Exercise halved falls in adults with fragile bones

For older adults with osteoporosis or osteopenia, a fall is not a minor event, and the fear of falling can be almost as damaging as the fall itself: it leads people to move less, which reduces mobility and quality of life further. Exercise is widely believed to help, but its specific effects on fear of falling and on the actual number of falls in this bone-fragile population have not been well documented. This review set out to appraise the trial evidence on balance, resistance and aerobic training for exactly these two outcomes in community-dwelling older adults.

The authors searched EMBASE, MEDLINE, PEDro, the Cochrane Library, PsycINFO, CINAHL and Google Scholar for randomised controlled trials of exercise training in older adults with osteoporosis or osteopenia. Fourteen trials with 2797 participants met the criteria: 8 measured fear of falling, 5 measured the number of falls, and 1 measured both. Two authors independently screened and extracted data on samples, interventions, comparisons, dosage and follow-up. Risk of bias and the quality of evidence were formally assessed, and results were pooled as standardised differences and incidence rate ratios.

Exercise training significantly reduced fear of falling measured on the Falls Efficacy Scale International, with an overall pooled effect of -2.15. The number of falls also dropped, with an incidence rate ratio of 0.46, meaning trained participants fell at less than half the rate of comparison groups. Both findings were statistically significant. However, all studies but one carried a high risk of bias, chiefly around how outcomes were measured and selectively reported, and the trials disagreed with each other considerably, which limits confidence in the precise numbers.

The result supports including tailored exercise within fall prevention strategies for people with osteoporosis or osteopenia, a group where the stakes of a fall are unusually high. It aligns with the broader belief that exercise benefits this population while adding specific evidence on falls and the fear of them. The authors are candid that the field needs standardised interventions and higher-quality trials before evidence-based guidelines can be optimised, and that the long-term durability of these programmes remains unestablished.

If osteoporosis or osteopenia is part of your life or your family's, this is a reason to view balance, resistance and aerobic training as protection against both falling and the fear that shrinks daily life. The halving of fall rates is striking, though the weaknesses in the underlying trials mean the true effect could be smaller. It is informational support for taking structured movement seriously in later life, not a specific programme to follow.