Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis

Evidence from animal and human trials indicates that bone responds positively to impact activities and high intensity progressive resistance training. Furthermore, the optimisation of muscle strength, balance and mobility minimises the risk of falls (and thereby fracture), which is particularly relevant for individuals with limited functional capacity and/or a very high risk of osteoporotic fracture. It is important that all exercise programs be accompanied by sufficient calcium and vitamin D, and address issues of comorbidity and safety. For example, loaded spine flexion is not recommended, and impact activities may require modification in the presence of osteoarthritis or frailty.

Specific guidelines for safe and effective exercise for bone health are presented. Individual exercise prescription must take into account existing bone health status, co-morbidities, and functional or clinical risk factors for falls and fracture.

Exercise is a vital strategy in the prevention and management of osteoporosis, if appropriately prescribed. For the healthy individual whose goal is to prevent osteoporosis, lifelong exercise including regular, brief, weight-bearing, high-impact exercise and high intensity PRT is recommended.

Although the optimal dose of exercise for bone health and fracture prevention is yet to be fully determined from human trials, a minimum of two sessions of PRT, four to seven sessions of impact activities, and balance training are recommended.

It is also recommended that a variety of activities are undertaken, so the skeleton continues to be exposed to unfamiliar patterns of loading. Adequate calcium and vitamin D will complement exercise programs for musculoskeletal health and function. For the high-risk individual with established osteoporosis and increased risk of fracture, falls prevention programs with a focus on balance and mobility training and high intensity PRT are essential. High load PRT and moderate impact loading may not only improve bone mass and reduce kyphosis, but be safe and well-tolerated in older adults with low bone mass.