GeriatricsBone Health and MobilityAdvanced LevelProfessionals
Osteoporosis: Strength, Balance and Fracture-Aware Exercise
Practical exercise planning for strength, balance and function in osteoporosis, adapted to fracture history and capacity.
13 October 20268–12 min readEvidence sources included
What You Should Be Able to Explain After Reading
- Select strength, balance and weight-bearing exercise appropriately.
- Adapt loading to fracture history and function.
- Recognize symptoms needing medical assessment.
Clinical framework
- Exercise can support strength, balance and function and may include progressive resistance, weight-bearing activity and impact when appropriate. It complements, rather than replaces, medical assessment and indicated osteoporosis treatment.
- Prescription depends on fracture history, vertebral fracture risk, frailty, pain, balance and previous training. A high-impact program is not appropriate for everyone with low bone density.
Assessment and outcomes
- Ask about fragility fractures, height loss, new back pain, falls, fear of falling, medication, vision, footwear, home hazards and prior exercise. Check for suspected recent fracture and existing restrictions.
- Assess chair-rise performance, gait, balance and confidence using suitable measures such as the 30-second chair stand or Timed Up and Go. Agree a functional goal.
Safety and exercise selection
- New sudden spinal pain after minimal trauma, acute focal bone pain, deformity or inability to bear weight after a fall needs prompt medical assessment; do not exercise through suspected fracture.
- For vertebral fracture or high fracture risk, avoid loaded repeated end-range spinal flexion and forceful twisting. Teach safer movement strategies and follow individualized clinical advice.
- For suitable patients, progressive resistance for major muscle groups 2–3 days weekly and balance training on multiple days can be practical starting points. Add impact only after considering fracture risk, technique and supervision needs.
Progression and summary
- Progress resistance or task difficulty when technique and recovery are acceptable. Review adherence, pain, falls, chair-rise ability and the person's goals every few weeks.
- Avoid blanket prohibition of lifting and activity, but do not prescribe vigorous impact without screening. Match challenge to risk, capacity and supervision; coordinate with the medical team when fracture risk or symptoms change.
Evidence & Further Reading
These sources are provided so learners can trace the clinical recommendations and read the original guidance.