks (RR 0.54, 95% CI 0.17 to 1.71; very low-quality evidence with control: 184 per 1000 and exercise: 100 per 1000, 95% CI 31 to 315; absolute difference: 8%, 95% CI 2 to 30). One trial reported no between-group difference in favor of the effect of exercise on incident falls after 52 weeks (RR 1.06, 95% CI 0.53 to 2.10; very low-quality evidence with control: 262 per 1000 and exercise: 277 per 1000; 95% CI 139 to 550; absolute difference: 2%, 95% CI -12 to 29). These findings should be interpreted with caution because of the very serious risk of bias in these studies and the small sample sizes resulting in imprecise estimates.We are uncertain that exercise could improve pain, self-reported physical function, and disease-specific quality of life, because certain studies showed no evidence of clinically important differences for these outcomes. Pooled analyses revealed a small between-group difference in favor of exercise for Timed Up and Go (MD -1.13 seconds, 95% CI -1.85 to -0.42; studies = 2), which did not change following a sensitivity analysis (MD -1.09 seconds, 95% CI -1.78 to -0.40; studies = 3; moderate-quality evidence). Exercise improved QUALEFFO-41 physical function score (MD -2.84 points, 95% CI -5.57 to -0.11; studies = 2; very low-quality evidence) and QUALEFFO-41 total score (MD -3.24 points, 95% CI -6.05 to -0.43; studies = 2; very low-quality evidence), yet it is unlikely that we observed any clinically important differences. Three trials reported four adverse events related to the exercise intervention (costal cartilage fracture, rib fracture, knee pain, irritation to tape, very low-quality evidence).

Authors' conclusions: In conclusion, we do not have sufficient evidence to determine the effects of exercise on incident fractures, falls or adverse events. Our updated review found moderate-quality evidence that exercise probably improves physical performance, specifically Timed Up and Go test, in individuals with vertebral fracture (downgraded due to study limitations). However, a one-second improvement in Timed Up and Go is not a clinically important improvement. Although individual trials did report benefits for some pain and disease-specific quality of life outcomes, the findings do not represent clinically meaningful improvements and should be interpreted with caution given the very low-quality evidence due to inconsistent findings, study limitations and imprecise estimates. The small number of trials and variability across trials limited our ability to pool outcomes or make conclusions. Evidence regarding the effects of exercise after vertebral fracture in men is scarce. A high-quality randomized trial is needed to inform safety and effectiveness of exercise to lower incidence of fracture and falls and to improve patient-centered outcomes (pain, function) for individuals with vertebral fractures (minimal sample size required is approximately 2500 untreated participants or 4400 participants if taking anti-osteoporosis therapy).

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Conflict of interest statement

J. Gibbs: None.

N. MacIntyre: None.

M. Ponzano: None.

J. Templeton: None.

L. Thabane: is a member of an Advisory Board for Network Meta‐analysis for GSK.

A. Papaioannou: is or has been a consultant, or on a speaker’s bureau, or received unrestricted grants for the following: Amgen, Eli Lilly, Merck Frosst Canada, Novartis, Pfizer, Warner Chilcott.

L. Giangregorio: has consulted for ICON on behalf of Eli Lilly related to physical performance and osteoporosis.

Figures

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1
PRISMA study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

