Exercise and Fall Prevention

Osteoporosis represents a major public health concern, particularly among older adults, due to its association with an increased risk of fragility fractures, functional limitations, and loss of independence. According to current clinical guidelines, bone-specific pharmacological therapies represent a cornerstone of fracture prevention in individuals at increased fracture risk. Although these treatments effectively improve bone mineral density and reduce osteoporotic fractures, their effects on fall-related risk factors, including muscle weakness, impaired balance, reduced mobility, and fall frequency, are limited. Importantly, osteoporotic fractures result from the interaction of reduced bone strength and increased fall risk, emphasizing the need for preventive strategies that address both determinants.

Physical exercise therefore represents an essential component of comprehensive osteoporosis management. In addition to its beneficial effects on bone strength, appropriately designed exercise programs can improve muscle strength, balance, and functional performance, thereby reducing the risk of falls. Accordingly, the recently published German S3 guideline "Physical Exercise for Fracture Prevention" (2025) recommends risk-adapted exercise interventions that simultaneously address skeletal and neuromuscular determinants of osteoporotic fractures. An important feature of this guideline is the differentiation of individuals according to their bone status, fall risk, and functional capacity, allowing specific training objectives and exercise recommendations to be assigned to different fracture risk groups.

Despite these recommendations, the availability of guideline-based, osteoporosis-specific exercise programs in routine healthcare remains limited. Existing supervised exercise programs are not universally accessible and frequently require qualified instructors, suitable facilities, and regular attendance at predefined times. These requirements may represent substantial barriers, particularly for older individuals with impaired mobility, limited access to exercise facilities, or difficulties attending scheduled exercise sessions. Furthermore, the availability of supervised exercise programs varies considerably between regions, potentially contributing to inequalities in osteoporosis care.

Home-based exercise programs may overcome these limitations by providing a flexible, accessible, and cost-effective alternative that can be performed independently of location and without continuous supervision. Such programs may be particularly attractive to older individuals who prefer exercising independently in their familiar home environment. However, currently available home-based exercise programs for individuals with osteoporosis are rarely based on comprehensive, risk-specific exercise guidelines. Furthermore, their effectiveness in improving relevant determinants of osteoporotic fracture risk has not been adequately evaluated in controlled clinical studies.

To address this gap, a series of structured, guideline-based home exercise programs was developed based on the recommendations of the German S3 guideline "Physical Exercise for Fracture Prevention". These programs specifically consider different combinations of reduced bone strength, fall risk, and functional limitations, allowing exercise selection and training objectives to be adapted to the individual's fracture risk profile. The development process included the selection of appropriate exercises, their integration into structured training programs, and the preparation of visual instructions to facilitate independent and safe exercise performance in the home environment.

The present study focuses on individuals characterized by substantially reduced bone strength (osteoporosis), relevant fall risk factors, but no previous osteoporotic fractures. This population represents an important target group for preventive interventions, as both major determinants of fracture risk are present, while physical exercise may still offer considerable potential to improve neuromuscular function and maintain mobility and independence.

The primary purpose of the study is to evaluate the effectiveness of a newly developed, guideline-based home exercise program in individuals with osteoporosis and increased fall risk. Specifically, the study aims to determine whether the intervention favorably affects surrogate measures of bone strength, fall risk, and functional mobility. The central research question is whether a structured, independently performed, risk-adapted home exercise program can improve these key determinants of osteoporotic fracture risk and thereby provide an effective, accessible, and practical exercise-based strategy for fracture prevention in this high-risk population.

By evaluating this intervention, the study aims to contribute to the implementation of evidence-based exercise recommendations in routine osteoporosis care and to establish a scientific basis for the