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Effects of Combined Exercise and Calcium/Vitamin D Supplementation on Bone Mineral Density in Postmenopausal Women: A Systematic Review and Meta-Analysis.

  • 2025-12-11
  • Nutrients 17(24)
    • Jie Bai
    • Wenrui Huang
    • Ruixiang Yan
    • Xuelian Du

Study Design

Type
Meta-Analysis
Population
13 RCTs involving postmenopausal women
Methods
Systematic search of eight databases through October 2025; data synthesized using Review Manager version 5.4; subgroup, sensitivity, and meta-regression analyses; risk of bias assessed with Cochrane RoB 2.0; GRADE framework for certainty of evidence
  • Rigorous Journal

Background

Postmenopausal osteoporosis (PMO) is a major cause of fragility fractures worldwide. While exercise and calcium/vitamin D are standard preventive measures, the synergistic effects of their combined use on bone mineral density (BMD) remain unclear.

Methods

We systematically searched eight databases through October 2025 and synthesized data using Review Manager version 5.4. Subgroup, sensitivity, and meta-regression analyses were conducted to examine heterogeneity and test the robustness of results. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and the certainty of evidence was graded with the GRADE framework.

Results

13 RCTs involving postmenopausal women were included. Compared with calcium and vitamin D supplementation alone, combined interventions significantly increased lumbar spine (SMD = 0.31, 95% CI [0.06, 0.55]) and femoral neck BMD (SMD = 0.47, 95% CI [0.09, 0.84]), with consistent but nonsignificant trends at other skeletal sites. Subgroup analyses showed that whole-body vibration produced the greatest and most consistent benefits at both sites, while mind-body or traditional Chinese exercises (e.g., Baduanjin) significantly improved lumbar spine BMD. Shorter interventions (≤6 months) yielded greater gains in BMD, whereas longer durations provided no additional advantage.

Conclusions

Exercise combined with calcium and vitamin D supplementation effectively improves bone mineral density in postmenopausal women, especially at the lumbar spine and femoral neck. Whole-body vibration and mind-body exercises show the greatest benefits, with short-term interventions proving most effective. This combined approach offers a practical, evidence-based strategy to preserve skeletal health in aging women.

Research Insights

  • Calcium→Increased Total Hip Bone Mineral Density

    Compared with calcium and vitamin D supplementation alone, combined interventions significantly increased lumbar spine (SMD = 0.31, 95% CI [0.06, 0.55]) and femoral neck BMD (SMD = 0.47, 95% CI [0.09, 0.84])

    Effect
    Beneficial
    Effect size
    Small
  • Vitamin D→Increased Total Hip Bone Mineral Density

    Compared with calcium and vitamin D supplementation alone, combined interventions significantly increased lumbar spine (SMD = 0.31, 95% CI [0.06, 0.55]) and femoral neck BMD (SMD = 0.47, 95% CI [0.09, 0.84])

    Effect
    Beneficial
    Effect size
    Small
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