Bennell 2010 {published data only}
    1. Bennell KL, Matthews B, Greig A, Briggs A, Kelly A, Sherburn M, et al. Effects of an exercise and manual therapy program on physical impairments, function and quality‐of‐life in people with osteoporotic vertebral fracture: a randomised, single‐blind controlled pilot trial. BMC Musculoskeletal Disorders 2010;11:36. - PMC - PubMed
Bergland 2011 {published data only}
    1. Bergland A, Thorsen H, Karesen R. Effect of exercise on mobility, balance, and health‐related quality of life in osteoporotic women with a history of vertebral fracture: a randomized, controlled trial. Osteoporosis International 2011;22(6):1863‐71. - PubMed
    1. Olsen CF, Bergland A. The effect of exercise and education on fear of falling in elderly women with osteoporosis and a history of vertebral fracture: results of a randomized controlled trial. Osteoporosis International 2014 Aug;25(8):2017‐25. - PubMed
Bergstrom 2011 {published data only}
    1. Bergstrom I, Bergstrom K, Kronhed A, Karlsson S, Brinck J. Back extensor training increases muscle strength in postmenopausal women with osteoporosis, kyphosis and vertebral fractures. Advances in Physiotherapy 2011;13(3):110‐7.
Evstigneeva 2016 {published data only}
    1. Evstigneeva L, Lesnyak O, Bultink IEM, Lems WF, Kozhemyakina E, Negodaeva E, Guselnikova G, Belkin A. Effect of twelve‐month physical exercise program on patients with osteoporotic vertebral fractures: a randomized, controlled trial. Osteoporosis International Aug 2016;27(8):2515‐24. [DOI: 10.1007/s00198-016-3560-4] - DOI - PubMed
    1. Evstigneeva L, Lesnyak O, Negodaeva E, Guselnikova G, Kozhemyakina E. A randomized, prospective study of the effects of exercise on quality of life in postmenopausal women with vertebral fractures. Osteoporosis International. 2013; Vol. 24, issue Suppl 1:S273‐274.
    1. Evstigneeva L, Negodaeva E, Kozhemykina E, Belkin A. Effect of exercise on balance and functional mobility in postmenopausal women with vertebral fractures. Osteoporosis International. 2016; Vol. 27, issue Suppl 1:S520. - PubMed
Gold 2004 {published data only}
    1. Gold DT, Shipp KM, Pieper CF, Duncan PW, Martinez S, Lyles KW. Group treatment improves trunk strength and psychological status in older women with vertebral fractures: results of a randomized, clinical trial. Journal of the American Geriatrics Society 2004;52(9):1471‐8. - PubMed
Malmros 1998 {published data only}
    1. Malmros B, Mortensen L, Jensen MB, Charles P. Positive effects of physiotherapy on chronic pain and performance in osteoporosis. Osteoporosis International 1998;8(3):215‐21. - PubMed
Papaioannou 2003a {published data only}
    1. Papaioannou A, Adachi JD, Winegard K, Ferko N, Parkinson W, Cook RJ, et al. Efficacy of home‐based exercise for improving quality of life among elderly women with symptomatic osteoporosis‐related vertebral fractures. Osteoporosis International 2003;14(8):677‐82. - PubMed
Wang 2015 {published data only}
    1. Wang XF, Xu B, Ye XY, Yang YY, Wang GH. Effects of different treatments on patients with osteoporotic fracture after percutaneous kyphoplasty. Zhongguo Gu Shang 2015;28(6):512‐6. - PubMed
Yang 2007 {published data only}
    1. Yang L, He CQ, Xie W, Lan Q. Effect of pain‐free exercises on female osteoporosis patients with spinal compressive fracture. Journal of Clinical Rehabilitative Tissue Engineering Research 2007;11(45):9108‐11.

