Effects of Mind-Body Exercise on Bone Health in Perimenopausal Women: A Systematic Review and Three-Level Meta-Analysis.

The perimenopausal phase represents a critical window for early intervention against accelerated bone loss, highlighting an urgent need for safe and accessible non-pharmacological strategies. Although mind-body exercises are widely recommended for healthy aging, their specific structural and metabolic impacts on the perimenopausal skeleton yield conflicting results and remain poorly understood. To address this gap, this systematic review and three-level meta-analysis evaluated the effects of mind-body modalities on bone health in perimenopausal women, utilizing this model to account for statistical dependencies among multiple effect sizes within individual studies. Quantitative synthesis suggested that mind-body exercise may offer modest structural benefits, indicated by positive effects on bone mineral density (SMD = 0.55, p < 0.01) and bone mineral content (SMD = 1.63, p < 0.01); however, these findings must be interpreted with caution as the accompanying certainty of evidence is low to very low. Conversely, these structural adaptations were not accompanied by stable alterations in bone turnover markers, which remained consistently unchanged (SMD = -0.10, p > 0.05). Furthermore, bone mineral metabolism was not statistically significant in the primary analysis, with a confidence interval that included the null (SMD = 0.90, p = 0.079) and demonstrated limited stability across robustness checks. Assessed via the GRADE framework, this overall very low certainty was primarily due to risk-of-bias concerns, inconsistency, imprecision, suspected publication bias, and clinical heterogeneity. Consequently, given the current evidence limitations, mind-body exercise is best conceptualized as a supportive lifestyle component of a healthy aging trajectory rather than a potent osteogenic therapy. It offers a holistic preventative approach that might support bone health while concurrently supporting overall musculoskeletal resilience, though firm clinical recommendations cannot yet be made. Future well-powered trials must adopt rigorous designs with precise endocrine staging to better clarify the underlying mechanisms of skeletal adaptation.