# The effects of extracorporeal shockwave therapy on bone mineral density and microarchitecture in animal models of osteoporosis: a systematic review and meta-analysis

## TL;DR

This study shows that shockwave therapy improves bone density and structure in animal models of osteoporosis, suggesting it could be a non-invasive treatment option.

## Contribution

The first quantitative meta-analysis of ESWT's effects on bone mineral density and microarchitecture in animal osteoporosis models.

## Key findings

- ESWT significantly increased bone mineral density with low heterogeneity.
- ESWT improved trabecular number and thickness, and reduced trabecular separation.
- High heterogeneity in some parameters suggests variability in study outcomes.

## Abstract

This systematic review and meta-analysis aimed to provide the first comprehensive, quantitative assessment of the efficacy of Extracorporeal Shockwave Therapy (ESWT) in improving bone mineral density (BMD) and key trabecular microarchitectural parameters (BV/TV, Tb.Sp, Tb.N, Tb.Th) in animal models of osteoporosis (OP).

We systematically searched six electronic databases for relevant animal randomized controlled trials (RCTs). Data extraction and quality assessment were performed on the seven studies that met the inclusion criteria. All statistical analyses were conducted using RevMan 5.4.

The meta-analysis revealed that ESWT significantly improved all assessed parameters: (1) a significant increase in BMD [SMD = 2.12, 95% CI (1.50, 2.73), P < 0.00001] with low heterogeneity (I2 = 0%); (2) a significant increase in bone volume fraction [BV/TV, SMD = 2.26, 95% CI (0.20, 4.32), P = 0.03] with high heterogeneity (I2 = 76%); (3) a significant decrease in trabecular separation [Tb.Sp, SMD = −1.39, 95% CI (−2.64, −0.14), P = 0.03] with moderate heterogeneity (I2 = 63%); (4) a significant increase in trabecular number [Tb.N, SMD = 3.51, 95% CI (1.93, 5.10), P < 0.0001] with moderate heterogeneity (I2 = 62%); and (5) a significant increase in trabecular thickness [Tb.Th, MD = 0.09, 95% CI (0.04, 0.13), P = 0.0005] with low heterogeneity (I2 = 20%). Although initial heterogeneity for BV/TV, Tb.Sp, and Tb.N was high, sensitivity analysis identified the sources, and their removal resulted in more stable effect estimates.

As the first quantitative synthesis in this field, this study provides preclinical evidence suggesting that ESWT is associated with improvements in bone density and optimizes bone microarchitecture. These findings establish a critical data foundation for ESWT as a potential non-invasive therapy for OP. However, it is important to note that the certainty of these findings is tempered by several factors, including the observed high heterogeneity for BV/TV, Tb.Sp, and Tb.N, the small total sample sizes across outcomes, and the potential for publication bias. The results are further constrained by exclusive reliance on animal models and a limited number of included studies. Future clinical research is required to validate these findings and further elucidate the underlying mechanisms.