References to studies excluded from this review

Bada 2009 {published data only}
    1. Bada AM, Rodriguez JE. What are the best treatments for reducing pain due to compression fractures?. Evidence Based Practice 2009;12(1):4‐5.
Barker 2014 {published data only}
    1. Barker KL, Javaid MK, Newman M, Lowe CM, Stallard N, Campbell H, et al. Physiotherapy Rehabilitation for Osteoporotic Vertebral Fracture (PROVE): study protocol for a randomised controlled trial. Trials 2014;15(22):1‐11. - PMC - PubMed
Bautmans 2010 {published data only}
    1. Bautmans I, Arken J, Mackelenberg M, Mets T. Rehabilitation using manual mobilization for thoracic kyphosis in elderly postmenopausal patients with osteoporosis. Journal of Rehabilitation Medicine 2010;42:129‐35. - PubMed
Bergland 2012 {published data only}
    1. Bergland A. Effect of exercise on falls efficacy in osteoporotic women with a history of vertebral fracture: A randomized controlled trial. 8th Congress of the European Geriatric Medicine 2012;3S:S67.
Borgo 2010 {published data only}
    1. Borgo MJ, Sinaki M. Back progressive resistive exercise program to reduce risk of vertebral fractures. Journal für Mineralstoffwechsel 2010;17(2):66‐71.
Chan 2017 {published data only}
    1. Chan DC, Chang CB, Liao JK, Han DS, Hwang JS, Liu PY, Hong CH, Tsai KS, Huang KC, Yang RS. Effects of two exercise programs on posture and back pain in community‐dwelling elderly with high fragility fracture risks. Osteoporosis International, 2017, Conference: World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases, WCO‐IOF‐ESCEO 2017. Italy. 28 (Suppl 1):S127–S636. 2017.
Chen 2011 {published data only}
    1. Chen BL, Zhong Y, Huang YL, Zeng LW, Li YQ, Yang XX, et al. Systematic back muscle exercise after percutaneous vertebroplasty for spinal osteoporotic compression fracture patients: a randomized fracture patients: a randomized controlled trial. Clinical Rehabilitation 2011;26(6):483‐92. - PubMed
Chen 2015 {published data only}
    1. Chen JP, Qi XW, Li SJ, Kuang LP, Yuan XH, Wang GS, et l. Bone cement injection as vertebral augmentation therapy for osteoporotic vertebral compression fractures. Journal of Clinical Rehabilitative Tissue Engineering Research 2015;19(21):3292.
Dusdal 2011 {published data only}
    1. Dusdal K, Grundmanis J, Luttin K, Ritchie P, Rompre C, Sidhu R, et al. Effects of therapeutic exercise for persons with osteoporotic vertebral fractures: a systematic review. Osteoporosis International 2011;22:755‐69. - PubMed
Evstigneyeva 2013 {published data only}
    1. Evstigneyeva L, Kozhemyakina E, Lesnyak O, Negodaeva E, Guselnikova G, Belkin A, et al. Effect of exercise for patients with osteoporotic vertebral fractures. Annals of the Rheumatic Diseases. 2013; Vol. 72:A137. - PubMed
Gandhi 2015 {published data only}
    1. Gandhi V, Cooper C, Barker K. Recruitment challenges in physiotherapy trials. Trials 2015 16(Suppl 2):P95. 2015. [DOI: 10.1186/1745-6215-16-S2-P95] - DOI
Giangregorio 2014c {published data only}
    1. Giangregorio LM, Thabane L, Adachi JD, Ashe MC, Bleakney RR, Braun EA, et al. Build better bones with exercise: protocol for a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in women with a vertebral fracture. Physical Therapy 2014;94(9):1337‐52. [ NCT01761084] - PMC - PubMed
Hongo 2007 {published data only}
    1. Hongo M, Itoi E, Sinaki M, Miyakoshi N, Shimada Y, Maekawa S, et al. Effect of low‐intensity back exercise on quality of life and back extensor strength in patients with osteoporosis: a randomized controlled trial. Osteoporosis International 2007;18(10):1389‐95. - PubMed
Jensen 2012 {published data only}
    1. Jensen RK, Leboeuf‐Yde C, Wedderkopp N, Sorensen JS, Manniche C. Rest versus exercise as a treatment for patients with low back pain and Modic changes. a randomized controlled clinical trial. BMC Medicine 2012;10(22):1‐13. - PMC - PubMed
Kaijser Alin 2016 {published data only}
    1. Kaijser Alin K, Grahn Kronhed AL, Uzunel E, Alinaghizadeh H, Salminen H. Effect of treatment on back extensor strength with a spinal orthosis in elderly women with osteoporosis: a randomized controlled trial. Osteoporosis International (2016) 27 (Suppl 1):S39–S62. 2016. - PMC - PubMed
Karakasidou 2013 {published data only}
    1. Karakasidou P, Skordilis EK, Lyritis GP. Motor control exercise can reduce pain and kyphosis in osteoporotic women with vertebral fractures: a randomized controlled trial. Review of Clinical Pharmacology and Pharmacokinetics 2013;27:95‐106.
Liu 2017 {published data only}
    1. Liu T, Sheng L, Huang Z. Influence of exercise intervention on pain, quality of life and functional mobility in patients with osteoporotic vertebral fractures: a systematic review and meta‐analysis. International Journal of Clinical and Experimental Medicine 2017;10(7):9864‐70.
