Effects of a Progressive Strength and Balance Exercise Program on Falls in Postmenopausal Women With Osteoporosis: A Randomized Controlled Pilot Trial

Postmenopausal osteoporosis is associated with an increased risk of fragility fractures, functional decline, disability, and loss of independence. Falls are a major modifiable pathway leading to fragility fractures in older adults. Exercise-based fall-prevention strategies, particularly those including balance and resistance training, may improve muscle strength, postural control, gait performance, and confidence during mobility. However, evidence remains limited regarding structured progressive exercise programs specifically evaluated in postmenopausal women with osteoporosis in clinical rehabilitation settings.

This study was designed as a single-center, single-blind, randomized, parallel-assignment pilot trial conducted in postmenopausal women with osteoporosis. The objective was to evaluate the effects of a supervised progressive strength and balance exercise program on fall occurrence and fractures compared with a conventional home-based exercise program. A secondary objective was to explore whether baseline functional measures, including balance performance and handgrip strength, were associated with fall occurrence during follow-up.

Eligible participants were postmenopausal women aged 60 to 80 years with osteoporosis confirmed by dual-energy X-ray absorptiometry, defined as a T-score <= -2.5 at the lumbar spine, total hip, or femoral neck. Participants were recruited from the Osteoarticular Rehabilitation Service of the Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico. The protocol was initiated in 2019; however, study activities were suspended during the COVID-19 pandemic. The final analyzed sample consisted of 46 participants recruited consecutively by convenience sampling between 2023 and 2025.

After baseline assessment, participants were randomly allocated to either the supervised progressive strength and balance exercise program or the home-based conventional exercise program. Randomization was performed using a random-number table, and allocation was concealed using opaque, sealed, sequentially numbered envelopes that were opened after completion of baseline assessment. Outcome assessments were performed by an evaluator blinded to group allocation. Participants and treating therapists could not be blinded because of the nature of the exercise intervention.

Participants in both groups were instructed to perform home exercises three times per week, with each session lasting approximately 60 minutes, for 6 months. Adherence of at least 80% of prescribed sessions was considered adequate. Before starting the exercise program, anteroposterior and lateral thoracolumbar and sacral spine radiographs were obtained to identify asymptomatic vertebral fractures. Incident fractures during follow-up were corroborated by available clinical imaging, including radiography or computed tomography.