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: ≈ 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 (