Helkropps-vibrationsbehandling hos personer med benskörhet och förhöjd frakturrisk

Benskörhet är vanligt hos äldre och framför allt hos postmenopausala kvinnor, det vill säga kvinnor som genomgått klimakteriet. Helkropps-vibrationsbehandling (WBV, whole body vibration therapy) innebär att den som får behandling står på en vibrationsplatta. Behandlingen kan ges en eller flera gånger i veckan, ofta under en längre tidsperiod. Den tänkta mekanismen är att WBV ska bidra till att bygga upp och stärka skelettet på ett liknande sätt som annan träning. Andra tänkbara effekter av vibrationsbehandling är förbättrad muskelstyrka, balans och mobilitet, vilket kan minska risken för fall för personer som har benskörhet eller förhöjd frakturrisk.

Fråga till SBU:s upplysningstjänst

Vilka vetenskapliga studier finns det som undersökt effekter av vibrationsbehandling för personer med benskörhet och äldre personer med förhöjd frakturrisk?

Frågeställare: Forskare och fysioterapeut, Region Stockholm

Sammanfattning SBU:s upplysningstjänst

SBU:s upplysningstjänst har efter litteratursökning och kvalitetsgranskning av systematiska översikter inkluderat fem systematiska översikter i svaret.

Fyra av översikterna fokuserade på personer 50 år eller äldre. Tre av dessa rapporterade funktionella utfall och författarna drog slutsatsen att Helkropps-vibrationsbehandling (WBV, whole body vibration therapy) möjligen ger en förbättring i benmuskelstyrka, balans och mobilitet för denna grupp, men att resultaten bör tolkas med försiktighet eftersom det är svårt att åtskilja effekten av WBV och de andra träningsmoment som ofta förekom samtidigt. Två av dessa översikter rapporterade ändringar i bentäthet (BMD, bone mineral density) hos äldre, varav författarna till den ena översikten skrev att det finns visst belägg för att WBV möjligen kan ge förbättringar i bentäthet hos äldre medan författarna till den andra översikten drog slutsatsen att WBV inte har någon effekt på bentäthet hos äldre kvinnor. Primärutfallet i en översikt var fall och fall-relaterade utfall, där författarna drog slutsatsen att WBV kan förebygga fall hos äldre, men att det behövs fler studier för att bedöma effekten på fall-relaterade frakturer.

En av de fem inkluderade översikterna fokuserade på postmenopausala kvinnor. Författarna till denna översikt drog slutsatsen att WBV kanske kan ge en liten men statistiskt signifikant förbättring i bentäthet i landryggen, men inte på andra ställen, för denna grupp.

Författarnas slutsatser har inte analyserats utifrån svenska förhållanden.

SBU har inte tagit ställning i sakfrågan eftersom vi inte har bedömt risken för systematiska fel i primärstudier och inte heller har vägt samman resultaten eller bedömt graden av vetenskaplig tillförlitlighet. Här redovisar vi därför endast författarnas slutsatser från systematiska översikter som bedöms ha låg eller måttlig risk för systematiska fel.

Ladda ner rapport

SBU:s upplysningstjänst Strukturerad litteratursökning som besvarar fråga från vården eller socialtjänsten om vilka relevanta översikter och studier som finns. Svaret utformas av medarbetare på SBU, vid behov med stöd av ämnessakkunnig. Kvalitetsgranskning av primärstudier görs inte.

