Effects of Pulsed Electromagnetic Fields on Bone Fractures: A Systematic Review Update

Executive summary

This 2024 review is the most recent assessment of the best-supported application in the PEMF field, and it reaches a negative conclusion.

The authors searched PubMed, Cochrane Library, Epistemonikos and Scopus for full articles published in English between January 2014 and December 2022, using a PICOS eligibility framework. Case reports, case series, uncontrolled studies and expert opinions were excluded, and all articles were checked for quality and risk of bias.

Three randomised controlled trials with 197 patients in total were included.

None of the studies found significant effects of pulsed electromagnetic fields on the acute bone healing process. Contradictory results emerged about pain relief. Only one study showed a transitory positive effect on strength and range of motion recovery in patients with acute bone fracture.

The authors' conclusion is unambiguous: this systematic review update does not support the use of pulsed electromagnetic fields for improving the bone healing process in patients with acute fractures. They note controversial evidence on pain and functional recovery, and identify the scant and heterogeneous literature as a limit on their own conclusion.

Read alongside the 2020 meta-analysis, which found a moderate-quality benefit on healing rate, this is a field in genuine disagreement.

Why this research matters

The 2020 meta-analysis is widely cited as establishing PEMF for bone healing. This update, on more recent trials, did not replicate that.

For a buyer, this matters because the strongest application in the category is the benchmark for everything else. If that application is contested, claims for weaker applications - sleep, energy, general recovery - stand on considerably less.

What the researchers found

Three randomised controlled trials with 197 patients in total were included.

None of the studies found significant effects of pulsed electromagnetic fields on the acute bone healing process.

Contradictory results emerged about pain relief.

Only one study showed a transitory positive effect of pulsed electromagnetic fields on strength and range of motion recovery in patients with acute bone fracture.

The review concludes that it does not support the use of pulsed electromagnetic fields for improving the bone healing process in patients with acute fractures. No pooled effect sizes are reported in the source abstract and none are reproduced here.

What the results mean

Three trials with 197 patients is a small evidence base, and a null result in a small sample can reflect insufficient power rather than absence of effect. The authors say as much when they identify the scant literature as a limit.

Even so, the direction is clear and it differs from the earlier meta-analysis. That earlier work pooled 22 studies including older and Chinese-language trials; this update examined only recent English-language randomised trials. Which is more relevant depends on whether you think older trials or newer ones better reflect reality - and there is no neutral answer.

The reasonable position is that PEMF for acute fracture healing is contested. That is a very different statement from 'proven', and it is the honest one.

Strengths and limitations

Strengths

• Most recent systematic assessment of this application.
• Restricted to controlled trials, with case reports and expert opinion explicitly excluded.
• Four databases searched with a PICOS framework.
• Quality and risk-of-bias checks applied to all included articles.
• Reports a negative finding clearly rather than emphasising the single transitory positive result.
• Candid about the limits its own small included set imposes.

Limitations

• Only three trials with 197 patients included.
• Narrow publication window of January 2014 to December 2022.
• English-language restriction, which excludes the Chinese-language trials that contributed to the earlier meta-analysis.
• No meta-analysis performed.
• Device parameters not reported in the source abstract.
• Small samples mean a true modest effect could have been missed.

Evidence in context

This update sits in direct tension with the 2020 meta-analysis of 22 studies, which found moderate-quality evidence that PEMF increased fracture healing rate. The difference is largely one of inclusion: the earlier work pooled a wider and older literature including Chinese-language trials; this update examined recent English-language randomised trials only.

A 2022 umbrella review of systematic reviews for osteoarthritis found a similar pattern - most concurrence on short-term pain reduction, greater variability for stiffness and physical function, and heterogeneous low-quality studies from which no sufficient proof of efficacy could be derived.

Across all three, the consistent theme is heterogeneous parameters and insufficient methodological quality, which is exactly what the 2020 authors called for further work on.

Related research

1. Effectiveness of pulsed electromagnetic fields on bone healing: a systematic review and meta-analysis of randomized controlled trials Peng L, Fu C, Xiong F, et al. Bioelectromagnetics 41(5):323-337. 2020. PMID 32495506; doi:10.1002/bem.22271.The 2020 meta-analysis reaching a more favourable conclusion on fracture healing rate - the direct counterpoint.
2. Effects of pulsed electromagnetic field therapy on outcomes associated with osteoarthritis: a systematic review of systematic reviews Markovic L, Wagner B, Crevenna R. Wiener klinische Wochenschrift 134(11-12):425-433. 2022. PMID 35362792; PMC9213303; doi:10.1007/s00508-022-02020-3.Umbrella review for osteoarthritis, showing the same pattern of heterogeneity and insufficient proof.
3. General wellness: policy for low risk devices - guidance for industry and FDA staff U.S. FDA, Center for Devices and Radiological Health. Docket FDA-2014-N-1039. 2019. CDRH guidance.FDA guidance on the boundary between general wellness products and regulated medical devices.