Comprehensive Review of Therapeutic Efficacy and Underlying Mechanisms of Various Exercise Modalities in Treating Osteoporosis

Osteoporosis (OP) is a major public health challenge affecting over 200 million individuals worldwide. While pharmacological interventions represent mainstream treatment, concerns regarding long-term side effects and patient compliance have driven the exploration of alternative therapies. Exercise interventions have emerged as promising complementary approaches due to their excellent safety profiles, cost-effectiveness, and high adherence rates. Diverse exercise modalities, including aerobic, resistance, and balance exercises, effectively modulate bone homeostasis by promoting osteogenesis, inhibiting osteoclastogenesis, enhancing muscle-bone crosstalk, regulating the vascular/lymphatic systems, and modulating inflammation. This review synthesizes current knowledge on exercise-based therapies for musculoskeletal disorders, with a particular emphasis on their anti-OP mechanisms, which target osteoblast- and osteoclast-mediated bone homeostasis, endocrine regulation, immune function, and muscle performance. Furthermore, we explore the potential of combining exercise with other therapies and systematically compare the clinical efficacy of various exercise types. This review provides deeper mechanistic insights into exercise-mediated bone protection and offers evidence-based perspectives for developing innovative therapeutic strategies in OP management.