Kontakta SBU: registrator@sbu.se
Rapportnr: ut201933
Diarienr: SBU 2019/354
https://www.sbu.se/ut201933

Litteratursökning

PubMed via NLM February 23, 2018
Title: Osteoporosis – Systematic Reviews
The search result, usually found at the end of the documentation, forms the list of abstracts.; (MeSH) = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; (MeSH:NoExp) = Does not include terms found below this term in the MeSH hierarchy; (MAJR) = MeSH Major Topic; (TIAB) = Title or abstract; (TI) = Title; (AU) = Author; (OT) = Other term; (TW) = Text Word; Systematic(SB) = Filter for retrieving systematic reviews; * = Truncation
Search terms Items found
Population: Osteoporosis
1. "Osteoporosis"(Mesh) or "Osteoporotic Fractures"(Mesh) or "Bone Density"(Mesh) or "Hip Fractures"(Mesh) or "Spinal Fractures"(Mesh) or "Accidental Falls"(Mesh) 125278
2. bone densit*(Title) or bone densit*(Other Term) or bone mineral densit*(Title) or bone mineral densit*(Other Term) or bone loss*(Title) or bone loss*(Other Term) or decalcification(Title) or decalcification(Other Term) or fall(Title) or fall(Other Term) or falls(Title) or falls(Other Term) or falling(Title) or falling (Other Term) or "accidental fall*"(Title) or "accidental fall*"(Other Term) or "fragility fracture*"(Title) or "fragility fracture*"(Other Term) or "hip fracture*"(Title) or "hip fracture*"(Other Term) or "femoral neck fracture*"(Title) or "femoral neck fracture*"(Other Term) "trochanteric fracture*"(Title) or "trochanteric fracture*"(Other Term) or "intertrochanteric fracture*"(Title) or "intertrochanteric fracture*"(Other Term) or "subtrochanteric fracture*"(Title) or "subtrochanteric fracture*"(Other Term) or "osseous densit*"(Title) or "osseous densit*"(Other Term) or osteoporo*(Title) or osteoporo*(Other term) or osteopenia*(Title) or osteopenia*(Other Term) or spine fracture*(Title) or spine fracture*(Other Term) or spinal fracture*(Title) or spinal fracture*(Other Term) or "slip and fall"(Other Term) or "slip and fall"(Title)  or "fall and slip"(Title) or "fall and slip"(Other Term) or vertebra fracture*(Title) or vertebral fracture*(Title)  or vertebra fracture*(Other Term) or vertebral fracture*(Other Term) 79038
3. 1 OR 2 148366
4. ((bone densit*(Title/Abstract) or bone mineral densit*(Title/Abstract) or bone loss*(Title/Abstract) or decalcification(Title/Abstract) or fall(Title/Abstract) or falls(Title/Abstract) or falling(Title/Abstract) or "accidental fall*"(Title/Abstract) or "fragility fracture*"(Title/Abstract) or "hip fracture*"(Title/Abstract) or "femoral neck fracture*"(Title/Abstract) or "trochanteric fracture*"(Title/Abstract) or "intertrochanteric fracture*"(Title/Abstract) or "subtrochanteric fracture*"(Title/Abstract) or "osseous densit*"(Title/Abstract) or osteoporo*(Title/Abstract) or osteopenia*(Title/Abstract) or spine fracture*(Title/Abstract) or spinal fracture*(Title/Abstract) or "slip and fall"(Title/Abstract) or "fall and slip"(Title/Abstract) or vertebra fracture*(Title/Abstract) or vertebral fracture*(Title/Abstract))) NOT medline(sb)) 32176
5. 3 OR 4 169242
Study types:  Systematic review
6. systematic(sb) 353687
Limits
7. ((animals (MeSH) NOT humans (MeSH)) OR (rat(Title/Abstract) OR rats(Title/Abstract)    OR mouse (Title/Abstract)  OR mice (Title/Abstract)  OR murine (Title/Abstract)  OR rodent (Title/Abstract)  OR rodents (Title/Abstract)  OR hamster (Title/Abstract)  OR hamsters (Title/Abstract)  OR pig (Title/Abstract)  OR pigs (Title/Abstract)  OR pORcine (Title/Abstract)  OR rabbit (Title/Abstract)  OR rabbits (Title/Abstract)  OR animal (Title/Abstract)  OR animals (Title/Abstract)  OR canine (Title/Abstract)  OR canines (Title/Abstract)  OR dog (Title/Abstract)  OR dogs (Title/Abstract)  OR cats (Title/Abstract) OR cow (Title/Abstract)  OR bovine (Title/Abstract)  OR sheep(Title/Abstract)  OR ovine(Title/Abstract)  OR monkey(Title/Abstract)  OR monkeys(Title/Abstract))) 5573846
8. Filters activated: Danish, English, Norwegian, Swedish  
Combined sets
9. 5 AND 6 5302
10. 9 NOT 7 5165
11. 10 AND 8 4756

