Bisphosphonates vs Exercise for the Prevention and Treatment of Osteoporosis

Bisphosphonate therapy reduces fracture risk and increases bone mineral density (BMD), primarily through inhibition of bone resorption. Regular exercise is also associated with reduced fracture risk but with smaller and less consistent increases in BMD. Properly prescribed exercise, however, can add to the benefits of bisphosphonates by increasing bone formation (osteogenesis) and bone strength, improving bone geometry (structural arrangement), and reducing fall risk and comorbidity, independent of BMD. Previous recommendations have underestimated the value of regular exercise for bone health by placing too much emphasis on BMD and not enough on other aspects of fracture risk.