Lord 1996 {published data only}
    1. Lord SR, Ward JA, Williams P, Zivanovic E. The effects of a community exercise program on fracture risk factors in older women. Osteoporosis International 1996;6(5):361‐7. - PubMed
Malmros 1999 {published data only}
    1. Malmros B, Mortensen L, Jensen M, Charles P. Effect of specific physiotherapy on chronic pain, functional level and quality of life in osteoporosis: A prospective randomized single‐blind placebo controlled study. Ugeskrift Laeger 1999;161(33):4636‐41. - PubMed
Marcu 2015 {published data only}
    1. Marcu RI, Patru S, Bighea AC, Traistaru R, Popescu RS. Role of physical exercice program in patients with osteoporosis. Annals of the Rheumatic Diseases 74:529. 2015.
Mihailov 2011 {published data only}
    1. Mihailov M, Popa D, Suciu N. Efficacy of a rehabilitation program on pain, daily activities and quality of life in women with osteoporosis. Osteoporosis International 2011;22(Suppl 1):S295.
Miyakoshi 2010 {published data only}
    1. Miyakoshi N, Horikawa A, Hongo M, Kasukawa Y, Shimada Y. Effects of a simple, low‐intensity back extension exercise on quality of life and back extensor strength in patients with osteoporosis and vertebral fractures: a 6‐month randomized controlled trial. Journal of Bone and Mineral Research. 2010; Vol. Abstract.
Nemes 2014 {published data only}
    1. Nemes D, Catan L, Popa D, Amaricai E, Andrei D, Puenea G. Role of rehabilitation in preventing radiculopathies due to osteoporotic vertebral compression fractures. Osteoporosis International. 2014; Vol. 25 Suppl 2:S205.
Rapp 2011 {published data only}
    1. Rapp SM. Early mobilization, rigid fixation after vertebral compression fractures reduces vertebral deformity. Orthopedics Today 2011;October:45.
Rittchen 1991 {published data only}
    1. Rittchen A, Petracic B. [Fruhfunktionelle Behandlung der stabilen Kompressionsbruche der Brusta und Lendenwirbelsaule]. Krankengymnastik 1991;43(4):336‐9.
Schwinning 1992 {published data only}
    1. Schwinning M. [Krankengymnastik nach Wirbelfrakturen der BWS‐LWS ohne neurologische symptomatik]. Krankengymnastik 1992;44(1):34‐8.
Shipp 2004 {published data only}
    1. Shipp KM, Pieper, CF, Gold DT, Lyles KW. Change in walking endurance among women with prevalent vertebral fractures: associations with concurrent change in impairment, functional status, and disability. Journal of Bone and Mineral Research. 2004; Vol. Abstract M454.
Shipp 2007 {published data only}
    1. Shipp KM, Gold DT, Pieper, CF, Lyles KW. Improving trunk strength and endurance in older women with vertebral fractures. Journal of Bone and Mineral Research. 2007; Vol. Abstract W398.
Sinaki 1984 {published data only}
    1. Sinaki M, Mikkelsen BA. Postmenopausal spinal osteoporosis: flexion versus extension exercises. Archives of Physical Medicine and Rehabilitation 1984;65(10):593‐6. - PubMed
Sinaki 1995 {published data only}
    1. Sinaki M. Rehabilitation of osteoporotic fractures of the spine. Physical Medicine and Rehabilitation 1995;9(1):105‐23.
Smith 1998 {published data only}
    1. Smith AA, Summers GD, Baxendale A, Butterly RJ. A randomized controlled trial of the effects of weight‐bearing exercise and resistance training on risk factors for fracture in women with osteoporosis. Current Research in Osteoporosis and Bone Mineral Measurement. London: British Institute of Radiology, 1998:128.
Stadhouder 2009 {published data only}
    1. Stadhouder A, Buskens E, Vergroesen DA, Fidler MW, Nies F, Oner FC. Nonoperative treatment of thoracic and lumbar spine fractures: a prospective randomized study of different treatment options. Journal of Orthopaedic Trauma 2009;23(8):588‐94. - PubMed
Svensson 2017 {published data only}
    1. Svensson Hk, Olsson LE, Hansson T, Karlsson J, Hansson‐Olofsson E. The effects of person‐centered or other supportive interventionsin older women with osteoporotic vertebral compressionfractures—a systematic review of the literature. Osteoporos International 2017;28(9):2521‐40. - PMC - PubMed
Webber 2003 {published data only}
    1. Webber CE, Papaioannou A, Winegard KJ, Adachi JD, Parkinson W, Ferko NC, et al. A 6‐mo home‐based exercise program may slow vertebral height loss. Journal of Clinical Densitometry 2003;6(4):391‐400. - PubMed
Zhong 2012 {published data only}
    1. Zhong Y, Huang Y, Li Y, Wang C. Medium and long term effects of systematic back muscle exercise after percutaneous vertebroplasty for osteoporotic fracture. Chinese Journal of Tissue Engineering Research 2012;16(30):5544‐5548.

