Twelve trials, 1,061 men, and one split verdict. A systematic review and meta-analysis in Frontiers in Physiology found that exercise raises bone mineral density in the lumbar spine and femoral neck of middle-aged and older men. At the total hip, it found nothing significant.
The question had been left hanging. Earlier studies on men were few and pointed in different directions, with some showing clear benefits and others none, which is why the authors set out to pool them.
How the review was done
The team searched PubMed, Web of Science, Embase and several other databases through December 20, 2025, and turned up 2,213 records. After removing 773 duplicates and screening 1,440 titles and abstracts, they assessed 90 full-text reports. Twelve randomized or semi-randomized trials made the cut. The review was registered in advance with PROSPERO, and the authors say they followed that protocol without major changes.
The included studies ran from 2007 to 2021. Participants averaged between 50.9 and 77.8 years old. Most trials compared an exercise group with usual care or no intervention, and the programs lasted 6 to 18 months, mostly with 2 to 5 sessions a week of 20 to 60 minutes. Seven trials used multicomponent programs. Resistance training was the most common ingredient, impact or weight-bearing exercise appeared in seven trials, and aerobic training in two. A few were more unusual: football, table tennis, whole-body vibration and Tai Chi.
What the pooled results showed
Exercise significantly increased density at the lumbar spine and femoral neck. No significant benefit showed up at the total hip or other regions dominated by cortical bone.
Subgroup analyses pointed to the same recipe for the biggest gains: more frequent sessions, programs lasting longer than six months, and multicomponent regimens. The authors say those factors maximized the skeletal benefit and stress the roles of training frequency and exercise type.
They describe exercise as an effective way to improve site-specific bone density in aging men, particularly at the spine and femoral neck, which are high fracture-risk sites.
Why men matter here
The paper puts male osteoporosis at roughly 12% globally, above 20% in some regions. Once a fracture happens, disability and death rates in men may exceed those in women. Most osteoporosis research has centered on women, though, and the authors argue that men are underestimated, underdiagnosed and undertreated. Current guidelines for men are largely extrapolated from studies of female cohorts.
Drug therapy, including calcium, vitamin D, hormone replacement and bisphosphonates, is commonly used. The authors note that it often means long courses, possible side effects, high costs and uneven adherence. Exercise offers a non-drug option, and they say the findings give an evidence base for exercise prescriptions designed for men.
