Across 26 controlled trials involving 1,880 women, exercise produced a large pooled effect on upper-limb bone outcomes (standardized mean difference 1.05; 95% CI 0.68–1.43), with the estimate remaining statistically robust across all leave-one-out sensitivity analyses. Combined training and dynamic weight-bearing programs, particularly at high or moderate-to-high intensity, showed the most consistently positive directional signals. The targeted outcome was distal radius bone mineral density or bone mineral content measured by DXA — the site responsible for the most common fragility fracture in women.
The finding matters because the exercise-bone literature has been overwhelmingly spine- and hip-centric, leaving clinicians with little evidence to guide wrist-fracture prevention specifically. This review starts to fill that gap. However, the enthusiasm must be tempered sharply: between-study heterogeneity is extreme (I² = 91%), and critically, the 95% prediction interval crosses zero (−0.96 to 3.06), meaning any individual intervention could realistically produce no benefit. GRADE certainty is rated very low. BMD is also a surrogate — whether these bone density gains translate into fewer actual fractures remains entirely unknown. The subgroup findings on intensity and modality are exploratory and hypothesis-generating only, not actionable clinical guidance. For adults concerned about fracture risk, resistance and impact exercise remain reasonable general recommendations, but this meta-analysis is best understood as a call for rigorous, fracture-endpoint trials targeting the wrist rather than a practice-changing result.