References to studies awaiting assessment

Bergstrom 2016 {published data only}
    1. Bergstrom I. Vertebral fractures in an osteoporotic perspective, symptoms and what to do. Osteoporosis International. 2016; Vol. 27 Suppl 1:S570.
Giangregorio 2017 {published data only}
    1. Giangregorio LM, Thabane L, Adachi JD, Ashe MC, Bleakney R, Cheung AM, et al. Build better bones with exercise: feasibility of a multicenter randomized controlled trial of 12 months of home exercise in women with a vertebral fracture. Journal of Bone and Mineral Research. 2017; Vol. 32 (Suppl 1). [NCT01761084]
Giangregorio 2018 {published data only}
    1. Giangregorio LM, Gibbs JC, Templeton JA, Adachi JD, Ashe MC, Bleakney RR, et al. Build better bones with exercise (B3E pilot trial): results of a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in older women with vertebral fracture. Osteoporosis International 2018;29:2545‐56. [DOI: 10.1007/s00198-018-4652-0] - DOI - PubMed
Pompa 2016 {published data only}
    1. Pompa A, Lugari G, Giampa E, Della Vedova C, Pace L, Tramontano M, et al. Effects of postural and respiratory rehabilitation in patients with hyper‐kyphosis by osteoporotic vertebral fractures: a pilot study. Osteoporosis International 2016;27(Suppl 1):S122.

References to ongoing studies

Stanghelle 2018 {published data only}
    1. NCT02781974. The effect of exercise on physical function in older women with osteoporosis and a history of vertebral fracture: a randomized controlled trial. clinicaltrials.gov/show/NCT02781974 (first posted May 25, 2016). [ClinicalTrials.gov: NCT02781974]
    1. Stanghelle B, Bentzen H, Giangregorio L, Pripp AH, Bergland A. Effect of a resistance and balance exercise programme for women with osteoporosis and vertebral fracture: study protocol for a randomized controlled trial. BMC Musculoskeletal Disorders 2018;19:100. [DOI: 10.1186/s12891-018-2021-y] - DOI - PMC - PubMed

