The Effect of Different Traditional Chinese Exercises on Bone Mineral Density in Menopausal Women: A Systematic Review and Network Meta-Analysis

Objective: To evaluate the optimal choice of traditional Chinese exercises (TCEs) for improving bone mineral density in postmenopausal women through a network meta-analysis. Methods: : Chinese and English databases were searched, including China National Knowledge Infrastructure, Chongqing VIP, PubMed, Web of Science and Cochrane Library. The outcomes included BMD of lumbar L2-L4, femoral neck, Ward’s triangle, and greater trochanter. Standardized mean differences (SMD) and 95% confidence intervals (CI) were used to assess the correlation between each group of interventions, and surface under the cumulative ranking (SUCRA) was used to rank the best interventions. Results: : A total of 20 randomized controlled trials (RCTs) including 1933 subjects and six interventions:( Tai Chi (TC), Baduanjin (BDJ), Wuqinxi (WQX), Yijinjing (YJJ), Tai Chi plus calcium supplementation (TA), and Baduanjin plus calcium supplementation (BA)) were analyzed. Regarding the BMD of the lumbar L2-L4: TC [SMD= 0.99 (0.62,1.37)], BDJ [SMD= 2.12 (1.39,2.85)], TA [SMD= (1.12(0.17,2.07)] and BA [SMD= 2.24 (1.16,3.31)] were superior in increasing BMD of lumbar L2-L4 relative to No exercise intervention (NEI). Regarding the BMD of the femoral neck: TC [SMD= 1.24 (0.70,1.78)] and BA [SMD= 3.77 (1.98,5.56)] were superior in increasing BMD of femoral neck relative to NEI. Regarding the BMD of the ward’s triangle: TC [SMD= 1.63 (1.09,2.17)] was superior in increasing the BMD of the ward’s triangle relative to NEI. Regarding the BMD of the greater trochanter: TC [SMD= 0.98 (0.28,1.68)] was superior in increasing the BMD of the greater trochanter relative to NEI. TC topped the SUCRA with BMD of lumbar L2-L4: 53.8, femoral neck: 74.9, Ward’s triangle:86.9 and greater trochanter: 77.7. Conclusion: Four TCEs (TC, BDJ, TA and BA) are all effective in partially improving BMD indicators in postmenopausal women, while TC was effective on all four BMD indicators, which seems to be recommended as the most suitable exercise modality for postmenopausal women.