Moderate- to high-impact exercise improves bone mineral density (BMD) across the lifespan, but its effects on bone structure, which predicts fracture independent of areal BMD, are unclear. This systematic review and meta-analysis investigated effects of impact exercise on volumetric BMD (vBMD) and bone structure. Four databases (PubMed, Embase, SPORTDiscus, Web of Science) were searched up to March 2022 for randomized controlled trials (RCTs) investigating the effects of impact exercise, with ground reaction forces equal to or greater than running, compared with sham or habitual activity, on bone vBMD and structure. Bone variables were measured by quantitative computed tomography or magnetic resonance imaging at the tibia, radius, lumbar spine, and femur. Percentage changes in bone variables were compared among groups using mean differences (MD) and 95% confidence intervals (CI) calculated via random effects meta-analyses. Subgroup analyses were performed in children/adolescents (<18 years), adults (18–50 years), postmenopausal women, and older men. Twenty-eight RCTs (n = 2985) were included. Across all studies, impact exercise improved trabecular vBMD at the distal tibia (MD = 0.54% [95% CI 0.17, 0.90%]), total vBMD at the proximal femur (3.11% [1.07, 5.14%]), and cortical thickness at the mid/proximal radius (1.78% [0.21, 3.36%]). There was no effect on vBMD and bone structure at the distal radius, femoral shaft, or lumbar spine across all studies or in any subgroup. In adults, impact exercise decreased mid/proximal tibia cortical vBMD (−0.20% [−0.24, −0.15%]). In postmenopausal women, impact exercise improved distal tibia trabecular vBMD (0.79% [0.32, 1.25%]). There was no effect on bone parameters in children/adolescents in overall analyses, and there were insufficient studies in older men to perform meta-analyses. Impact exercise may have beneficial effects on bone structure and vBMD at various skeletal sites, but additional high-quality RCTs in different age and sex subgroups are needed to identify optimal exercise protocols for improving bone health across the lifespan. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

中文翻译：

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中度至高强度运动训练对整个生命周期骨结构的影响：随机对照试验的系统回顾和荟萃分析

中度至高强度运动可改善整个生命周期的骨矿物质密度 (BMD)，但其对骨结构的影响尚不清楚，而骨结构可预测骨折，与面积 BMD 无关。这项系统回顾和荟萃分析研究了冲击运动对体积骨密度 (vBMD) 和骨结构的影响。截至 2022 年 3 月，在四个数据库（PubMed、Embase、SPORTDiscus、Web of Science）中检索了随机对照试验 (RCT)，这些试验调查了冲击运动的效果，与假运动或习惯性活动相比，地面反作用力等于或大于跑步，关于骨 vBMD 和结构。通过定量计算机断层扫描或磁共振成像测量胫骨、桡骨、腰椎和股骨的骨变量。使用平均差 (MD) 和通过随机效应荟萃分析计算的 95% 置信区间 (CI) 比较各组之间骨变量的百分比变化。对儿童/青少年（<18 岁）、成人（18-50 岁）、绝经后妇女和老年男性进行了亚组分析。纳入28 项随机对照试验 ( n = 2985)。在所有研究中，冲击运动改善了胫骨远端的小梁 vBMD（MD = 0.54% [95% CI 0.17, 0.90%]）、股骨近端的总 vBMD（3.11% [1.07, 5.14%]）以及股骨近端的皮质厚度。中/近端半径 (1.78% [0.21, 3.36%])。在所有研究或任何亚组中，对桡骨远端、股骨干或腰椎的 vBMD 和骨结构没有影响。在成人中，冲击运动降低了中/近端胫骨皮质 vBMD（−0.20% [−0.24, −0.15%]）。在绝经后女性中，冲击运动改善了远端胫骨小梁 vBMD（0.79% [0.32, 1.25%]）。总体分析中，对儿童/青少年的骨骼参数没有影响，并且对老年男性的研究不足，无法进行荟萃分析。冲击运动可能对不同骨骼部位的骨结构和 vBMD 产生有益影响，但需要在不同年龄和性别亚组中进行额外的高质量随机对照试验，以确定改善整个生命周期骨骼健康的最佳运动方案。© 2023 作者。《Journal of Bone and Mineral Research》由 Wiley periodicals LLC 代表美国骨与矿物研究学会 (ASBMR) 出版。