Additional references

Adachi 2001
    1. Adachi JD, Loannidis G, Berger C, Joseph L, Papaioannou A, Pickard L, et al. The influence of osteoporotic fractures on health‐related quality of life in community‐dwelling men and women across Canada. Osteoporosis International 2001;12(11):903‐8. - PubMed
Avenell 2014
    1. Avenell A, Mak JC, O'Connell D. Vitamin D and vitamin D analogues for preventing fractures in post‐menopausal women and older men. Cochrane Database of Systematic Reviews 2014, Issue 4. [DOI: 10.1002/14651858.CD000227.pub4] - DOI - PMC - PubMed
Bessette 2008
    1. Bessette L, Ste‐Marie LG, Jean S, Davison KS, Beaulieu M, Baranci M, et al. Recognizing osteoporosis and its consequences in Quebec (ROCQ); background, rationale and methods of an anti‐fracture patient health‐management programme. Contemporary Clinical Trials 2008;29(2):194‐210. - PubMed
Black 1996
    1. Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 1996 Dec 7;348(9041):1535‐41. - PubMed
Briggs 2007
    1. Briggs AM, Dieën JH, Wrigley TV, Greig AM, Phillips B, Lo SK, et al. Thoracic kyphosis affects spinal loads and trunk muscle force. Physical Therapy 2007;87(5):595‐607. - PubMed
Bruno 2012
    1. Bruno AG, Anderson DE, D'Agostino J, Bouxsein ML. The effect of thoracic kyphosis and sagittal plane alignment on vertebral compressive loading. Journal of Bone and Mineral Research 2012;27(10):2144‐51. - PMC - PubMed
Cauley 2000
    1. Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D. Risk of mortality following clinical fractures. Osteoporosis International 2000;11(7):556‐61. - PubMed
Cauley 2007
    1. Cauley JA, Hochberg MC, Lui LY, Palermo L, Ensrud KE, Hillier TA, et al. Long‐term risk of incident vertebral fractures. JAMA 2007;298(23):2761‐7. - PubMed
Chou 2012
    1. Chou CH, Hwang CL, Wu YT. Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: a meta‐analysis. Archives of Physical Medicine and Rehabilitation 2012;93(2):237‐44. - PubMed
Cooper 1993
    1. Cooper C, O'Neill T, Silman A. The epidemiology of vertebral fractures. European Vertebral Osteoporosis Study Group. Bone 1993;14(Supp1):S89‐97. - PubMed
Dusdal 2010
    1. Dusdal K, Grundmanis J, Luttin K, Ritchie P, Rompre C, Sidhu R, et al. Effects of therapeutic exercise for persons with osteoporoticvertebral fractures: a systematic review. Osteoporosis International 2010;22:755–69. - PubMed
Evstigneeva 2013
    1. Evstigneeva L, Lesnyak O, Negodaeva E, Guselnikova G, Kozhemyakina E. A randomized, prospective study of the effects of exercise on quality of life in postmenopausal women with vertebral fractures. Osteoporosis International. 2013; Vol. 24(Suppl 1):S273‐274.
FDA 1995
    1. Expert Working Group (Efficacy) of the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use. Clinical Safety Data Management: Definitions and Standards for Expedited Reporting. FDA Center for Drug and Evaluation Research 1995.
Gallacher 2007
    1. Gallacher SJ, Gallagher AP, McQuillian C, Mitchell PJ, Dixon T. The prevalence of vertebral fracture amongst patients presenting with non‐vertebral fractures. Osteoporosis International 2007;18(2):185‐92. - PMC - PubMed
Gautschi 2017
    1. Gautschi OP, Stienen MN, Corniola MV, Joswig H, Schaller K, Hildebrandt G, et al. Assessment of the Minimum Clinically Important Difference in the Timed Up and Go Test After Surgery for Lumbar Degenerative Disc Disease. Neurosurgery 2017;80(3):380‐5. - PubMed
Ghogomu 2014
    1. Ghogomu EA, Maxwell LJ, Buchbinder R, Rader T, Pardo Pardo J, Johnston RV, et al. Editorial Board of the Cochrane Musculoskeletal Group. Updated method guidelines for Cochrane Musculoskeletal Group systematic reviews and metaanalyses. Journal of Rheumatology 2014 Feb;41(2):194‐205. [DOI: 10.3899/jrheum.121306] - DOI - PubMed
Giangregorio 2014a
    1. Giangregorio LM, Papaioannou A, Macintyre NJ, Ashe MC, Heinonen A, Shipp K, et al. Too Fit to Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Osteoporosis International 2014 March;25(3):821‐35. - PMC - PubMed
Giangregorio 2014b
