High-Intensity Training Increases Osteocalcin Levels: A Meta-Analysis of Effects of Exercise on Bone Remodeling biomarkers.

BACKGROUND

The relationship between biomarkers of bone remodeling due to systematic training is not known, it is not possible to predict the optimal type and volume of exercise for bone remodeling.

OBJECTIVE

We aimed to quantify the effects of systematic training on bone remodeling biomarkers, particularly osteocalcin and bone alkaline phosphatase in healthy adult populations.

METHODS

This study (PROSPERO: CRD42023483811) explored the effects of systematic training (training programs lasting more than two weeks) through a systematic review and meta-analysis and included only randomized controlled trials of different types (endurance, power, and mixed) and intensities, frequency and duration of training. MEDLINE, Embase, and CENTRAL were searched on November 22, 2023, and we updated the search on 19, September 2025. Risk-of-bias and quality assessment were performed using the Cochrane Risk-of-Bias 2 (RoB2) tool and the GRADEpro Guideline Development Tool (GRADEpro).

RESULTS

A total of 16,434 records were screened, and 24 studies with 1,238 participants were analyzed. Endurance training showed no significant effect on osteocalcin level. High- and low-intensity endurance training also had no significant effect on osteocalcin. High-intensity training significantly increased osteocalcin levels (MD = 6.88; 95% CI 0.37 to 13.38). Endurance training significantly decreased the Body Mass Index (MD = -1.40; 95% CI -2.23 to -0.57). Power training showed no significant change in osteocalcin levels. Mixed training (endurance + power) did not significantly change osteocalcin levels. Bone alkaline phosphatase showed no significant change following endurance training. Bone Mineral Density showed no significant changes after endurance or power training. The risk of bias was low for all outcomes. GRADEpro assessment for osteocalcin in the high-intensity training group revealed moderate to low certainty.

CONCLUSION

This is the first systematic review and meta-analysis on the effects of systematic training on bone biomarkers in healthy adults. Our findings show that high-intensity systematic training significantly decreases Body Mass Index and significantly increases osteocalcin levels, whereas other training types had no effect.