Effects of exercise regimens on balance ability in older patients with osteoporosis: a systematic review and Bayesian network meta-analysis of randomized controlled trials

To determine the optimal exercise regimen for improving balance and preventing severe falls in older patients with osteoporosis (OP). Four databases were searched until September 1, 2025. The risk of bias was assessed using Cochrane ROB2. Outcomes included Berg Balance Scale (BBS, primary), timed up and go test (TUG), bone mineral density (BMD), one-leg stand test (OLS), and number of falls. A Bayesian network meta-analysis in R4.4.1/GeMTC synthesized effects, presented as MD (95% CrI) and ranked by SUCRA. Analysis of 22 RCTs (n=1538) versus usual care showed virtual reality (VR) most effective for BBS (MD 9.2, 95% CrI 7.2, 11; SUCRA 99.66%) and TUG (MD -4.6, 95% CrI -5.8, -3.3; SUCRA 98.51%); balance training+resistance training+aerobics (BT + RT + aerobics) best improved BMD (MD 0.016, 95% CrI 0.012, 0.020; SUCRA 72.38%); trampoline best improved OLS (MD 8.8, 95% CrI 1.7, 5.5; SUCRA 72.38%); RT most significantly reduced falls (MD 0.29, 95% CrI 0.100, 0.68; SUCRA 84.86%). For older OP patients, VR is most effective in improving overall balance and mobility, with reliable evidence. Combination training, trampoline, and RT exhibit potential benefits for BMD, OLS, and fall prevention, respectively. Due to the limited amount of evidence and network strength, however, these interventions cannot yet be considered definitive clinical recommendations. More high-quality direct comparisons are required for further validation in the future.