Effects of balance training on balance and fall efficacy in patients with Osteoporosis: A systematic review and meta-analysis with trial sequential analysis.

Almost everyone in the trials was a woman (680 of 684), so this says little about men with osteoporosis; the authors ask for research in men. The control groups did very different things, including medication, health education, aerobic exercise, usual daily activities and single-task balance training, and programmes ran from 4 weeks to 1 year, so the pooled estimate mixes quite different comparisons. The trials were not well blinded: 4 of the 10 did not clearly describe how participants were randomised and only 3 mentioned blinding participants, which can inflate exercise effects. There was a lot of variation between trial results for the Timed Up and Go and the Berg Balance Scale, and the authors say the results should be read carefully for that reason. Too few studies were pooled to test for publication bias, so it is unknown whether unpublished null trials are missing. The thresholds used to judge whether the balance changes were clinically meaningful come from people with lumbar disc disease and multiple sclerosis, not osteoporosis, and the authors advise caution in applying them. Only 2 trials reported numbers of falls, and the authors say the best length and frequency of training, and the effect on falls, remain unclear. For two outcomes, fear of falling and the Berg Balance Scale, the trial sequential analysis did not reach the required sample size, so the authors state that more trials are needed before firm conclusions.

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Do not read this as proof that balance training prevents falls. Only two of the ten trials reported how many falls happened, and the authors state that evidence on fall prevention, and on the best dose, is still lacking. The thresholds used to decide whether the balance gains were clinically meaningful come from people with other conditions, so the size of these changes may not mean the same thing in osteoporosis.