 

PubMed via NLM 10 April 2019
Title: Osteoporosis – Systematic Reviews
The search result, usually found at the end of the documentation, forms the list of abstracts.; [MeSH] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; [MeSH:NoExp] = Does not include terms found below this term in the MeSH hierarchy; [MAJR] = MeSH Major Topic; [TIAB] = Title or abstract; [TI] = Title; [AU] = Author; [OT] = Other term; [TW] = Text Word; Systematic[SB] = Filter for retrieving systematic reviews (updated after first search date); * = Truncation
Search terms Items found
Population: Osteoporosis
1. "Osteoporosis"[Mesh] or "Osteoporotic Fractures"[Mesh] or "Bone Density"[Mesh] or "Hip Fractures"[Mesh] or "Spinal Fractures"[Mesh] or "Accidental Falls"[Mesh] 132731
2. bone densit*[Title] or bone densit*[Other Term] or bone mineral densit*[Title] or bone mineral densit*[Other Term] or bone loss*[Title] or bone loss*[Other Term] or decalcification[Title] or decalcification[Other Term] or fall[Title] or fall[Other Term] or falls[Title] or falls[Other Term] or falling[Title] or falling [Other Term] or accidental fall*[Title] or accidental fall*[Other Term] or fragility fracture*[Title] or fragility fracture*[Other Term] or hip fracture*[Title] or hip fracture*[Other Term] or femoral neck fracture*[Title] or femoral neck fracture*[Other Term] OR trochanteric fracture*[Title] or trochanteric fracture*[Other Term] or intertrochanteric fracture*[Title] or intertrochanteric fracture*[Other Term] or subtrochanteric fracture*[Title] or subtrochanteric fracture*[Other Term] or osseous densit*[Title] or osseous densit*[Other Term] or osteoporo*[Title] or osteoporo*[Other term] or osteopenia*[Title] or osteopenia*[Other Term] or spine fracture*[Title] or spine fracture*[Other Term] or spinal fracture*[Title] or spinal fracture*[Other Term] or "slip and fall"[Other Term] or "slip and fall"[Title]  or "fall and slip"[Title] or "fall and slip"[Other Term] or vertebra fracture*[Title] or vertebral fracture*[Title]  or vertebra fracture*[Other Term] or vertebral fracture*[Other Term] 92318
3. ((bone densit*[Title/Abstract] or bone mineral densit*[Title/Abstract] or bone loss*[Title/Abstract] or decalcification[Title/Abstract] or fall[Title/Abstract] or falls[Title/Abstract] or falling[Title/Abstract] or accidental fall*[Title/Abstract] or fragility fracture*[Title/Abstract] or hip fracture*[Title/Abstract] or femoral neck fracture*[Title/Abstract] or trochanteric fracture*[Title/Abstract] or intertrochanteric fracture*[Title/Abstract] or subtrochanteric fracture*[Title/Abstract] or osseous densit*[Title/Abstract] or osteoporo*[Title/Abstract] or osteopenia*[Title/Abstract] or spine fracture*[Title/Abstract] or spinal fracture*[Title/Abstract] or "slip and fall"[Title/Abstract] or "fall and slip"[Title/Abstract] or vertebra fracture*[Title/Abstract] or vertebral fracture*[Title/Abstract])) NOT medline[sb]) 36999
4. 1 OR 2 OR 3 183039
Combined sets, limited to systematic reviews, humans, languages
5. 4 AND systematic[SB] 2181
6. 5 NOT ((animals[MeSH] NOT humans[MeSH]) 2171
7. 6 AND (english[la] OR swedish[la] OR danish[la] OR norweigan[la]) 2131
8. 7 AND Filters activated: Publication date from 2018/02/01 483

