Effect of exercise on bone-related outcomes in patients with cancer affected by bone metastases or bone loss: a systematic review and meta-analysis

doi:10.1007/s00198-025-07645-4

Review

. 2025 Aug 6.

doi: 10.1007/s00198-025-07645-4. Online ahead of print.

Effect of exercise on bone-related outcomes in patients with cancer affected by bone metastases or bone loss: a systematic review and meta-analysis

Anita Borsati^{1

2}, Gloria Adamoli², Diana Giannarelli³, Lorenzo Belluomini⁴, Andrea Trevisan², Piero Schenal², Francesco Bettariga^{5

6}, Anna M Markarian^{5

6}, Federico Schena², Michele Milella⁴, Robert U Newton^{5

6

7}, Sara Pilotto⁴, Alice Avancini^{8

9}

Affiliations

¹ Biomedical, Clinical and Experimental Sciences, Department of Medicine, University of Verona, Verona, Italy.
² Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy.
³ Fondazione Policlinico Universitario A. Gemelli, IRCCS-Epidemiology & Biostatistic, Rome, Italy.
⁴ Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, P. Le L.A. Scuro 10, 37134, Verona, Italy.
⁵ Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia.
⁶ School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.
⁷ School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia.
⁸ Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy. alice.avancini@univr.it.
⁹ Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, P. Le L.A. Scuro 10, 37134, Verona, Italy. alice.avancini@univr.it.

PMID: 40764418
DOI: 10.1007/s00198-025-07645-4

Review

Effect of exercise on bone-related outcomes in patients with cancer affected by bone metastases or bone loss: a systematic review and meta-analysis

Anita Borsati et al. Osteoporos Int. 2025.

. 2025 Aug 6.

doi: 10.1007/s00198-025-07645-4. Online ahead of print.

Authors

Affiliations

¹ Biomedical, Clinical and Experimental Sciences, Department of Medicine, University of Verona, Verona, Italy.
² Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy.
³ Fondazione Policlinico Universitario A. Gemelli, IRCCS-Epidemiology & Biostatistic, Rome, Italy.
⁴ Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, P. Le L.A. Scuro 10, 37134, Verona, Italy.
⁵ Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia.
⁶ School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.
⁷ School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia.
⁸ Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy. alice.avancini@univr.it.
⁹ Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, P. Le L.A. Scuro 10, 37134, Verona, Italy. alice.avancini@univr.it.

PMID: 40764418
DOI: 10.1007/s00198-025-07645-4

Abstract

Introduction: This systematic review and meta-analysis aimed to evaluate the effects of exercise interventions on bone mineral density (BMD), bone mineral content (BMC), and bone turnover markers in patients with cancer and compromised bone health.

Materials and methods: A comprehensive search of four electronic databases was conducted to identify randomized controlled trials evaluating the effect of exercise intervention compared to supplementation or bone-targeted agents only on BMD, BMC and bone turnover markers. Meta-analyses were performed using random-effects models to calculate effect sizes (ES) with 95% confidence intervals (CI).

Results: Eighteen studies were included, involving 1,478 patients with mainly breast and prostate cancer. Meta-analyses of 11 trials showed no significant effect of exercise on whole-body (ES: 0.16, 95% CI: -0.10 to 0.41; p = 0.23), lumbar spine (ES: 0.10, 95% CI: -0.03 to 0.24; p = 0.14), hip (ES: -0.06, 95% CI: -0.77 to 0.64; p = 0.86), or femoral neck (ES: 0.07, 95% CI: -0.08 to 0.21; p = 0.37) BMD. However, individual studies reported improvements in lumbar spine and hip BMD following resistance or high-impact training. In patients with bone metastases, resistance training increased BMD at metastatic vertebrae. Bone turnover markers showed mixed trends, with some studies reporting increased bone formation and reduced resorption, especially after 3 months of intervention.

Conclusions: Our results suggest that, while exercise does not significantly increase BMD in patients with cancer and bone impairments when added to standard therapies, there are important variations across studies. High-intensity resistance and impact-loading training may be beneficial for specific bone sites and patient subgroups. Further research is warranted to identify optimal exercise modalities tailored to cancer type, treatment stage, and bone health status, including feasibility for patients with bone metastases.

Keywords: Bone health; Bone metastases; Cancer; Osteoporosis; Physical exercise.

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Conflict of interest statement

Declarations. Conflict of interest: SP received honoraria or speakers’ fees from AstraZeneca, Eli Lilly, Bristol-Myers Squibb, Merck, Takeda, Amgen, Novartis, and Roche, outside the submitted manuscript. LB received speakers’ fees from AstraZeneca, Merck Sharp & Dohme, and Roche, outside the submitted manuscript; travel fees from Takeda. The remaining authors declare no conflict of interest.

References

1. Avancini A et al (2022) Exercise and bone health in cancer: enemy or ally? Cancers (Basel) 14(24):6078 - PubMed
1. Saad F et al (2008) Cancer treatment-induced bone loss in breast and prostate cancer. J Clin Oncol 26(33):5465–5476 - PubMed
1. Handforth C et al (2018) Cancer treatment and bone health. Calcif Tissue Int 102(2):251–264 - PubMed - PMC
1. Huang JF et al (2022) Bone mineral density, osteopenia and osteoporosis among US adults with cancer. QJM 115(10):653–660 - PubMed
1. Buzasi E et al (2024) Risk of fractures in half a million survivors of 20 cancers: a population-based matched cohort study using linked English electronic health records. Lancet Healthy Longev 5(3):e194–e203 - PubMed - PMC

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[1] Avancini A et al (2022) Exercise and bone health in cancer: enemy or ally? Cancers (Basel) 14(24):6078 - PubMed

[2] Avancini A et al (2022) Exercise and bone health in cancer: enemy or ally? Cancers (Basel) 14(24):6078 - PubMed

[3] Saad F et al (2008) Cancer treatment-induced bone loss in breast and prostate cancer. J Clin Oncol 26(33):5465–5476 - PubMed

[4] Saad F et al (2008) Cancer treatment-induced bone loss in breast and prostate cancer. J Clin Oncol 26(33):5465–5476 - PubMed

[5] Handforth C et al (2018) Cancer treatment and bone health. Calcif Tissue Int 102(2):251–264 - PubMed - PMC

[6] Handforth C et al (2018) Cancer treatment and bone health. Calcif Tissue Int 102(2):251–264 - PubMed - PMC

[7] Huang JF et al (2022) Bone mineral density, osteopenia and osteoporosis among US adults with cancer. QJM 115(10):653–660 - PubMed

[8] Huang JF et al (2022) Bone mineral density, osteopenia and osteoporosis among US adults with cancer. QJM 115(10):653–660 - PubMed

[9] Buzasi E et al (2024) Risk of fractures in half a million survivors of 20 cancers: a population-based matched cohort study using linked English electronic health records. Lancet Healthy Longev 5(3):e194–e203 - PubMed - PMC

[10] Buzasi E et al (2024) Risk of fractures in half a million survivors of 20 cancers: a population-based matched cohort study using linked English electronic health records. Lancet Healthy Longev 5(3):e194–e203 - PubMed - PMC

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Effect of exercise on bone-related outcomes in patients with cancer affected by bone metastases or bone loss: a systematic review and meta-analysis

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Effect of exercise on bone-related outcomes in patients with cancer affected by bone metastases or bone loss: a systematic review and meta-analysis

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