Periodically clients ask me if they should invest in a whole body vibration machine to treat their osteoporosis. My preferred Physical Therapy modality is, of course, an evidence-based osteoporosis exercise program tailored to their needs. However, some clients have mobility limitations, in which case whole body vibration therapy could be beneficial.
The scientific research evaluating the efficacy of whole body vibration therapy for osteoporosis has generated mixed and confusing results. Some studies state that whole body vibration therapy does not increase bone mineral density (BMD) while others show positive results.
Whole body vibration (WBV) machines from companies such as Power Plate, Juvent and WAVE can get quite pricey. They can range in price between $200 and $10,000. Before you put down your money, you want to make sure that this investment will pay its dividend, in terms of improved BMD.
Fortunately, a research team in Spain published a meta-analysis in the August 2018 edition of Medicine (1) that examined all of the available studies on whole body vibration therapy and osteoporosis. This study determined if, in fact, WBV does increase bone density. The study was lead by Dr. Elena Marin-Cascales of the Universidad Católica de Murcia (UCAM) in Murcia, Spain.
In this blog I am going to cover the following:
- Review the research into whole body vibration therapy and osteoporosis.
- Describe how whole body vibration therapy works.
- Examine if whole body vibration therapy does build bone density in postmenopausal and older women.
- Identify the optimal protocol for whole body vibration therapy — based on the best research available today.
- Provide some insight into other health benefits of whole body vibration therapy.
- List any contraindications you need to know before starting whole body vibration therapy.
Before we get into the research, let start with a definition of whole body vibration and what we know about how it works.
How Whole Body Vibration Machines Work
Whole body vibration platforms work the following way:
- The user stands on an oscillating plate
- Whole body vibration machine generates vibrations that are “vertical acceleration movements”
- Vertical movement transmits high-frequency mechanical stimuli to sensory receptors throughout the body
- Muscles and bone tissues, in response, “absorb and dampen the energy cause by the oscillatory action”
- These responses produce the “osteogenic effects that counteract” the reduction in bone mass experience by many postmenopausal and older women
How Whole Body Vibration Affects Bone Mineral Density
Dr. Marin-Cascales and her research team assume “that the vibration training may produce microtrauma to the bone tissue which is then repaired by the osteoblast action, increasing bone density after physical stress.” (2)
They go onto state “Furthermore, WBV has demonstrated improvements in growth hormone and testosterone levels at the lumbar and hip regions in men and women.” (3) (4) (5)
Next we will cover the research into whole body vibration therapy and osteoporosis.
Whole Body Vibration Therapy and Osteoporosis Research
I am going to cover some of the recent research on whole body vibration therapy and osteoporosis. I do this for two reasons.
First, some readers like detail on the various research that has been done.
Second, I feel it is important that I spend time on this topic because certain manufacturers of whole body vibration machines quote studies that indicate that this technology can improve bone mineral density but overlook studies that contradict this finding.
If you want to skip this section, please do and go directly to my discussion in the next section of the 2018 meta-analysis published by Dr. Marin-Cascales.
There have been quite a few research studies examining the effectiveness of whole body vibration therapy as a means to increase bone mineral density in postmenopausal and older women. Unfortunately, there is no consensus on whether WBV actually works.
Here is a quick summary of several of the studies.
Whole Body Vibration Therapy Increases Bone Density
Several studies demonstrate that a protocol of whole body vibration therapy increased bone mineral density:
- Japanese researchers published a study published in Aging Clinical and Experimental Research that looked at the BMD in the lumbar spine in postmenopausal, osteoporotic women over a 12 month period. During the trial period the women used a combination of alendronate and WBV and saw a “significant improvement in BMD”. (6)
- Chinese researchers lead by Ruan et al conducted a six month whole vibration platform study. The study involved the following protocol: 10 minute duration, 5 times per week, at a frequency of 30Hz and amplitude of 5mm. They observed that by the end of the trial, BMD of the lumbar spine:
- Increased by 4.3%.
- Femoral neck BMD improved by 3.2% .
