Additive Effects of Exercise and Vitamin D Supplementation (with and without Calcium) on Bone Mineral Density in Older Adults: A Systematic Review and Meta-Analysis

• Published in: Journal of osteoporosis 2023-08, Vol.2023, p.1-13
• Main Authors: Fischer, Cecilie, Jakob, Franz, Kohl, Matthias, Kast, Stephanie, Von Stengel, Simon, Kerschan-Schindl, Katharina, Lange, Uwe, Thomasius, Friederike, Peters, Stefan, Uder, Michael, Kemmler, Wolfgang
• Format: Article
• Language: English
• Subjects: Aged; Alfacalcidol; Analysis; Bone density; Bones; Calcifediol; Clinical trials; Denosumab; Density; Dietary supplements; Exercise; Fractures; Intervention; Meta-analysis; Metabolism; Online databases; Osteoporosis; Physical fitness; Review; Systematic review; Vitamin D; Weightlifting
• ISSN: 2090-8059; 2042-0064; 2042-0064
• DOI: 10.1155/2023/5570030

Exercise is a recognized component in the prevention and therapy of osteoporosis. The present systematic review and meta-analysis aimed to determine the effect of Vitamin D (Vit-D) added to exercise versus exercise alone on bone mineral density (BMD) at the lumbar spine (LS) or hip in older adults. A systematic review based on six literature databases according to PRISMA included (a) exercise trials, with an exercise (EX) and a combined exercise + Vit-D group (EX + Vit-D), (b) intervention ≥ 6 months, and (c) BMD assessments at LS or hip. Effects sizes (MD) and 95%-confidence intervals (95%-CI) were calculated using a random-effect model that includes the inverse heterogeneity model (IVhet). Five studies with 281 participants in the EX and 279 participants in the EX + Vit-D were included. No significant differences between EX versus EX + Vit-D were observed for BMD-LS (MD: 0.002, 95%-CI: −0.033 to 0.036) or BMD-hip (MD: 0.003, 95%-CI: −0.035 to 0.042). Heterogeneity between the trial results was moderate-substantial for LS (I2 = 0%) and moderate for hip-BMD (I2 = 35%). The funnel plot analysis suggests evidence for a publication/small study bias for BMD-LS and hip results. In summary, this present systematic review and meta-analysis were unable to determine significant positive interaction of exercise and Vit-D on LS- or hip-BMD. We predominately attribute this finding to (1) the less bone-specific exercise protocols of at least two of the five studies and (2) the inclusion criteria of the studies that did not consequently focus on Vit-D deficiency. This issue should be addressed in more detail by adequately powered exercise trials with promising exercise protocols and participants with Vit-D deficiency. This trial is registered with the International Prospective Register of Systematic Reviews (PROSPERO) ID: CRD42022309813.