Effects of exercise interventions on health-related quality of life in older adults with osteoporosis: a systematic review and meta-analysis

Background Osteoporosis is a prevalent skeletal disorder that substantially impairs quality of life (QoL) through reduced bone mineral density, increased fracture risk, and functional decline, particularly in older adults. Aims To evaluate the effects of exercise interventions on health-related quality of life (HRQoL) in adults aged ≥50 years with osteoporosis and to identify the most effective exercise modalities and intervention durations. Methods PubMed (MEDLINE), Web of Science, and Scopus were systematically searched to February 4, 2026, following PRISMA 2020 guidelines. Randomized controlled trials assessing exercise interventions and HRQoL outcomes in adults aged ≥ 50 years with osteoporosis were included. Risk of bias was assessed using the Cochrane tool, and certainty of evidence using GRADE. Random-effects meta-analyses were conducted using standardized mean differences (SMDs) for overall mixed-instrument analyses and mean differences (MDs) for subgroup analyses restricted to comparable instruments or domains. Results Eighteen trials involving 1,591 participants were included, with 1,448 contributing data to the meta-analyses. Exploratory pooling across heterogeneous HRQoL instruments showed no significant overall effect (SMD = −0.18, 95% CI [−0.42–0.06]; I 2 ≈ 95%). In contrast, prespecified subgroup analyses demonstrated significant improvements in HRQoL, particularly with resistance training (MD = 10.58, 95% CI [6.79–14.36]) and multicomponent exercise (MD = 5.62, 95% CI [2.65–8.58]). Short-term exercise programs (<20 weeks) produced the most consistent benefits (MD = 9.91, 95% CI [7.27–12.55]). Improvements were observed across physical and mental HRQoL domains. Certainty of evidence was moderate for resistance training and short-term interventions, and low for longer-duration and multicomponent programs. Conclusions Exercise interventions, particularly resistance training, meaningfully improve HRQoL in adults aged ≥ 50 years with osteoporosis. Shorter-duration programs appear most effective, although further high-quality trials are needed to strengthen the evidence base.