- Signiﬁcant decrease in BMD in the control group by 1.9% at the lumbar spine and 1.7% at the femoral neck.” (7)
Whole Body Vibration Therapy Has No Effect on Bone Density
The studies listed above did not settle this topic for good. It appears that a number of studies demonstrate that a protocol of whole body vibration therapy has no significant effect on bone mineral density:
- Lubomira Slatkovska and a team of Canadian researchers published a study in Calcified Tissue International showing no changes in BMD in the calcaneal (heel bone) after 12 months of WBV. (8)
- A similar study by Rubin et al, published in Journal of Bone Mineral Research, also found no significant change in the BMD of the spine, hip and distal radius in postmenopausal women who followed a regimen of WBV. (9)
- Davis et al analyzed bone density in a group of postmenopausal women (62.2±6.0yr), who were randomly assigned to 3 groups low intensity (2mm; 30–35Hz); high-intensity (4mm; 40–50Hz); and control group. They showed no changes in BMD in any of the groups following WBV. (10)
- Whole body vibration did not improve the bone health in healthy younger women, mean age 24 years. In this study, the peak vertical acceleration was 0.2g, and the frequency was 30 Hz. Participants stood on the platforms for two 10 minute sessions per day (separated by ≥ 3 hours), 5 days a week, for six months. This study showed that the whole body vibration therapy did not increase the density or quality of bone. (11)
Does Whole Body Vibration Therapy Improve Bone Health?
Confused? Why would groups of researchers studying the same question contradict each other? Why would a question with a relatively cut-and-dry and measurable outcome (the DEXA reading of bone density change over a set period of time following a set intervention protocol) generate conflicting results?
The meta-analysis by Dr. Marin-Cascales in 2018 looked into the various research studies, set out to see if whole body vibration therapy improved bone mineral density, and address the questions above.
Whole Body Vibration Therapy and Bone Health
Almost 10 years before Dr. Marin-Cascales published her meta-analysis, Totosy de Zepetnek and associates at the University of Waterloo published an overview of the research into whole body vibration therapy and bone mineral density up to 2009 (12).
The Waterloo research team found that many whole body vibration therapy studies had limitations and stated “WBV platform manufacturers should be encouraged to publish their findings from clinical trials. In addition, clinicians need to conduct more rigorous randomized controlled trials (RCTs) held to the same standard as pharmaceutical trials.“
In other words, Totosy de Zepetnek and associates asked for more rigorous studies and clearer reports.
This message has not registered yet with many manufacturers and researchers. Still, the 2018 meta-analysis by Dr. Marin-Cascales and her team provides valuable insights.
2018 Whole Body Vibration Training and Bone Health Study
The 2018 Marin-Cascales systematic review and meta-analysis evaluated “published, randomized controlled trials (RCTs) that investigated the effects of WBV on total, femoral neck, and lumbar spine BMD in postmenopausal women and identified the potential moderating factors explaining the adaptations to such training”.
The team searched PubMed, Web of Science and Cochrane for published studies and pruned a total of 33 studies down to 10.
The team filtered on:
- Postmenopausal or older women not older than 75 years of age.
- DEXA was used to measure BMD.
- Measured BMD in total, femoral neck and lumbar spine.
- Participants had to be standing on platform (not sitting or lying).
- Excluded participants taking medications that might influence BMD.
Characteristics of the 10 studies were:
- Published between 2004 and 2017.
- Total of 462 women studies with study sizes between 22 and 96 participants.
- Mean (average) age of participants ranged between 53.4 to 68.9 years.
In their report, Dr. Marin-Cascales and her team go into a lot of detail on the various reported results from the studies.
Unfortunately, because of the inconsistencies between the ten studies and the conflicting outcomes, the Marin-Cascales report is a difficult read. Instead of going through all of the points in the report, let me summarize what the team concluded:
- Whole body vibration is a potential means to improve bone mass in postmenopausal and older women.
- Lumbar spine appears to be the area that experienced the most gain compared to the femoral neck or the total.
- The femoral neck area, in general, does not seem to be affected by whole body vibration therapy. The exception is for women under the age of 65 where the femoral neck area showed BMD gain.
- Whole body vibration appears to be most effective in women younger than the age of 65 years and with a Body Mass Index (BMI) less than 25 kg/m(squared).
- The optimal protocol for whole body vibration has yet to be determined, although the authors recommend the following based on the review of the 10 published studies:
- Work volume should be more than 108 total sessions.
- Vibration frequency should be greater than or equal to 20Hz.
- Amplitude of the oscillation should be greater than or equal to 5 mm / 8 g.
Explanation of Study Findings
Let me explain some of the key findings from the Marin-Cascales report. Let’s start with a discussion of the skeletal regions that experience an increase in bone mineral density and those that did not.