    1. Giangregorio LM, MacIntyre NJ, Heinonen A, Cheung AM, Wark JD, Shipp K, et al. Too Fit To Fracture: a consensus on future research priorities in osteoporosis and exercise. Osteoporosis International 2014 May;25(5):1465‐72. - PMC - PubMed
Giangregorio 2015
    1. Giangregorio LM, McGill S, Wark JD, Laprade J, Heinonen A, Ashe MC, et al. Too Fit To Fracture: outcomes of a Delphi consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral fractures. Osteoporosis International 2015 March;26(3):891‐910. - PMC - PubMed
Handoll 2011
    1. Handoll HH, Sherrington C, Mak JC. Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database of Systematic Reviews 2011, Issue 3. [DOI: 10.1002/14651858.CD001704.pub4] - DOI - PubMed
Handoll 2015
    1. Handoll HH, Elliott J. Rehabilitation for distal radial fractures in adults. Cochrane Database of Systematic Reviews 2015, Issue 9. [DOI: 10.1002/14651858.CD003324.pub3] - DOI - PMC - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. - PMC - PubMed
Higgins 2011
    1. Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org. The Cochrane Collaboration.
Howe 2011
    1. Howe TE, Shea B, Dawson LJ, Downie F, Murray A, Ross C, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews 2011, Issue 7. [DOI: 10.1002/14651858.CD000333.pub2] - DOI - PubMed
Jackson 2000
    1. Jackson SA, Tenenhouse A, Robertson L. Vertebral fracture definition from population‐based data: preliminary results from the Canadian Multicenter Osteoporosis Study (CaMos). Osteoporosis International 2000;11(8):680‐7. - PubMed
Kado 2007
    1. Kado DM, Huang MH, Nguyen CB, Barrett‐Connor E, Greendale GA. Hyperkyphotic posture and risk of injurious falls in older persons: the Rancho Bernardo Study. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 2007;62(6):652‐7. - PubMed
Kanis 2001
    1. Kanis JA, Oden A, Johnell O, Jonsson B, Laet C, Dawson A. The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporosis International 2001;12(5):417‐27. - PubMed
Kanis 2004
    1. Kanis JA, Johnell O, Laet C, Johansson H, Oden A, Delmas P, et al. A meta‐analysis of previous fracture and subsequent fracture risk. Bone 2004;35(2):375‐82. - PubMed
Kastner 2007
    1. Kastner M, Straus S, Goldsmith CH. Estimating the Horizon of articles to decide when to stop searching in systematic reviews: an example using a systematic review of RCTs evaluating osteoporosis clinical decision support tools. AMIA Annual Symposium Proceedings. 2007:389‐93. - PMC - PubMed
Kastner 2009
    1. Kastner M, Straus SE, McKibbon KA, Goldsmith CH. The capture‐mark‐recapture technique can be used as a stopping rule when searching in systematic reviews. Journal of Clinical Epidemiology 2009;62(2):149‐57. - PubMed
Kelley 1998
    1. Kelley GA. Exercise and regional bone mineral density in postmenopausal women: a meta‐analytic review of randomized trials. American Journal of Physical Medicine and Rehabilitation 1998;77(1):76‐87. - PubMed
Lips 2005
    1. Lips P, Schoor NM. Quality of life in patients with osteoporosis. Osteoporosis International 2005 May;16(5):447‐55. - PubMed
Little 1987
    1. Little RJ, Rubin DB. Statistical Analysis with Missing Data. 2nd Edition. New York: John Wiley and Sons, 1987.
Martyn‐St James 2009
    1. Martyn‐St James M, Carroll S. A meta‐analysis of impact exercise on postmenopausal bone loss: the case for mixed loading exercise programmes. British Journal of Sports Medicine 2009;43(12):898‐908. - PubMed
Moayyeri 2008
    1. Moayyeri A. The association between physical activity and osteoporotic fractures: a review of the evidence and implications for future research. Annals of Epidemiology 2008;18(11):827‐35. - PubMed
Oleksik 2000
    1. Oleksik A, Lips P, Dawson A, Minshall ME, Shen W, Cooper C, et al. Health‐related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. Journal of Bone and Mineral Research 2000;15(7):1384‐92. - PubMed
Olsen 2014
    1. Olsen CF, Bergland A. The effect of exercise and education on fear of falling in elderly women with osteoporosis and a history of vertebral fracture: results of a randomized controlled trial. Osteoporos International 2014;25(8):2017‐25. - PubMed
