Seven recruited from the community into the Mean age 56.7±9.6 years register; no other inclusion nurse interview municipalities in Japanese Population-based criteria described but no Fractures based on Japan; baseline Osteoporosis Cohort Study; followed independent Excluded from the analysis 1996 up at 10 years after baseline; verification were women without baseline Surveys undertaken in 1999, response rate 84.7% DXA and women who were 2002 and 2006; first fracture Low risk of bias in of population taking HRT or osteoporosis counted as end of follow-up selection and study design; however, drugs at baseline time high risk of bias in terms of coverage of fractures as only self-reports included, and follow up not good Limited population applicability DXA = dual X-ray absorptiometry; FRAX® = WHO Fracture Risk Calculator Table 40 Studies included to determine whether proposed DXA testing would result in a change in management: exercise Study Study design / Quality Study population Selection criteria Studies included Findings appraisal Moayyeri () Systematic review of Men and (reported Systematic reviews, RCTs and No RCTs found; 21 prospective Exercise protective against hip fracture exercise interventions for separately) older than prospective studies featuring a studies fulfilled the inclusion in women (RR 0.62; 95%CI 0.56, 0.69) preventing fracture 40 years of age (although measure of exercise with fracture criteria Low heterogeneity some studies included as an outcome No systematic quality Studies with hip fracture as an Association likely to be confounded by younger participants) appraisal of studies Studies with participants all under endpoint were pooled in other health-related issues such as reported; other parts of 40 years of age and not in other studies not review satisfactory; overall English were excluded suitable Problems associated with low event unclear risk of bias Included studies were all quite rates in these studies large (between 1,959 and 93,676 Data for other fracture sites variable; participants), ages 35 years and limited evidence for protective impact of older; duration of follow-up exercise on vertebral fractures; possible between 4 and 15 years increases in risk of wrist and other site Exercise variously categorised as fractures with exercise walking and moderate, regular and intermediate work activity
Seven municipalities in Japan; baseline 1996 recruited from the community into the Japanese Population-based Osteoporosis Cohort Study; followed up at 10 years after baseline; response rate 84.7% Low risk of bias in of population selection and study design; however, high risk of bias in terms of coverage of fractures as only self-reports included, and follow up not good Limited population applicability Mean age 56.7±9.6 years Fractures based on Surveys undertaken in 1999, 2002 and 2006; first fracture counted as end of follow-up time register; no other inclusion criteria described Excluded from the analysis were women without baseline DXA and women who were taking HRT or osteoporosis drugs at baseline nurse interview but no independent verification DXA = dual X-ray absorptiometry; FRAX® = WHO Fracture Risk Calculator Table 40 Studies included to determine whether proposed DXA testing would result in a change in management: exercise Study Study design / Quality appraisal Study population Selection criteria Studies included Findings Moayyeri () Systematic review of exercise interventions for preventing fracture No systematic quality appraisal of studies reported; other parts of review satisfactory; overall unclear risk of bias Men and (reported separately) older than 40 years of age (although some studies included younger participants) Systematic reviews, RCTs and prospective studies featuring a measure of exercise with fracture as an outcome Studies with participants all under 40 years of age and not in English were excluded No RCTs found; 21 prospective studies fulfilled the inclusion criteria Studies with hip fracture as an endpoint were pooled in other studies not suitable Included studies were all quite large (between 1,959 and 93,676 participants), ages 35 years and older; duration of follow-up between 4 and 15 years Exercise variously categorised as walking and moderate, regular and intermediate work activity Exercise protective against hip fracture in women (RR 0.62; 95%CI 0.56, 0.69) Low heterogeneity Association likely to be confounded by other health-related issues such as Problems associated with low event rates in these studies Data for other fracture sites variable; limited evidence for protective impact of exercise on vertebral fractures; possible increases in risk of wrist and other site fractures with exercise
1162_assessment_report.docx