Lumbar Spine and Femoral Neck Regions
One of the more surprising findings from the meta-analysis is that although postmenopausal and older women who participated in a whole body vibration therapy program saw an increase in bone mineral density in the lumbar spine region, they did not experience an increase in the femoral neck region.
This outcome seems odd. Why would one region benefit more than the other especially in light of the fact that the femoral neck region is closer to the stimulus than the lumbar region?
Dr. Marin-Cascales and her team suggest that the difference can be explained by the fact “that mechanotransduction varies at different regions of the body due to the nonlinear musculoskeletal system, as well as due to the different body positions used during vibration training.” (13) (14) Marin-Cascales and her team did not elaborate on the “different body positions used.”
Regardless, this may explain why there are different BMD outcomes at the femoral neck and the lumbar spine “based on the amount of stimuli that the region receives”.
The implications are that if you decide to use whole body vibration therapy, you may need to supplement that intervention with weight-bearing exercises that challenge the femoral neck area. I wrote a blog on how to increase femoral neck BMD and identified exercises specific to that area.
A final observation is that the researchers found that one sub-group in particular benefited from whole body vibration therapy. They reported that “for participants younger than 65 years old and with a BMI lower than 25kg/m2, whole body vibration was effective in reducing bone loss at the lumbar spine.”
Optimal Whole Body Vibration Program
Usage protocols in the 10 studies varied dramatically based on the following factors — meaning that the training varied dramatically from study to study:
- The intensity, measured in hertz, ranged from as low as 12.5 to 50Hz.
- Amplitude, measured in millimetres, ranged from 1.5 to 12mm.
- The duration of the trial, measured in weeks, ranged from 12 weeks to 52 weeks of training.
- Weekly frequency of sessions ranged from 2 sessions per week to 7 per week.
- Session length ranged from 90 seconds to 1,800 seconds (30 minutes).
- Acceleration value, measured in metres per second (squared), ranged from 0.2 to 20.12.
The Marin-Cascales meta-analysis evaluated these factors to determine the optimal protocol for individuals to follow.
Dr. Marin-Cascales and her team report that the best results were obtained when the whole body vibration therapy protocol included greater than or equal to 108 sessions with the vibration frequency greater than or equal to 20Hz and the amplitude of the oscillation greater than or equal to 5 mm / 8 g.
The research team noted “that the cumulative dose (ie, the total time in which the subjects stand on the vibration platform) is positively related with improved bone mass and that it seems to be more important than the duration of intervention.”
More sessions per week over a longer period of time leads to increased BMD as opposed to just length of time (or duration) per session (assuming the number of sessions is low).
Type of Whole Body Vibration Exercise
Type of exercise showed no significant differences. However, static exercises appeared more beneficial to lumbar spine BMD compared to dynamic exercises — with the exception of one study that showed an increase in lumbar spine BMD with a group that did dynamic squat exercises on a whole body vibration platform for a 12 month trial period. Perhaps it was the squat exercise that generated the benefit and not the whole body vibration therapy?
Conclusion: the meta-analysis does not show a clear answer on which of dynamic, static or a mixed exercise program is superior on a whole body vibration platform for increasing BMD.
Whole Body Vibration Therapy and Bone Quality
The Marin-Cascales meta-analysis only looked at studies that recorded bone density using Dual Energy X-ray Absorptiometry (DEXA) tests. They did not examine any changes in bone quality with High Resolution peripheral Quantitative Computed Tomography (HR-pQCT) testing. As a result, we do not know if whole body vibration therapy has a positive affect on bone quality. We do know that exercise does.
Whole Body Vibration Therapy Benefits
Whole body vibration has several benefits:
- If you have a medical condition which limits or restricts your ability to do weight-bearing exercise, a whole body vibration platform will allow you to build bone density.
- Perceived lower exertion on the part of the user.
In addition, studies that require participants to strength training while standing on a vibrating platform (15) or have people exercising on a vibration platform (16) show improvements in other fitness parameters such as:
- Walking speed.
- Step length.
- Maximum standing time on one leg ( an indicator of balance and strength).
Progress in each of these areas can improve your balance which, in turn, can reduce your fall risk.
Whole Body Vibration is Not For Everyone
Individuals with certain medical conditions should avoid whole body vibration therapy. I identify each of these in my blog post, Whole Body Vibration Therapy Contraindications.
