Osteoporosis and aging: Impact on mobility, balance, and functional independence in the elderly

Abstract

Introduction: Osteoporosis is a highly significant condition among the elderly, characterized by reduced bone mass and increased skeletal fragility. Associated with age-related changes, it can negatively impact gait, balance, mobility, and functional capacity, increasing vulnerability to falls and contributing to a loss of autonomy. In this context, physical exercise emerges as an important strategy for preserving functionality and maintaining independence during aging. Objective: To synthesize the available evidence on the impacts of osteoporosis on the mobility, balance, and functional independence of older adults, as well as to analyze the effects of physical exercise-based interventions on these outcomes. Methods: This is an integrative literature review of a qualitative and descriptive nature, conducted using the PubMed/MEDLINE, SciELO, and BVS databases. The search included descriptors and keywords related to osteoporosis, aging, the elderly, balance, gait, mobility, falls, functional capacity, activities of daily living, and physical exercise. Initially, 125 records were identified, 25 of which were duplicates. After screening the remaining 100 studies, 35 were selected for eligibility assessment; ultimately, 12 studies met the established criteria and constituted the review sample. Data were organized by author/year, title, methodological design, objective, and main findings. Results: The 12 included studies were secondary syntheses of the literature, covering populations with osteoporosis, osteopenia, or low bone mineral density, as well as community-dwelling or frail older adults. Regarding evidence specific to bone impairment, associations were observed with gait alterations, functional impairment, increased risk and fear of falls, and reduced independence. In general older adult populations, slower gait speed, reduced muscle strength, low physical activity levels, and balance impairments were linked to functional disability. Interventions involving balance training and multicomponent programs yielded favorable results across various components of physical function, although heterogeneity was observed regarding populations, interventions, and outcomes. Conclusion: Evidence specific to individuals with osteoporosis or osteopenia indicates impacts on mobility, balance, falls, and functional independence, alongside potential benefits from exercise-based interventions. Evidence from community-dwelling or frail older adults complements these findings regarding age-related functional changes but should not be directly attributed to osteoporosis. The heterogeneity of available evidence precludes the definition of a single exercise protocol.