Advances in medical sciences · 2026
Effects of blood flow restriction and resistance training on bone health biomarkers and Bone Mineral Density: a Systematic Review and Meta-Analysis.
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Bottari Gustavo Dias, Silva Giulianna Faypher Morena Vieira da, Colonetti Tamy, Rosa Maria Inês da, Lago Fernanda Marçal de, Farias Joni Márcio de, Grande Antonio Jose
Аннотация
PURPOSE: Low-intensity resistance training combined with blood flow restriction (LIBFR) has been proposed as an alternative to conventional resistance training, but its effects on bone metabolism remain unclear. This review compared LIBFR with high-intensity resistance training (HIRT), low-intensity resistance training (LIRT) and non-exercise on bone formation and resorption markers and bone mineral density (BMD).
METHODS: MEDLINE (PubMed), Cochrane Library (CENTRAL), EMBASE, APA and Global Health (EBSCO) were searched up to 20th May 2026 for clinical trials in adults assessing bone-specific alkaline phosphatase (BSAP), cross-linked C-telopeptides of type I collagen (CTX-I) or BMD. Risk of bias was assessed with RoB 2 and certainty of evidence with GRADE. Meta-analyses were performed where applicable.
RESULTS: Eight studies (nine reports; n=211 participants) were included. Compared with HIRT, LIBFR resulted in significantly lower BSAP (MD = -2.72 [95% CI -5.17 to -0.28]) and CTX-I (MD = -0.08 [95% CI -0.13 to -0.03]), with no difference in BMD. Compared with LIRT, BSAP and CTX-I did not differ, but BMD was significantly higher in a single study (MD = 0.04 [95% CI 0.03 to 0.05]). Compared with non-exercise, LIBFR significantly reduced CTX-I and BMD, with no difference in BSAP. The certainty of evidence was very low for all comparisons.
CONCLUSION: LIBFR reduced BSAP and CTX-I compared with HIRT, and CTX-I compared with non-exercise. BMD findings were mixed: higher versus LIRT, similar versus HIRT and lower versus non-exercise. Given the very low certainty of evidence, these findings should be interpreted with caution.
METHODS: MEDLINE (PubMed), Cochrane Library (CENTRAL), EMBASE, APA and Global Health (EBSCO) were searched up to 20th May 2026 for clinical trials in adults assessing bone-specific alkaline phosphatase (BSAP), cross-linked C-telopeptides of type I collagen (CTX-I) or BMD. Risk of bias was assessed with RoB 2 and certainty of evidence with GRADE. Meta-analyses were performed where applicable.
RESULTS: Eight studies (nine reports; n=211 participants) were included. Compared with HIRT, LIBFR resulted in significantly lower BSAP (MD = -2.72 [95% CI -5.17 to -0.28]) and CTX-I (MD = -0.08 [95% CI -0.13 to -0.03]), with no difference in BMD. Compared with LIRT, BSAP and CTX-I did not differ, but BMD was significantly higher in a single study (MD = 0.04 [95% CI 0.03 to 0.05]). Compared with non-exercise, LIBFR significantly reduced CTX-I and BMD, with no difference in BSAP. The certainty of evidence was very low for all comparisons.
CONCLUSION: LIBFR reduced BSAP and CTX-I compared with HIRT, and CTX-I compared with non-exercise. BMD findings were mixed: higher versus LIRT, similar versus HIRT and lower versus non-exercise. Given the very low certainty of evidence, these findings should be interpreted with caution.