 

Embase via Elsevier February 23, 2018
Title: Osteoporosis – Systematic Reviews
The search result, usually found at the end of the documentation, forms the list of abstracts.; /de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti:ab = Title or abstract; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population: Osteoporosis
1. 'osteoporosis'/exp/mj or 'fragility fracture'/exp/mj or 'bone density'/exp/mj or 'hip fracture'/exp/mj or 'spine fracture'/exp/mj or 'falling'/exp/mj 119443
2. ('bone densit*' or 'bone mineral densit*' or 'bone loss*' or decalcification or fall or falls or falling or 'accidental fall*' or 'fragility fracture*' or 'hip fracture*' or 'femoral neck fracture*' or 'trochanteric fracture*' or 'intertrochanteric fracture*' or 'subtrochanteric fracture*' or 'osseous densit*' or osteoporo* or osteopenia* or 'spine fracture*' or 'spinal fracture*' or 'slip and fall' or 'fall and slip' or 'vertebra fracture*' or 'vertebral fracture*'):ti,kw 121513
3. 1 OR 2 159136
Systematic review
4. 'systematic review'/exp OR 'meta analysis'/de OR (systematic* NEXT/3 (review* OR overview)):kw,ti,ab OR (systematic* NEXT/3  bibliographic*):kw,ti,ab OR (systematic* NEXT/3 literature):kw,ti,ab OR (meta-analy* or metaanaly*):kw,ti,ab 320096
Limits
5. (('animal'/exp OR 'nonhuman'/exp) NOT 'human'/exp) 6328563
6. (danish)/lim OR (english)/lim OR (norwegian)/lim OR (swedish)/lim 27541421
Combined sets
7. 3 AND 4 3873
8. 7 NOT 5 3849
9. 8 AND 6 3568

 

Embase via Elsevier 10 April 2019
Title: Osteoporosis – Systematic Reviews
The search result, usually found at the end of the documentation, forms the list of abstracts.; /de = Term from the EMTREE controlled vocabulary; /exp= Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti:ab = Title or abstract; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population: Osteoporosis
1. 'osteoporosis'/exp/mj or 'fragility fracture'/exp/mj or 'bone density'/exp/mj or 'hip fracture'/exp/mj or 'spine fracture'/exp/mj or 'falling'/exp/mj 127,089
2. ('bone densit*' or 'bone mineral densit*' or 'bone loss*' or decalcification or fall or falls or falling or 'accidental fall*' or 'fragility fracture*' or 'hip fracture*' or 'femoral neck fracture*' or 'trochanteric fracture*' or 'intertrochanteric fracture*' or 'subtrochanteric fracture*' or 'osseous densit*' or osteoporo* or osteopenia* or 'spine fracture*' or 'spinal fracture*' or 'slip and fall' or 'fall and slip' or 'vertebra fracture*' or 'vertebral fracture*'):ti,kw 134,720
3. 1 OR 2 171,362
Combined sets: limited to systematic review, humans, languages
4. 3 AND ('systematic review'/exp OR 'meta analysis'/de OR (systematic* NEXT/3 (review* OR overview)):kw,ti,ab OR (systematic* NEXT/3  bibliographic*):kw,ti,ab OR (systematic* NEXT/3 literature):kw,ti,ab OR (meta-analy* or metaanaly*):kw,ti,ab) 4,527
5. 4 NOT (('animal'/exp OR 'nonhuman'/exp) NOT 'human'/exp) 4,499
6. 5 AND ([danish]/lim OR [english]/lim OR [norwegian]/lim OR [swedish]/lim) 4,119
7. 5 AND [1-2-2018]/sd 837

 

