Review article
The Effects of Tai Chi on Bone Mineral Density in Postmenopausal Women: A Systematic Review

https://doi.org/10.1016/j.apmr.2007.02.012Get rights and content

Abstract

Wayne PM, Kiel DP, Krebs DE, Davis RB, Savetsky-German J, Connelly M, Buring JE. The effects of Tai Chi on bone mineral density in postmenopausal women: a systematic review.

Objective

To evaluate the evidence for Tai Chi as an intervention to reduce rate of bone loss in postmenopausal women.

Data Sources

Literature search using Medline, Science Citation Index, Cochrane databases, China Biological Medicine Database, and additional manual reference searches of retrieved articles and personal libraries.

Study Selection

Randomized controlled trials (RCTs), prospective cohort studies, and cross-sectional studies that included Tai Chi as an intervention, and had at least 1 outcome related to measurement of bone mineral density (BMD).

Data Extraction

Authors critically reviewed studies, evaluated methodologic quality, and synthesized study results in a summary table.

Data Synthesis

Six controlled studies were identified by our search. There were 2 RCTs, 2 nonrandomized prospective parallel cohort studies, and 2 cross-sectional studies. The 2 RCTs and 1 of the prospective cohort studies suggested that Tai Chi-naive women who participated in Tai Chi training exhibited reduced rates of postmenopausal declines in BMD. Cross-sectional studies suggested that long-term Tai Chi practitioners had higher BMD than age-matched sedentary controls, and had slower rates of postmenopausal BMD decline. No adverse effects related to Tai Chi were reported in any trial.

Conclusions

Conclusions on the impact of Tai Chi on BMD are limited by the quantity and quality of research to date. This limited evidence suggests Tai Chi may be an effective, safe, and practical intervention for maintaining BMD in postmenopausal women. In combination with research that indicates Tai Chi can positively impact other risk factors associated with low BMD (eg, reduced fall frequency, increased musculoskeletal strength), further methodologically sound research is warranted to better evaluate the impact of Tai Chi practice on BMD and fracture risk in postmenopausal women.

Section snippets

Low BMD: Definitions and Prevalence

Osteoporosis is a skeletal disorder characterized by compromised bone strength that predisposes one to an increased risk of fracture. Bone strength primarily reflects the integration of bone density and bone quality. Because bone density can be easily measured, people are often classified as having osteoporosis or osteopenia based on the value of their BMD. Osteoporosis is technically defined by the World Health Organization as a BMD T score of less than −2.5 (ie, 2.5 standard deviations [SDs]

Clinical Trials Examining Tai Chi’s Effect on BMD in Postmenopausal Women

To systematically review the evidence evaluating Tai Chi for reducing rates of postmenopausal BMD loss, we conducted a literature search using Medline, Science Citation Index, and Cochrane Database of Randomized Controlled Trials. Search strategies for each of these databases included using the following statements and key words: Tai Chi or Tai Chi Chuan or Taijiquan and bone or osteoporosis or menopause, and included the period 1966 through April 2006. We also conducted a separate literature

Limitations of Reviewed Studies Evaluating Tai Chi’s Impact on BMD

Although the 6 studies summarized in table 2 suggest Tai Chi may improve BMD of postmenopausal women, these results should be considered inconclusive and interpreted with caution for the following reasons.

First, the majority of these studies have design and methodologic limitations. Only 2 of the 6 studies were randomized trials. Although cross-sectional studies enable investigations of long-term effects of Tai Chi, absence of randomization and longitudinal monitoring introduces great potential

Conclusions

Conclusions on the efficacy of Tai Chi for reducing rates of BMD loss in postmenopausal women are limited by the small number and generally low quality of studies to date. Acknowledging these limitations, the totality of the available evidence suggests Tai Chi may be an effective, safe, and practical intervention for maintaining BMD is postmenopausal women. One methodologically sound prospective RCT suggests Tai Chi reduces rates of tibial BMD loss, 2 sound cross-sectional studies suggest

Acknowledgments

We thank Weidong Lu for his assistance reviewing the Chinese language literature, and Monica Shields and Ellen Connors for administrative support.

The contents of this review are solely the responsibility of the authors and do not necessarily represent the official views of the Center for Complementary and Alternative Medicine or the National Institutes of Health.

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    Supported by the National Center for Complementary and Alternative Medicine (grant no. 5 U19 AT002022-02 and 7 R21 AT003503-02).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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    Copyright © 2007 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.