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Impact of high-load resistance training on bone mineral density in osteoporosis and osteopenia: a meta-analysis



This study aimed to examine the effect of high-load resistance training (HLRT) on bone mineral density (BMD) in patients with osteoporosis and osteopenia using a meta-analysis.

Materials and methods

We searched for randomized controlled trials (RCTs) on HLRT in patients with osteoporosis and osteopenia from medical databases. Our meta-analysis was performed with the primary endpoints being the standardized mean difference (SMD) of the change in BMD of the lumbar spine (LS), femoral neck (FN), and total hip (TH). The robustness of the results was assessed by subgroup analysis. Heterogeneity factors were examined by meta-regression. Publication bias was evaluated using a funnel plot.


We selected nine RCTs, with 259 patients in the HLRT group (women, 55.2%) and 236 patients in the control group (women, 62.7%). The HLRT group showed a significant increase in BMD in the LS [SMD = 1.40, 95% confidence interval (CI) = 0.68–2.12, p < 0.001, I2 = 90%], the FN (SMD = 0.86, 95% CI = 0.05–1.67, p = 0.04, I2 = 92%), and the TH (SMD = 1.26, 95% CI = 0.45–2.08, p = 0.002, I2 = 91%). Subgroup analysis confirmed the robustness of the results only in LS. Total sessions and a high risk of bias were identified as the factors of heterogeneity in FN and TH (p < 0.05). The funnel plot showed asymmetry in all measurement sites.


This study suggested that HLRT can be effective in increasing BMD, mainly of LS, in patients with osteoporosis and osteopenia. However, due to high heterogeneity and publication bias, additional studies with a low risk of bias should be conducted to generalize our findings.

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We are grateful to Ryoko Ikehara for providing secretarial assistance. This work was supported by Grants-in-Aid from the Ministry of Health, Labour and Welfare (subject no.:19FA1014) and received funding from Tottori University.

Author information




All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by YK, TW, and HH. HN and MO contributed to the analysis and interpretation of the data in the study. The first draft of the manuscript was written by YK, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Yuki Kitsuda.

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Kitsuda, Y., Wada, T., Noma, H. et al. Impact of high-load resistance training on bone mineral density in osteoporosis and osteopenia: a meta-analysis. J Bone Miner Metab 39, 787–803 (2021).

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  • Osteoporosis
  • Exercise
  • Resistance training
  • Bone mineral density
  • Meta-analysis