Men's Osteoporosis Support Group

Exercise interventions to reduce fall-related fractures

Osteoporos Int. 2009 May 7. [Epub ahead of print]. Exercise interventions to reduce fall-related fractures and their risk factors in individuals with low bone density: a systematic review of randomized controlled trials. de Kam D and others. PMID: 19421702. This is a review article that searched databases for relevant studies between 1996 and June 2008. Methodological quality was assessed with the Jadad score and the PEDro scale. A total of 28 articles are included in the review. The authors found, "Interventions with balance exercises reduced falls or fall-related fractures and improved balance in the majority of the studies. Muscle strengthening exercises were effective in improving lower extremity strength and back extensor strength; however, not all RCT's [randomized controlled trials] reported positive effects. Bone strength was improved by weight-bearing aerobic exercise with or without muscle strengthening exercise when the duration of the intervention was at least a year." They concluded, "Exercise interventions for patients with osteoporosis should include weight-bearing activities, balance exercise, and strengthening exercises to reduce fall and fracture risk."

Editor's comments. I think the common belief is that weight-bearing exercise is the main requirement to reduce fracture risk and to strengthen bones in those individuals with osteoporosis. But this review shows that balance exercise and muscle strengthening exercises that help prevent falls are also important. In fact, I suspect exercises that help prevent falls are the most important ones to do because long-term and high-intensity weight-bearing exercise is required to increase BMD. See this review article by Zehnacker and Bemis-Dougherty which found that in postmenopausal women, "The increases in BMD were site-specific and required high loading with a training intensity of 70% to 90% of 1 RM [repetition maximum testing] for 8 to 12 repetitions of 2 to 3 sets performed over one year duration." So the prudent approach for those with osteoporosis would be to include all three forms of exercise in your weekly routine: weight-bearing, balance exercise and strengthening exercises. This NIH site includes information on doing these exercises.

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