Cochrane Library via Wiley February, 23 2018
Title: Osteoporosis– Systematic Reviews
The search result, usually found at the end of the documentation, forms the list of abstracts.; (mh) = Term from the Medline controlled vocabulary, including term explosion (terms found below this term in the MeSH hierarchy); (mh ^) = Term from the Medline controlled vocabulary, without term explosion; :ti, ab, kw = Title or abstract or keyword; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; CDSR = Cochrane Database of Systematic Review; CENTRAL = Cochrane Central Register of Controlled Trials, “trials”; CRM = Method Studies; DARE = Database Abstracts of Reviews of Effects, “other reviews”; EED = Economic Evaluations; HTA = Health Technology Assessments
Search terms Items found
Population: Osteoporosis
1. (mh "Osteoporosis") or (mh "Osteoporotic Fractures") or (mh "Bone Density") or (mh "Hip Fractures") or (mh "Spinal Fractures") or (mh "Accidental Falls") 8740
2. ("bone densit*" or "bone mineral densit*" or "bone loss*" or decalcification or fall or falls or falling or "accidental fall*" or "fragility fracture*" or "hip fracture*" or "femoral neck fracture*" or "trochanteric fracture*" or "intertrochanteric fracture*" or "subtrochanteric fracture*" or "osseous densit*" or osteoporo* or osteopenia* or "spine fracture*" or "spinal fracture*" or "slip and fall" or "fall and slip" or "vertebral fracture*" or "vertebral fracture*"):ti,kw 17233
3. 1 OR 2 17490
    CDSR/118
DARE/762
Central/
16034
CRM/33
HTA/246
EED/297

 

Cochrane Library via Wiley 10 April 2019 (CDSR)
Title: osteoporosis- systematic reviews
The search result, usually found at the end of the documentation, forms the list of abstracts.; :au = Author; MeSH = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; this term only = Does not include terms found below this term in the MeSH hierarchy; :ti = title; :ab = abstract; :kw = keyword; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; CDSR = Cochrane Database of Systematic Review; CENTRAL = Cochrane Central Register of Controlled Trials, “trials”; CRM = Method Studies; DARE = Database Abstracts of Reviews of Effects, “other reviews”; EED = Economic Evaluations; HTA = Health Technology Assessments
Search terms Items found
Population: Osteoporosis
1. [mh "Osteoporosis"] or [mh "Osteoporotic Fractures"] or [mh "Bone Density"] or [mh "Hip Fractures"] or [mh "Spinal Fractures"] or [mh "Accidental Falls"] 8795
2. ("bone density" or "bone mineral density" or "bone loss" or decalcification or fall or falls or falling or "accidental fall" or "accidental falls" OR "accidental falling" or "fragility fracture" or "fragility fractures" or "hip fracture" or "hip fractures" or "femoral neck fracture" or "femoral neck fractures" or "trochanteric fracture" OR "trochanteric fractures" or "intertrochanteric fracture" or "intertrochanteric fractures" or "subtrochanteric fracture" or "subtrochanteric fractures" or "osseous density" or osteoporo* or osteopenia* or "spine fracture" or "spine fractures" or "spinal fracture" or "spinal fractures" or "slip and fall" or "fall and slip" or "vertebral fracture" or "vertebral fractures"):ti,kw 21226
3. 1 OR 2 21230
    CDSR/101
  Limits: with Cochrane Library publication date from Feb 2018 to Apr 2019 CDSR/8

 

