Combined effects of bisphosphonates and rehabilitation exercise on osteoporosis management: a systematic review and meta-analysis

Abstract Introduction Postmenopausal osteoporosis, defined by reduced bone mineral density and fracture risk, is a major health concern. Bisphosphonates are standard therapy, but the added value of exercise is uncertain. This study examined their combined effects on BMD, bone turnover, body composition, strength, and balance in postmenopausal women. Content PubMed, Embase, and Cochrane Central were systematically searched for RCTs on bisphosphonates, exercise, or their combination in postmenopausal osteoporosis. Primary outcomes were changes in BMD at lumbar spine, femoral neck, and total hip. Secondary outcomes included bone turnover markers (ALP-B, NTx), body composition (fat and lean mass), and leg extensor strength. Study quality was assessed with Cochrane Risk of Bias tool. Mean differences with 95 % confidence intervals (CI) were calculated using a random-effects model, with heterogeneity evaluated by I 2 . Summary Six RCTs with 1,059 subjects qualified for inclusion. Bisphosphonate + exercise treatment showed small and non-significant improvement in lumbar spine and femoral neck BMD (p=0.41 and p=0.11, respectively), and no significant change in total hip BMD (p=0.48). Levels of ALP-B significantly increased (p=0.0008), reflecting bone turnover rather than a direct clinical benefit; NTx showed non-significant trend (p=0.10). Fat mass significantly decreased (p<0.00001), leg strength significantly increased (p<0.00001), and lean mass showed no significant change (p=0.14). Outlook Combined exercise and bisphosphonates yield modest yet consistent improvements in site-specific BMD, fat loss, and strength in postmenopausal osteoporosis, supporting exercise as an adjunct to pharmacologic therapy for musculoskeletal health.