Journal of Osteoporosis and Physical Activity
Open Access

Exploring the Relationship Between Physical Activity and Fracture Risk in Osteoporotic Patients

Natalia Mikhailova^{* *}Correspondence: Natalia Mikhailova, Sechenov University, Moscow, Russia, Email:

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Description

Osteoporosis is a chronic skeletal disorder characterized by reduced bone mass and structural deterioration of bone tissue, resulting in bone fragility and an increased risk of fractures. It predominantly affects older adults, especially postmenopausal women, and is a major public health concern worldwide due to its impact on morbidity, mortality, and quality of life. Physical activity has long been recognized as a non-pharmacological strategy to maintain bone health. However, the relationship between physical activity and fracture risk in osteoporotic patients is complex and multifactorial, influenced by the type, intensity, and duration of exercise as well as the individual's health status, bone density, and risk of falls.

Regular physical activity contributes to better bone health by promoting bone remodeling, enhancing muscle strength, improving balance and coordination, and reducing the likelihood of falls—all of which are key factors in fracture prevention. However, for osteoporotic individuals, there exists a fine balance between engaging in activity that supports bone strength and avoiding high-impact movements that may increase fracture risk.

Weight-bearing and resistance exercises are particularly beneficial for individuals with osteoporosis. These forms of exercise place stress on bones, stimulating osteoblast activity and helping to maintain or even increase bone mineral density (BMD). Activities such as brisk walking, stair climbing, and strength training have demonstrated positive effects on BMD in the spine and hips—common sites of osteoporotic fractures. Moreover, resistance training enhances muscle mass, which is critical for supporting skeletal integrity and reducing fall risk.

Balance and flexibility exercises, including Tai Chi and yoga, can further reduce the risk of falls by improving postural control, proprioception, and overall mobility. Improved balance and coordination are essential in minimizing accidental falls, one of the leading causes of fractures in osteoporotic patients. As falls are the precipitating event in most osteoporotic fractures, especially hip fractures, integrating these forms of exercise into a routine is vital for prevention strategies.

Aerobic activities also contribute to general health and may indirectly impact bone health by improving cardiovascular fitness and body weight regulation. Overweight and obesity are associated with poor balance and mobility, while underweight status is linked to reduced BMD. A balanced body weight maintained through regular physical activity can thus support skeletal health and reduce fracture susceptibility.

However, not all physical activity is beneficial for individuals with osteoporosis. High-impact sports or exercises that involve sudden movements, twisting, or bending (e.g., jumping, running, or certain yoga poses) can pose a risk for vertebral compression fractures or falls, especially in advanced osteoporosis. Therefore, physical activity for these patients should be individualized and guided by healthcare professionals, ideally incorporating a multidisciplinary approach that includes physiotherapists, physicians, and exercise specialists.

Research has consistently demonstrated that individuals with higher levels of physical activity tend to have lower rates of hip and vertebral fractures. Longitudinal studies have shown that consistent moderate exercise reduces the risk of first-time and recurrent fractures in older adults with osteoporosis. Additionally, physical activity has been linked to improvements in mental well-being, confidence, and social engagement, which may further enhance adherence to fall-prevention strategies.

Another critical factor is exercise adherence. Many osteoporotic patients, particularly older adults, may be hesitant to engage in physical activity due to fear of injury or due to pre-existing comorbidities such as arthritis or cardiovascular disease. Addressing these barriers through supervised exercise programs, patient education, and motivational support is essential to ensure long-term engagement and effectiveness of exercise interventions in reducing fracture risk.

Conclusion

In conclusion, the relationship between physical activity and fracture risk in osteoporotic patients is both significant and nuanced. When appropriately prescribed and performed, physical activity serves as an essential tool in reducing fracture risk through its beneficial effects on bone density, muscle strength, balance, and overall mobility. Weight-bearing and resistance training remain the cornerstone of exercise for bone health, while balance-enhancing activities further minimize the risk of falls, the primary cause of fractures in osteoporotic individuals.

Despite these benefits, it is important to recognize the need for personalized and supervised exercise regimens that account for an individual’s bone health status, age, comorbidities, and physical capabilities. Overly strenuous or poorly selected activities may pose harm, while appropriately tailored exercises can improve both physical and psychological well-being.

Healthcare professionals must promote physical activity as a central component of osteoporosis management and fracture prevention. By fostering a proactive approach to physical health in osteoporotic patients, the burden of fractures can be reduced, leading to improved longevity, reduced healthcare costs, and better quality of life for this vulnerable population. As evidence continues to support the protective role of physical activity in bone health, future research should focus on optimizing exercise prescriptions and increasing accessibility to safe, effective programs for osteoporotic patients across all settings.