Conclusion and My Recommendations
Having read the report by Dr. Marin-Cascales and her team, I am reluctant to recommend whole body vibration therapy solely as an intervention for osteoporosis.
The only meaningful outcome from using whole body vibration therapy is that lumber spine BMD will increase if you do the treatment for an extended period with the vibration frequency greater than or equal to 20Hz and the amplitude of the oscillation greater than or equal to 5 mm / 8 g.
There is more to an osteoporosis exercise program than increasing bone mineral density. For example, your program should include exercises that perfect your posture, improve balance and address flexibility.
If you have low bone density, osteopenia or osteoporosis, and even if you have access to a whole body vibration platform, I still recommend that you follow a well-designed osteoporosis exercise program that incorporates weight bearing, strength, flexibility, balance and postural exercises developed and supervised by a health professional (such as a Physical Therapist) knowledgeable in the area of osteoporosis and exercise.
- Marin-Cascales E., et al. Whole body vibration training and bone health in postmenopausal women: A systematic review and meta-analysis. 2018 Aug;97(34):e11918.
- Burr DB, Martin RB, Schafﬂer MB, et al. Bone remodelling in response to in vivo fatigue microdamage. J Biomech 1985;18:189–200
- Murphy S, Khaw KT, Cassidy A , et al. Sex hormones and bone mineral density in elderly men. Bone Miner 1993;20:133–40
- Kelly PJ, Pocock NA, Sambrook PN, et al. Dietary calcium, sex hormones, and bone mineral density in men. BMJ 1990;300:1361–4.
- Greendale GA, Edelstein S, Barrett-Connor E. Endogenous sex steroids and bone mineral density in older women and men: the Rancho Bernardo Study. J Bone Miner Res 1997;12:1833–43.
- Iwamoto J, Takeda T, Sato Y, et al. Effect of whole-body vibration exercise on lumbar bone mineral density, bone turnover, and chronic back pain in post-menopausal osteoporotic women treated with alendronate. Aging Clin Exp Res 2005;17:157–63
- Ruan XY, Jin FY, Liu YL, et al. Effects of vibration therapy on bone mineral density in postmenopausal women with osteoporosis. Chin Med J (Engl) 2008;121:1155–8
- Slatkovska L, Beyene J, Alibhai SM, et al. Effect of whole-bodyvibration on calcaneal quantitative ultrasound measurements in postmenopausal women: a randomized controlled trial. Calcif Tissue Int 2014;95:547–56.
- Rubin C, Recker R, Cullen D, et al. Prevention of postmenopausal bone loss by a low-magnitude, high-frequency mechanical stimuli: a clinical trial assessing compliance, efﬁcacy, and safety. J Bone Miner Res 2004;19:343–51.
- Davis R, Rowe J, Nichols D, et al. Effects of two intensities of whole body vibration on fall related risk factors in postmenopausal women. J Womens Health Issues Care 2014;3:2.
- Charles H. Negus, Rachel K. Evans, Mark E. Lester, Amanda Antczak, Kathleen Galloway. A Six-Month Vibration Intervention Did Not Enhance Bone Adaptation in Healthy Young Females. San Diego CA USA; Natick MA USA; Natick Massachusetts USA; Nashville Tennessee USA.
- Totosy de Zepetnek JO et al. Whole-body vibration as potential intervention for people with low bone mineral density and osteoporosis: A review JRRD Vol 46, No. 4 2009 pg 529-542
- Marques EA, Mota J, Machado L, et al. Multicomponent training program with weight-bearing exercises elicits favorable bone density, muscle strength, and balance adaptations in older women. Calcif Tissue Int 2011;88:117–29
- Prioreschi A, Oosthuyse T, Avidon I, et al. Whole body vibration increases hip bone mineral density in road cyclists. Int J Sports Med 2012;33:593–9
- Bruyere O, et al.Controlled whole body vibration to decrease fall risk and improve health-related quality of life of nursing home residents, Archives of Physical Medicine and Rehabilitation, Volume 86, Issue 2 , Pages 303-307, February 2005
- Kawanabe K, Kawashima A, Sashimoto I, Takeda T, Sato Y, and Iwamoto J. Effect of whole-body vibration exercise and muscle strengthening, balance, and walking exercises on walking ability in the elderly. The Keio Journal of Medicine, Vol. 56, 28-33 (2007).
For more information, check out my Osteoporosis Guidelines.