Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age


Exercise in the elderly

Evidence statement

The evidence presented in this guideline for the benefits of exercise applies (in general) to the elderly population. The strongest evidence for benefit is in those with mild to moderately impaired mobility. The frailest (eg highly dependent institutional populations), have limited potential for benefit and may be at higher risk of falls and fracture from exercise programs if left unsupervised. This may be due to either overestimation of ability following exercise (false sense of security) or a lag in improvement in balance, despite improvement in strength.1-6 

Grade: B

Recommendation 33
Evidence-based exercise modalities that progress in intensity as capacity improves are recommended for the maintenance of bone strength, muscle function and balance in people over the age of 75.

Grade: C

Recommendation 34
Exercise programs for very frail elderly institutionalised people and those with vertebral fracture risk should be supervised, modified and tailored to minimise the potential to increase the risk of falls, injury and vertebral fractures.

  1. Howe TE, Shea B, Dawson LJ, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev 2011;7:CD000333.
  2. Kemmler W, Haberle L, von Stengel S. Effects of exercise on fracture reduction in older adults: A systematic review and meta- analysis. Osteoporos Int 2013;24(7):1937–50.
  3. Cameron ID, Gillespie LD, Robertson M, et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 2012;12:CD005465.
  4. El-Khoury F, Cassou B, Charles MA, Dargent-Molena P. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: Systematic review and meta-analysis of randomised controlled trials. BMJ 2013;347:f6234.
  5. Martyn-St James M, Carroll S. A meta-analysis of impact exercise on postmenopausal bone loss: The case for mixed loading exercise programmes. Br J Sports Med 2009;43(12):898–908.
  6. Dusdal K, Grundmanis J, Luttin K, et al. Effects of therapeutic exercise for persons with osteoporotic vertebral fractures: A systematic review. Osteoporos Int 2011;22(3):755–69.
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