Osteoporosis and physical activity: what does the scientific evidence say?

When it comes to osteoporosis, the advice to “stay physically active” is now widely recognised. Fragility fractures affecting the hip, spine and wrist are among the leading causes of loss of independence in people over 65. But what scientific evidence supports the effectiveness of physical activity in preventing osteoporosis and its consequences?

This question was addressed in a systematic review published in the International Journal of Behavioral Nutrition and Physical Activity, conducted to inform the World Health Organization (WHO) guidelines on physical activity and sedentary behaviour for adults aged 65 and over.

What is osteoporosis?

Osteoporosis is a systemic skeletal disease characterised by reduced bone density and quality, making bones more fragile and susceptible to fractures.

“During growth, the body progressively builds up its bone mass, reaching peak bone mass at around the age of 30” – explains Dr Maria Chiara Reitano, specialist in Physical and Rehabilitation Medicine at ISICO. “After this point, bone resorption gradually begins to outweigh bone formation, and the ageing process can contribute to the development of osteoporosis. As it is a ‘silent disease’, osteoporosis is often diagnosed only after a fracture has occurred, although an examination such as dual-energy X-ray absorptiometry (DXA) can detect it at an earlier stage.”

With advancing age, bone loss results from the interaction of physiological changes, declining muscle strength, reduced physical activity and other risk factors, including chronic diseases, certain medications and an increased risk of falls.

“This is why prevention should combine any necessary pharmacological treatments with an active lifestyle, in which physical activity plays a key role,” Dr Reitano emphasises.

What does the scientific research show?

The systematic review examined the available studies to assess the effects of physical exercise on bone health in older adults. The findings confirm that physical activity is an important component in counteracting age-related changes in the musculoskeletal system and helping to reduce the risk of fragility fractures.

Physical activity plays a dual role. On the one hand, it helps preserve bone mineral density, with particularly consistent findings at the lumbar spine. On the other, it improves muscle strength, balance, coordination and mobility, reducing the risk of falls, one of the main causes of fractures in older people.

Another important finding concerns the type of exercise.

“The programmes that have shown the best results are progressive and personalised, combining aerobic activity, resistance training and specific exercises targeting balance and movement control,” explains Dr Reitano. “There is no single ‘miracle’ exercise: the greatest benefits come from combining different types of exercise, tailored to each individual’s needs and abilities.”

Regular walking is an important healthy habit, but it may not be sufficient on its own. To maintain strong, resilient bones, it is essential to combine walking with muscle-strengthening exercises and activities specifically designed to improve balance and coordination. This approach not only supports bone health but also helps preserve independence in everyday activities. Every exercise programme should be tailored to the individual’s clinical condition, age, fitness level and any coexisting medical conditions. For this reason, it is advisable to seek guidance from qualified professionals, such as physiotherapists, medical specialists or exercise science professionals, who can identify the most appropriate exercises and ensure that physical activity progresses safely. “It is important to remember that physical exercise is one of the pillars of prevention, but it does not replace pharmacological treatment when this is indicated” – Dr Reitano concludes. “For people already diagnosed with osteoporosis or with markedly reduced bone mineral density, treatment should be determined by a physician and may involve a combination of medication, physical activity, appropriate nutrition and fall-prevention strategies”.

The available evidence therefore reinforces a simple but essential message: it is never too late to start moving.

Regular, well-planned physical activity, adapted to individual abilities, is one of the most effective ways to protect bone health, maintain independence and improve quality of life, even after the age of 65.

References

Pinheiro, M. B., Oliveira, J., Bauman, A., Fairhall, N., Kwok, W., & Sherrington, C. (2020).

Evidence on physical activity and osteoporosis prevention for people aged 65+ years: a systematic review to inform the WHO guidelines on physical activity and sedentary behaviour.

International Journal of Behavioral Nutrition and Physical Activity, 17(1), 150.

DOI: 10.1186/s12966-020-01040-4