Physical Therapist Management of Patients With Suspected or Confirmed Osteoporosis: A Clinical Practice Guideline From the Academy of Geriatric Physical Therapy.

The guideline reports no new patient data of its own. Its recommendations rest on older systematic reviews, and the authors state that the original studies had diverse methodological and reporting problems that left them of low quality. Falls and fractures were deliberately excluded. This document addresses bone mineral density only, and makes no recommendation about fall risk. No study directly compared two exercise approaches, so the ranking of exercise types comes from separate sets of trials rather than head-to-head evidence. The single-leg standing evidence comes from one small trial in Asian women without a clear diagnosis of osteoporosis, so it may not generalise to other populations. The studies lacked racial diversity, which the authors say makes it difficult to extend the findings to the general US population. Some doses are unresolved. The guideline states the specific dose for single-leg standing is unclear, and how aerobic activity was performed in the combination studies is not reported. For men, the evidence base was 3 studies of unclear quality, 2 of them unpublished dissertations. Safety was inferred from the few adverse events reported in trials. None of the studies specifically examined exercise safety or included people at high risk of adverse outcomes from exercise. Several exercise programmes had high dropout rates, which the authors say means motivational strategies need to be part of the programme.

Development group members all report grants from APTA Geriatrics and APTA during the work, so the professional association that produced the guideline also funded it. No commercial or industry funding is described. Dr Hartley sat on the APTA Geriatrics board of directors and Dr Betz chaired its Bone Health Special Interest Group; neither was paid for those roles, though the Academy covered some travel to meetings. The guideline was endorsed by the medical and scientific advisory boards of American Bone Health and the National Osteoporosis Foundation. The source guideline developers at SIGN gave consent for the adaptation and asked only that the document make clear it excludes falls and fractures.

Do not read this as proof that exercise prevents fractures or falls. The guideline left fracture and fall outcomes out on purpose, and none of the studies behind it examined exercise safety or included people at high risk of harm from exercise.