Exercise Improves Upper-Limb Bone Health in Women: A Systematic Review and Meta-Analysis of Exercise Type and...

Distal radius fractures are common fragility fractures in women, but exercise-related evidence has focused mainly on the hip and spine. This review and meta-analysis examined whether exercise improves upper-limb bone outcomes and whether exercise modality and intensity influence the response.

Twenty-six controlled trials involving 1,880 women were included. The pooled estimate favored exercise with a standardized mean difference (SMD) of 1.05; with a 95% confidence interval (CI) from 0.68 to 1.43; p < 0.001), representing a large positive average effect. The direction of effect was positive in the majority of trials, and the pooled estimate remained statistically significant in all leave-one-out analyses. Between-study heterogeneity was very high (I² = 91%), and the prediction interval crossed the null (- 0.96 to 3.06), indicating that effects may vary substantially across interventions and populations. Exploratory within-category estimates were positive for combined and dynamic weight-bearing interventions and for high- and moderate-to-high-intensity programs. These intensity categories were modality-specific operational classifications rather than directly comparable measures of skeletal loading. The GRADE certainty was very low for the specifically assessed body of evidence on distal radius bone mineral density (BMD) or bone mineral content (BMC) measured by dual-energy X-ray absorptiometry (DXA) at the end of the intervention. Exercise may improve upper-limb bone outcomes in women, and the positive pooled estimate and its stability in leave-one-out analyses provide an encouraging basis for further investigation. Combined, dynamic weight-bearing, and progressively intensified programs emerged as promising candidates, although the subgroup and mechanobiological interpretations remain hypothesis-generating. The analyzed outcomes were surrogate measures of bone health, and the effect of exercise on distal radius fracture incidence remains unknown.