Physical Exercise After Fragility Fractures: A Systematic Review and Meta-Analysis of Function and Morbidity

Background/Objectives: Fragility fractures cause disability, independence loss, and death in older adults with osteoporosis. While exercise rehabilitation is recommended, its effectiveness and consistency in improving function, quality of life, and outcomes after a fracture remain uncertain. This study aimed to systematically assess the impact of structured exercise programs on physical function, quality of life, falls, morbidity, and mortality among adults recovering from fragility fractures. Methods: This review and meta-analysis followed PRISMA guidelines, with protocol registration in PROSPERO (CRD42024503933). MEDLINE, PubMed, EMBASE, Cochrane Library, CINAHL, and Web of Science were searched. Randomized controlled trials and quasi-experimental studies including adults (mean age ≥ 50 years) with fragility fractures were eligible if they evaluated structured exercise programs lasting ≥8 weeks compared with usual care or minimal intervention, and reported physical function, quality of life, falls, mortality, or morbidity outcomes. Risk of bias was assessed following the Cochrane Handbook for Systematic Reviews of Interventions guidelines. Primary outcomes comprised physical function, strength, balance, and health-related quality of life. Random-effects meta-analysis was applied where data were comparable. Results: Twenty-six studies with 4142 participants were included (n = 4142; ~80.4% women; mean age ~74.83 years). Interventions were mainly multicomponent (strength, balance, mobility, and functional training). Exercise improved physical function outcomes. At 12 months, pain measured by QUALEFFO-41 decreased (MD -11.61; 95% CI -22.99 to -0.23). Effects on strength, balance, and cognitive outcomes were inconsistent. Conclusions: Exercise-based rehabilitation after fragility fractures may improve physical function and reduce pain, but pooled effects are inconsistent and often highly heterogeneous. Evidence for effects on falls and mortality is sparse and does not support firm conclusions. Physical function measures may be the most practical primary endpoint for evaluating these interventions, interpreted cautiously. Funding: PIGE-0040-2020.