REVIEW article
Front. Endocrinol.
Sec. Bone Research
This article is part of the Research TopicInteractions Between Diet, Sleep and Musculoskeletal Health: Beyond a Disease-Specific PerspectiveView all 7 articles
The Effect of Non-Pharmacological Interventions on Bone Health among Patients with Low Bone Mass: A Systematic Review and Meta-analysis
Provisionally accepted
Xiaona Na1
Yucheng Yang1Huanhuan Yang1Zekun Chen1
Xiaochen Qu2Jian Zhang3Mo Chen3
Dantong Wang3Denis Breuille3
Kai Yu3*
Ai Zhao1*Zhihui Li1- 1Vanke School of Public Health, Tsinghua University, Beijing, Beijing Municipality, China
- 2Curtin University, Perth, Western Australia, Australia
- 3Nestlé Research Center, Lausanne, Vaud, Switzerland
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Background and objective: Low bone mass represents a critical period for "watchful waiting" interventions to prevent osteoporosis. This systematic review provides a comprehensive overview of non-pharmacological interventions for patients with low bone mass. Methods: We included randomized controlled trials (RCTs) investigating the efficacy of non-pharmacological interventions for improving bone health outcomes in participants with low bone mass. Publications were collected from three databases. A meta-analysis was performed for outcomes reported in three or more articles, with changes in outcomes expressed as mean differences (MD) or standardized mean differences (SMD) with 95% confidence intervals (CIs). Results: A total of 26 eligible articles were included. Exercise interventions increased lumbar spine bone mineral density (BMD) (MD=0.01 g/cm2, 95% CI: 0.00–0.02) and serum osteocalcin levels (SMD=1.26, 95% CI: 0.22– 2.31) compared to the control group. Narrative synthesis of studies showed a protective effect of exercise on lumbar spine and femoral neck BMD. For nutrition interventions, polyphenol extracts showed efficacy in improving lumbar spine BMD. The results of collagen supplements were inconsistent, and the effects of micronutrients were limited. Conclusion: In conclusion, more evidence from RCTs, particularly those investigating comprehensive lifestyle interventions and tailored prevention for moderate and severe low bone mass, especially among older men, is necessary.
Keywords: Exercise, Diet, Life Style, Low bone mass, Systematic review, Meta-analysis
Received: 25 Apr 2025; Accepted: 20 Nov 2025.
Copyright: © 2025 Na, Yang, Yang, Chen, Qu, Zhang, Chen, Wang, Breuille, Yu, Zhao and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Kai Yu, kai.yu1@rd.nestle.com
Ai Zhao, aizhao18@tsinghua.edu.cn
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.