Effects of exercise on balance function in people with osteoporosis: A systematic review and meta-analysis of randomized controlled trials

Objectives Osteoporosis (OP) is often accompanied by impaired balance, which substantially increases the risk of falls and fragility fractures. This study aimed to quantify the effects of exercise on balance function in individuals with OP and to explore potential exercise-related characteristics associated with greater improvements in balance function. Study design Systematic review and meta-analysis. Methods A comprehensive search was conducted in PubMed, Web of Science, Embase, Cochrane Library, and Scopus from inception to November 10, 2025. Outcomes were pooled using standardized mean difference (SMD) with 95% confidence intervals under a random-effects model. Results Thirteen studies met the inclusion criteria. Exercise significantly improved balance function (SMD, 0.83; 95%CI, 0.45 to 1.22; p < 0.00001). Subgroup analyses revealed that certain exercise characteristics, including interventions lasting ≥ 12 weeks (SMD, 0.83; 95% CI, 0.42 to 1.24; p < 0.0001), ≥ 3 times per week (SMD, 1.07; 95% CI, 0.46 to 1.68; p = 0.0006), ≥ 60 min per session (SMD, 1.09; 95% CI, 0.44 to 1.75; p = 0.001), and ≥ 180 min per week (SMD, 1.96; 95% CI, 0.42 to 3.50; p = 0.01), may be associated with larger improvements in balance function. In addition, relatively larger pooled effect sizes were observed in studies using composite balance outcomes (SMD, 0.93; 95% CI, 0.48 to 1.38; p < 0.0001) in studies involving middle-aged participants (SMD, 1.97; 95% CI, 0.42 to 3.52; p < 0.0001). Conclusions Exercise is effective in improving balance function in OP patients. Observed differences across exercise characteristics and participant subgroups should be interpreted as exploratory and hypothesis-generating rather than definitive evidence of optimal exercise prescription. Future research should focus on establishing standardized exercise protocols and investigating the long-term effects of exercise interventions on clinically relevant outcomes. © 2026 The Royal Society for Public Health.