Eleven RCTs (n=347 patients) were included in the review. Study quality was variable. Nine RCTs blinded patients and outcome assessors and follow-up ranged from 84% to 100%, but none used an intention-to-treat analysis. Two trials reported substantial differences in participant characteristics between intervention and control groups, while three others had other methodological or reporting flaws.
Bone union (four RCTs): Meta-analysis found no statistically significant difference between the groups for bone union (RR 1.76, 95% CI: 0.8 to 3.8). There was significant statistical heterogeneity (I2=60%), which was not explained by sensitivity analyses.
Clinical outcomes: No trial found any statistically significant difference between the groups for a clinical outcome, with the exception of one trial which found significant reductions in pain measures in a small subgroup of patients.
Bone densitometry: There was evidence from single trials for a positive effect of treatment on callus formation in femoral intertrochanteric osteotomies, for conservatively managed Colles fracture and for lower limb strengthening.