The regional impact of exercise on bone density in older adults: a meta-analysis with molecular mechanism insights

To systematically evaluate the effects of physical exercise on bone mineral density (BMD) in older adults and to explore the potential underlying mechanisms.

A meta-analysis was conducted through a systematic search of randomized controlled trials (RCTs) published up to May 14, 2025, in Web of Science, PubMed, and the Cochrane Library. The study adhered to PRISMA 2020 guidelines to ensure rigorous literature screening and methodological transparency. Included studies underwent strict quality assessment, with primary outcomes focusing on BMD and related physiological parameters, and secondary outcomes including fall rates and quality of life (QoL) scores. Data were analyzed using Stata 14.0 and RevMan 5.4, encompassing 14 RCTs involving 1219 participants with age-related low BMD.

Compared to control groups, exercise interventions significantly increased BMD at the femoral neck, total femur, and trochanter. Additionally, improvements were observed in QoL scores and reductions in fall rates, while other indicators remained unchanged. These findings suggest that exercise has a positive impact on skeletal health and functional outcomes in older adults with low BMD.

Exercise demonstrates beneficial effects in managing low BMD among older adults, improving bone density, physical function, and overall quality of life. Potential underlying mechanisms include increased mechanical loading, modulation of myokine secretion, enhanced bone metabolism, and regulation of osteocytic autophagy. These findings support the use of exercise as a non-pharmacological strategy for preventing and treating osteopenia and osteoporosis in aging populations.