ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2015
Too Fit To Fracture: outcomes of a Delphi consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral fractures.
Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 5 of them syntheses that pooled it.
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Who cites it
51 citing papers in PubMed, 5 syntheses or guidelines pooled it, 135 citations in OpenAlex.
- Physical Exercise as an Adjuvant to Glucocorticoid Therapy: Clinical Recommendations and Evidence Review.Sports medicine (Auckland, N.Z.) · 2026Pooled it
- Effects of exercise interventions on fall-related functional performance in postmenopausal women with osteoporosis or low bone mass: a systematic review and meta-analysis with an exploratory analysis of reported consistency with ACSM recommendations.Frontiers in physiology · 2026Pooled it
- Exercise for improving outcomes after osteoporotic vertebral fracture.The Cochrane database of systematic reviews · 2019Pooled it
- Exercise to improve functional outcomes in persons with osteoporosis: a systematic review and meta-analysis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2018Pooled it
- The effects of person-centered or other supportive interventions in older women with osteoporotic vertebral compression fractures-a systematic review of the literature.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2017Pooled it
- [Impact of osteoporosis on physical performance parameters of middle-aged and elderly individuals-a cross-sectional study].Orthopadie (Heidelberg, Germany) · 2023Trial
- Fall prevention interventions in primary care to reduce fractures and falls in people aged 70 years and over: the PreFIT three-arm cluster RCT.Health technology assessment (Winchester, England) · 2021Trial
- The Effects of Home Exercise in Older Women With Vertebral Fractures: A Pilot Randomized Controlled Trial.Physical therapy · 2020Trial
- Effects of 12-Week Exercise Program on Enzyme Activity of Serum Matrix Metalloproteinase-9 and Tissue Inhibitor of Metalloproteinase-1 in Female Patients with Postmenopausal Osteoporosis: A Randomized Control Study.BioMed research international · 2020Trial
- Trial
- The effect of exercise on body composition and bone mineral density in breast cancer survivors taking aromatase inhibitors.Obesity (Silver Spring, Md.) · 2017Trial
- Approach to personalizing the treatment of osteoporosis.The Journal of clinical endocrinology and metabolism · 2026Review
- Eccentric Countermovement Jump Mechanics Are Associated with Bone Properties in Physically Inactive Early Postmenopausal Women.Sports (Basel, Switzerland) · 2026Article
- Development of Functional Performance, Bone Mineral Density, and Back Pain Under Specific Pharmacological Osteoporosis Therapy in an Elderly, Multimorbid Cohort.Diagnostics (Basel, Switzerland) · 2026Article
- Implementation of Small Group Physiotherapy for People at Risk of Falls with Compromised Bone Mineral Density.Clinical interventions in aging · 2026Article
- Challenges and dilemmas of exercise therapy in the management of osteoporosis: a narrative review.Frontiers in endocrinology · 2026Review
- CT- and MRI-based endplate osteoporosis status assessment for predicting adjacent vertebral fractures after thoracolumbar percutaneous kyphoplasty: a matched comparison study.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2025Article
- Enhancing resistance training adherence in older adults with sarcopenia or osteoporosis: a study on referral success rates.Frontiers in public health · 2025Article
- Regular physical activity improves physical function and health-related quality of life among middle-aged and older women who suffered a fragility fracture-a population-based cohort.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024Article
- Association of combined healthy lifestyle factors with incident osteoporosis in patients with and without type 2 diabetes.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024Article
Corrections and comments
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Authors and funding
12 authors at 9 institutions in 4 countries.
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Abstract
unlabelledAn international consensus process resulted in exercise and physical activity recommendations for individuals with osteoporosis. Emphasis was placed on strength, balance, and postural alignment. Rather than providing generic restrictions, activity should be encouraged while considering impairments, fracture risk, activity history, and preference, and guidance on spine sparing techniques should be provided.
introductionThe objectives of this study were to establish expert consensus on key questions posed by patients or health care providers regarding recommended assessment domains to inform exercise prescription, therapeutic goals of exercise, and physical activity and exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture.
methodsThe Too Fit To Fracture expert panel identified researchers and clinicians with expertise in exercise and osteoporosis and stakeholder groups. We delivered a modified online Delphi survey (two rounds) to establish consensus on assessment, exercise, and physical activities for three cases with varying risk (osteoporosis based on bone mineral density; 1 spine fracture and osteoporosis; multiple spine fractures, osteoporosis, hyperkyphosis, and pain). Duplicate content analyses of free text responses were performed.
resultsResponse rates were 52% (39/75) and 69% (48/70) for each round. Key consensus points are the following: (a) Current physical activity guidelines are appropriate for individuals with osteoporosis without spine fracture, but not for those with spine fracture; (b) after spine fracture, physical activity of moderate intensity is preferred to vigorous; (c) daily balance training and endurance training for spinal extensor muscles are recommended for all; (d) providing guidance on spine-sparing techniques (e.g., hip hinge) during activities of daily living or leisure, considering impairments, fracture risk, activity history, and preference, is recommended rather than providing generic restrictions (e.g., lifting <10 lbs, no twisting), but for those with vertebral fracture, especially in the presence of pain, multiple fractures, or hyperkyphosis, the risks of many activities may outweigh the benefits-physical therapist consultation is recommended. Examples of spine-sparing techniques and exercise prescription elements are provided.
conclusionsOur recommendations guide health care providers on assessment, exercise prescription, and safe movement for individuals with osteoporosis.
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