Cochrane in CORR®: Exercise for Improving Outcomes after Osteoporotic Vertebral Fracture.

Osteoporosis is characterized by low bone mineral density changing the architecture of bone, which increases susceptibility to low-energy fractures [9]. Patients with osteoporotic vertebral fractures, the most-common type of osteoporosis fracture, are more likely to have increased spine-related disability, increased risk of future vertebral fracture, heightened fear of falling, and even increased risk of death [2, 5, 6]. Among US women older than 50 years of age, there is an estimated 25% prevalence of vertebral fractures however only 30% of vertebral fractures come to clinical attention, making estimates of the impact of all vertebral fractures difficult to assess [1]. Exercise programs have the potential to decrease the rate of bone resorption and may improve muscle strength and balance, preventing falls [7, 10]. Therapeutic exercise is often recommended for patients sustaining vertebral fractures to reduce pain and morbidity. However, there is controversy about how effective such exercise programs are, and which type of exercise program—if any—is most effective. This Cochrane systematic review with limited meta-analysis [4] is an update of a previous Cochrane review of the same title from 2013 and includes two additional studies (216 more patients) [3, 11]. In the current review, the authors reviewed all randomized and quasi-randomized controlled trials (nine trials, 749 patients) and compared exercise or active physical therapy interventions with placebo or non-exercise control group patients with a history of vertebral fracture [4]. The authors found that low-level evidence showed that exercise likely improves physical