Tai Chi Exercise and Bone Health in Women at Perimenopausal and Postmenopausal Stages: A Systematic Review and Meta-Analysis

This study systematically examined the effects of Tai Chi exercise on bone health in menopausal women, with subgroup analyses of potential moderators. A systematic search was conducted across nine databases (PubMed, Web of Science, Cochrane Library, EBSCO-Medline, EBSCO-Sportdiscus, Embase, CNKI, VIP and Wanfang Data) on June 1 and updated on 14 September 2025 to identify controlled trials evaluating perimenopausal or postmenopausal women. A three-level meta-analysis was performed to pool effect estimates, reported as standardized mean differences (SMDs), with heterogeneity further explored through subgroup analyses. Across 16 studies involving 1091 participants aged 49–64 years, Tai Chi interventions led to significant improvements in bone health. Training protocols ranged from 6 to 104 weeks, with sessions lasting 30 to 90 min. Bone mineral density (BMD) improved significantly at the femoral neck (SMD = 0.50), greater trochanter (SMD = 0.61), and lumbar spine L2–L4 (SMD = 0.81), with stronger effects observed in perimenopausal women. Bone mineral content (BMC) also increased significantly in menopausal women (SMD = 1.63, I² = 91.46%), although heterogeneity was substantial, and no significant differences were detected in subgroup moderators. In contrast, no significant effects were found for bone mineral metabolism (p = 0.38) or bone turnover markers (p = 0.25). According to GRADE assessments, the certainty of evidence ranged from low to moderate across these outcomes. In conclusion, while Tai Chi has been shown to improve BMD and BMC in menopausal women, the relatively high heterogeneity observed for BMC necessitates cautious interpretation of these particular outcomes. In contrast, no statistically significant effects were observed on bone mineral metabolism (BMM) and bone turnover markers (BTMs). Notably, given the significant differences observed between perimenopausal and postmenopausal women, future well-designed studies that stratify participants by menopausal status and possess adequate statistical power are needed to further explore the potential differential effects of Tai Chi on bone health.