1 Prescribing Exercise for Osteoporosis Shona L Bass, Mark R Forwood, Judy A Larsen, and Leanne Saxon Osteoporosis is a major public health problem because of the morbidity and mor- tality associated with fracture. Minimizing the risk of fracture is the primary objec- tive of osteoporosis management. The role of exercise in osteoporosis management is to increase and maintain peak bone density and reduce the rate of bone loss and the risk of falling. This article provides recommendations focusing on a life-span ap- proach to minimizing the risk of fracture associated with osteoporosis. Osteoporosis prevention begins in childhood, when exercise can increase peak bone strength. In young adults, it can maintain peak bone mineral density. In elderly individuals, physi- cal activity can slow bone loss and improve fitness and muscle strength, helping prevent falls and lower the risk of fracture. Exercise goals for individuals with os- teoporosis should include reducing pain, increasing mobility, and improving muscle endurance, balance, and stability in order to improve the quality of life and reduce the risk of falling. Thus, exercise plays a significant part in reducing fractures in later life. Key Words: bone density, children, adults, fracture Key Points: • Osteoporosis prevention begins in childhood, when exercise is recommended to increase peak bone strength. • In young adults, the aim of exercise is to maintain peak bone mineral density. • In elderly individuals, physical activity can reduce the rate of bone loss and improve fitness and muscle strength. • Exercise goals for individuals with osteoporosis should include pain reduction, increased mobility, and improvements in muscle endurance, balance, and stability. Introduction The World Health Organization 1 describes osteoporosis as a “disease char- acterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in frac- ture risk.” p3 Regular, vigorous physical activity may contribute to preven- tion of this condition, 2-6 but inappropriate prescription of physical activity to individuals with osteoporosis could also exacerbate the risk of fracture. For the purpose of diagnosis, a bone mineral density (BMD) 2.5 standard deviations (SDs) or more below the young adult mean in the same sex at the same site is indicative of osteoporosis. 1 Despite a large number of pub- lications on the skeletal effects of exercise on healthy individuals, there are few reports in which subjects with a diagnosis of osteoporosis were spe-