Comparative effectiveness of exercise interventions on bone mineral density, balance, pain, and quality of life in patients with osteopenia and osteoporosis: a systematic review and network meta-analysis

The incidence of age-related conditions such as osteopenia and osteoporosis rises with increasing age. Exercise is widely recognized for its benefits in improving bone mineral density and reducing bone loss. However, the comparative effectiveness of different exercise modalities remains insufficiently investigated. A comprehensive search was conducted in seven databases. The included studies were evaluated for risk of bias, sensitivity analysis, subgroup analysis, and meta-regression. A network meta-analysis was conducted to identify the most effective exercise intervention. Compared with the control group, the network meta-analysis demonstrated that exercise interventions significantly improved bone mineral density (SMD = 0.38, 95% CI: 0.13, 0.63), balance (SMD = -0.81, 95% CI: -1.36, 0.26), pain (SMD = -1.43, 95% CI: -1.88, -0.98), and quality of life (SMD = 0.70, 95% CI: 0.08, 1.33) compared with the control interventions. Yi Jin Jing suggested a greater likelihood of improving bone mineral density (SUCRA = 92.3%). For balance (SUCRA = 77.9%) and pain (SUCRA = 91.4%), Pilates demonstrated a relatively more favorable trend. Ba Duan Jin may have an advantage in improving quality of life (SUCRA = 99.2%). This study indicates that, compared with other exercise interventions, Yi Jin Jing, Pilates and Ba Duan Jin may be associated with more favorable outcomes for symptoms related to osteopenia and osteoporosis. Subgroup analyses further indicated that an intervention duration of ≤ 6 months, a frequency of ≥ 7 sessions per week, and session lengths of 30–60 min might be linked to greater improvement. However, given the low certainty of the evidence, these findings should be interpreted cautiously. Future large-scale, high-quality randomized controlled trials are still needed for further verification. Trial registration CRD420251003263.