Medline via OvidSP 10 April 2019
Title: Osteoporosis – Systematic Reviews
The search result, usually found at the end of the documentation, forms the list of abstracts.; .ab. = Abstract; .ab,ti. = Abstract or title; .af. = All fields; Exp = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; .sh. = Term from the Medline controlled vocabulary; .ti. = Title; / = Term from the Medline controlled vocabulary, but does not include terms found below this term in the MeSH hierarchy; * = Focus (if found in front of a MeSH-term); * or $ = Truncation (if found at the end of a free text term); .mp = text, heading word, subject area node, title
Search terms Items found
Population: Osteoporosis
1. exp Osteoporosis/ or Osteoporotic Fractures/ or Bone Density/ or exp Hip Fractures/ or exp Spinal Fractures/ or exp Accidental Falls/ 132668
2. ("bone densit*" or "bone mineral densit*" or "bone loss*" or decalcification or fall or falls or falling or "accidental fall*" or "fragility fracture*" or "hip fracture*" or "femoral neck fracture*" or "trochanteric fracture*" or "intertrochanteric fracture*" or "subtrochanteric fracture*" or "osseous densit*" or osteoporo* or osteopenia* or "spine fracture*" or "spinal fracture*" or "slip and fall" or "fall and slip" or "vertebra fracture*" or "vertebral fracture*").ti,kw. 90585
3. 1 OR 2 157898
Combined sets, limited to systematic reviews, languages
4. 3 AND systematic review[SB] 5150
5. 3 AND meta-analysis/ 1457
6. 4 OR 5 5154
7. 6 limited to (danish or english or norwegian or swedish) 4739
8. 7 limited to (yr="2018 -Current") 429

 

Cinahl via EBSCO 10 April 2019
Title: osteoporosis -systematic reviews
The search result, usually found at the end of the documentation, forms the list of abstracts.; AB = Abstract; AU = Author; DE = Term from the thesaurus; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields; ZC = Methodology Index; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population: osteoporosis
1. (MH "Osteoporosis") OR (MH "Osteoporotic Fractures") OR (MH "Bone Density") OR (MH "Hip Fractures+") OR (MH "Spinal Fractures+") OR (MH "Accidental Falls") 56,822
2. TI ("bone densit*" or "bone mineral densit*" or "bone loss" or decalcification or fall or falls or falling or "fragility fracture*" or "hip fracture*" or "femoral neck fracture*" or "trochanteric fracture*" or "intertrochanteric fracture*" or "subtrochanteric fracture*" or "osseous densit*" or osteoporo* or osteopenia* or "spine fracture*" or "spinal fracture*" or "slip and fall" or "fall and slip" or "vertebra fracture*" or "vertebral fracture*") 36,907
3. 1 OR 2 65,739
Study type: systematic review
4. MH "Systematic Review" OR ZT "systematic review" OR MH "Meta Analysis" OR ZT "meta analysis" 108,478
5. (TI (systematic* n3 review*)) or (AB (systematic* n3 review*)) or (TI (systematic* n3 bibliographic*)) or (AB (systematic* n3 bibliographic*)) or (TI (systematic* n3 literature)) or (AB (systematic* n3 literature)) or (TI (comprehensive* n3 literature)) or (AB (comprehensive* n3 literature)) or (TI (comprehensive* n3 bibliographic*)) or (AB (comprehensive* n3 bibliographic*)) or (TI (integrative n3 review)) or (AB (integrative n3 review)) or (JN "Cochrane Database of Systematic Reviews") or (TI (information n2 synthesis)) or (TI (data n2 synthesis)) or (AB (information n2 synthesis)) or (AB (data n2 synthesis)) or (TI (data n2 extract*)) or (AB (data n2 extract*)) or (TI (medline or pubmed or psyclit or cinahl or (psycinfo not "psycinfo database") or "web of science" or scopus or embase)) or (AB (medline or pubmed or psyclit or cinahl or (psycinfo not "psycinfo database") or "web of science" or scopus or embase)) or (TI (meta-analy* or metaanaly*)) or (AB (meta-analy* or metaanaly*))  
6. 4 OR 5  
Combined sets & limits
7. 3 AND 6 2,743
8. 7 AND Limiters  - Language: Danish, English, Norwegian, Swedish 2,670
9. 8 AND Limiters - Published Date: 20180101-20191231 351

Projektgrupp

Detta svar är sammanställt av Rebecca Silverstein (projektledare), Sara Fundell (projektadministratör) samt Miriam Entesarian Matsson (produktsamordnare) vid SBU.

Granskningsmall för att översiktligt bedöma risken för snedvridning/systematiska fel hos systematiska översikter

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