Effectiveness and safety of physical exercise and health education for the management of osteoporotic vertebral fractures: a systematic review and meta-analysis.

Osteoporotic vertebral fractures (OVFs) are the second most common fractures in osteoporosis, often leading to reduced functional capacity, chronic pain, and lower quality of life. Physical exercise and health education are considered promising options for managing these symptoms. To determine the effectiveness and safety of exercise and health education compared to usual care in patients with OVFs. A literature search up to April 2024 was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library. Clinical trials involving adults with OVFs were included, focusing on physical capacity (primary outcome) and other health outcomes. Study selection, bias assessment, and data extraction were independently conducted by two authors, with a third author resolving conflicts. Nineteen studies were included in the meta-analysis of exercise interventions. Exercise interventions were analyzed using a standardized mean difference (SMD) meta-analysis, with additional sensitivity analyses. Physical exercise significantly improves functional capacity (SMD -0.41; 95% CI -0.69 to -0.14; p 0.003), aerobic capacity, balance, trunk muscle strength, pain, and quality of life in patients with OVF. No significant effects were observed on thoracic posture or fear of falling. Adverse event risk was low (6%), comparable to usual care or daily activities. Health education interventions (two studies) were synthetized narratively, both showing improvements in pain, mobility, and patient knowledge. Physical exercise is effective and safe in the recovery of OVFs; thus, its prescription is recommended. Most interventions focus first on core strength and motor control and then on aerobic and resistance training. Further evidence is needed to demonstrate the effectiveness of health education.