Can patients with osteoporosis exercise and what treatments are recommended?

Exercise and Treatment Recommendations for Patients with Osteoporosis

Patients with osteoporosis should engage in regular physical activity that includes a combination of balance training, resistance exercises, and weight-bearing exercises to reduce fracture risk and improve bone health. 1

Exercise Recommendations for Osteoporosis

Types of Exercise

• Combination exercise programs that include multiple exercise types have shown the greatest effects on bone mineral density (BMD), particularly for the lumbar spine 1
• Resistance exercises are particularly effective for improving bone health and should be a core component of any osteoporosis exercise program 1
• Balance training exercises (such as tai chi, physical therapy, and dancing) help reduce fall risk, which is critical for preventing fractures 1, 2
• Weight-bearing exercises contribute to maintaining and potentially improving bone mass 1, 3

Exercise Dosage

• Optimal exercise programs should be performed for at least 60 minutes, 2-3 times per week for 7+ months 1
• Longer exercise programs (12+ months) are likely to have greater effects on bone health 1
• Exercise should be tailored according to the individual's needs and abilities, especially for those with impaired gait or balance 1, 2

Exercise Safety Considerations

• Avoid generic advice like "don't bend or twist," which may create fear and activity avoidance 2
• Instead, focus on modifying activities that involve rapid, repetitive, sustained, weighted, or end-range spinal movements, especially for high-risk individuals 2
• For patients with balance impairments, supervised exercise is recommended until they can safely perform exercises independently 1

Treatment Recommendations for Osteoporosis

Non-Pharmacological Interventions

• Ensure adequate calcium intake of 1,000-1,200 mg daily through diet or supplements 1, 4, 5
• Vitamin D supplementation of 800-1,000 IU daily is recommended, particularly for those at risk of deficiency 1, 4
• Lifestyle modifications should include smoking cessation and limiting alcohol consumption 1, 4
• Fall prevention strategies should be implemented, including home safety assessments and vision/hearing evaluations 1, 3

Pharmacological Treatment

• For patients with osteoporosis (T-scores ≤-2.5) or high fracture risk (10-year probability of ≥20% for major osteoporotic fractures or ≥3% for hip fractures), bone-modifying agents should be offered 1, 4, 6
• First-line therapy typically includes oral bisphosphonates such as alendronate, which should be taken with plain water first thing in the morning, at least 30 minutes before food 5, 6
• Patients should remain upright for at least 30 minutes after taking bisphosphonates to reduce the risk of esophageal irritation 5
• For patients who cannot tolerate bisphosphonates, denosumab is an effective alternative, administered as a subcutaneous injection every 6 months 1, 7, 6
• All patients on pharmacological treatment should receive calcium and vitamin D supplementation 5, 7
• For very high-risk individuals (e.g., recent vertebral fractures, hip fracture with T-score ≤-2.5), anabolic medications (teriparatide, abaloparatide, romosozumab) should be considered, followed by an antiresorptive agent 6, 8

Monitoring

• Bone mineral density testing should be performed every 2 years, or more frequently if medically necessary, but generally not more than annually 1, 4
• Regular assessment of medication adherence, side effects, and fracture risk is essential for optimal management 1, 6

Clinical Benefits and Outcomes

• Physical activity generates clinically meaningful benefits for osteoporosis prevention and management by improving BMD and reducing fall risk 1
• Exercise improves multiple fracture risk factors including balance, muscle strength, and coordination 3, 9
• Pharmacological treatments significantly reduce vertebral fractures (risk difference -52 per 1000 person-years) and hip fractures (risk difference -6 per 1000 person-years) 6
• Combined approaches of appropriate medication, adequate calcium and vitamin D, and regular exercise provide the most comprehensive fracture risk reduction 6, 8