Pahor 2014
    1. Pahor M, Guralnik JM, Ambrosius WT, Blair S, Bonds DE, Church TS, et al. LIFE study investigators. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA 2014 Jun 18;311(23):2387‐96. - PMC - PubMed
Papaioannou 2002
    1. Papaioannou A, Watts NB, Kendler DL, Yuen CK, Adachi JD, Ferko N. Diagnosis and management of vertebral fractures in elderly adults. American Journal of Medicine 2002;113(3):220‐8. - PubMed
Papaioannou 2003b
    1. Papaioannou A, Parkinson W, Ferko N, Probyn L, Ioannidis G, Jurriaans E, et al. Prevalence of vertebral fractures among patients with chronic obstructive pulmonary disease in Canada. Osteoporosis International 2003;14(11):913‐7. - PubMed
Petrella 2000
    1. Petrella RJ, Payne M, Myers A, Overend T, Chesworth B. Physical function and fear of falling after hip fracture rehabilitation in the elderly. American Journal of Physical Medicine and Rehabilitation 2000;79(2):154‐60. - PubMed
Polidoulis 2012
    1. Polidoulis I, Beyene J, Cheung AM. The effect of exercise on pQCT parameters of bone structure and strength in postmenopausal women‐‐a systematic review and meta‐analysis of randomized controlled trials. Osteoporosis International 2012 Jan;23(1):39‐51. - PubMed
Salaffi 2004
    1. Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. European Journal of Pain 2004 Aug;8(4):283‐91. - PubMed
Schousboe 2008
    1. Schousboe JT, Vokes T, Broy SB, Ferrar L, McKiernan F, Roux C, et al. Vertebral Fracture Assessment: the 2007 ISCD Official Positions. Journal of Clinical Densitometry 2008;11(1):92‐108. - PubMed
Sherrington 2011
    1. Sherrington C, Tiedemann A, Fairhall N, Close J, Lord SR. Exercise for preventing falls in older adults: an updated meta‐analysis and best practice recommendations. NSW Public Health Bulletin 2011;22(3‐4):78‐83. - PubMed
Wells 2008a
    1. Wells GA, Cranney A, Peterson J, Boucher M, Shea B, Welch V, et al. Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database of Systematic Reviews 2008, Issue 1. [DOI: 10.1002/14651858.CD001155.pub2] - DOI - PubMed
Wells 2008b
    1. Wells GA, Cranney A, Peterson J, Boucher M, Shea B, Welch V, et al. Etidronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database of Systematic Reviews 2008, Issue 1. [DOI: 10.1002/14651858.CD003376.pub3] - DOI - PMC - PubMed
Wells 2008c
    1. Wells GA, Cranney A, Peterson J, Boucher M, Shea B, Welch V, et al. Risedronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database of Systematic Reviews 2008, Issue 1. [DOI: 10.1002/14651858.CD004523.pub3] - DOI - PubMed
WHO 2003
    1. WHO Scientific Group on the Prevention and Management of Osteoporosis. Prevention and management of osteoporosis: report of a WHO scientific group. WHO Technical Report Series 2003; Vol. 921.
Wiktorowicz 2001
    1. Wiktorowicz ME, Goeree R, Papaioannou A, Adachi JD, Papadimitropoulos E. Economic implications of hip fracture: health service use, institutional care and cost in Canada. Osteoporosis International 2001;12(4):271‐8. - PubMed
Wright 2011
    1. Wright AA, Cook CE, Baxter GD, Dockerty JD, Abbott JH. A comparison of 3 methodological approaches to defining major clinically important improvement of 4 performance measures in patients with hip osteoarthritis. Journal of Orthopaedic and Sports Physical Therapy 2011;41(5):319‐27. - PubMed

References to other published versions of this review

Giangregorio 2010
    1. Giangregorio LM, MacIntyre N, Thabane L, Cranney A, Cook R, Papaioannou A. Exercise for improving outcomes after osteoporotic vertebral fracture. Cochrane Database of Systematic Reviews 2010, Issue 7. [DOI: 10.1002/14651858.CD008618] - DOI - PMC - PubMed
Giangregorio 2013
    1. Giangregorio LM, Macintyre NJ, Thabane L, Skidmore CJ, Papaioannou A. Exercise for improving outcomes after osteoporotic vertebral fracture. Cochrane Database of Systematic Reviews 2013, Issue 1. [DOI: 10.1002/14651858.CD008618.pub2] - DOI - PMC - PubMed

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