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

Purpose: We aimed to conduct a systematic review to identify any adverse effects of physical activity and/or exercise for adults with osteoporosis and osteopaenia. We synthesised the evidence from observational studies and grey literature, and updated the evidence from three previously published systematic reviews of interventional studies (RCTs) of exercise for adults with osteoporosis, osteopaenia and falls risk.
Methods: We searched MEDLINE, EMBASE, CINAHL, Web of Science, grey literature and reference lists of relevant studies from inception to 27 June 2017. Selection criteria were (1) any observational studies, case reports/studies, and non-randomised controlled trials conducted in patients with osteoporosis or osteopaenia; and (2) in accordance with the criteria used in the 3 previous RCT reviews. Pairs of independent investigators screened and extracted data. Where the data allowed, random effects meta-analysis was undertaken for the evidence updates. A narrative synthesis was conducted for the observational data.
Results: For the observational synthesis, 14 studies out of 1,013 potentially relevant citations were included. The greater majority of studies reported no adverse events, reduced incidence/improvement in adverse events, or no significant change in adverse events after physical activity or exercise. Horseback riding, golfing, and activities that involved spinal flexion (certain yoga moves and sit-ups) were associated with a greater risk of back pain and vertebral compression fractures but these events were rare and presented as case studies, not delivered interventions. For the update of interventional studies, 57 additional studies were identified. Exercise was generally associated with a greater number of minor adverse events including mild muscle and joint pain in the intervention arms (OR ranging from 1.08 to 1.50). Serious adverse events were rare and could not be attributed to the intervention.
Conclusion: Patients with osteoporosis and osteopaenia can safely participate in structured exercise programmes, whether at home or in supervised facilities. There is little reported on adverse events with physical activities. We do not recommend complete avoidance of any physical activities, but consideration of safe technique and adaptations. Future studies on interventions should report adverse events more robustly.