The Impact of Sedentary Behavior and Physical Activity on Bone Health: A Narrative Review from the Rehabilitation Working Group of the International Osteoporosis Foundation.
Humans; Sedentary Behavior; Exercise/physiology; Bone Density/physiology; Osteoporosis; Bone and Bones/physiology; Fractures, Bone; Adult; Child; Bone health; Fracture; Physical activity; Sedentary behavior
Abstract :
[en] Physical activity (PA) and sedentary behavior (SB) are two key lifestyle factors with profound implications for bone health across the lifespan. While PA is recognized for its positive effects on bone mineral density (BMD) and fracture prevention, emerging evidence highlights the detrimental consequences of prolonged sedentary time, independent of PA levels. This review synthesizes current knowledge on the impact of PA and SB on bone health outcomes, focusing on BMD and fracture risk in children, adolescents, adults, and older populations. A selection of epidemiological studies, systematic reviews, and meta-analyses was analyzed to explore the associations between movement behaviors and bone health indicators across different life stages. Particular attention was given to studies objectively measuring SB and PA and to the substitution effects of sedentary time with light or moderate-to-vigorous PA. In children and adolescents, higher levels of SB are associated with lower BMD, particularly at weight-bearing sites, while participation in weight-bearing and impact-loading PA positively influences bone mass accrual. In adults and older individuals, regular PA, including moderate-to-vigorous intensity weight-bearing PA and resistance training activities, is consistently linked to greater BMD and reduced fracture risk. Conversely, high sedentary time is associated with lower BMD and increased fracture incidence, particularly among frail or pre-frail individuals. Importantly, replacing sedentary time with even light-intensity PA yields measurable benefits for bone health, particularly among older adults and postmenopausal women, and may contribute to a reduced risk of fractures, although evidence remains limited. Promoting PA while minimizing SB should be central to clinical practice and public health policies aimed at maximizing and preserving skeletal health and preventing osteoporotic fractures, across the lifespan. Early intervention, continuous promotion across life stages, and adherence to WHO guidelines offer an effective, evidence-based framework for lifelong bone health maintenance.
Disciplines :
Orthopedics, rehabilitation & sports medicine
Author, co-author :
Bruyère, Olivier ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Scott, David; Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia. ; School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.
Papaioannou, Alexandra; Departments of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Camargos, Bruno Muzzi; Densitometry Unit - Rede Materdei de Saúde, Belo Horizonte, Minas Gerais, Brazil.
Chapurlat, Roland; INSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital E Herriot, Lyon, France.
Chevalley, Thierry; Faculty of Medicine, Service of Bone Diseases, Geneva University Hospitals, 1211, Geneva, Switzerland.
Dennison, Elaine M; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
Kaux, Jean-François ; Université de Liège - ULiège > Département des Sciences de l'activité physique et de la réadaptation > Médecine physique, réadaptation et traumatologie du sport
Lane, Nancy E; Department of Medicine, U.C. Davis Health, Sacramento, CA, 95817, USA.
Messina, Osvaldo Daniel; IRO Medical Center, Investigaciones Reumatologicas y Osteologicas SRL, Buenos Aires, Argentina.
Rizzoli, Rene; Faculty of Medicine, Service of Bone Diseases, Geneva University Hospitals, 1211, Geneva, Switzerland.
Torres, Jorge Morales; Morales Vargas Centro de Investigación and Osteoporosis Unit, Hospital Aranda de la Parra, León, GTO, Mexico.
Paccou, Julien; Department of Rheumatology, Univ. Lille, CHU Lille, MABlab ULR 4490, 59000, Lille, France.
Reginster, Jean-Yves ; Université de Liège - ULiège > Département des sciences de la santé publique ; Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia.
Tuzun, Sansin; Department of Physical Medicine and Rehabilitation, Cerrahpaşa School of Medicine, Istanbul University- Cerrahpaşa, Istanbul, Turkey.
Blank, Robert D; Garvan Institute of Medical Research, Darlinghurst, NSW, Australia. ; Medical College of Wisconsin, Milwaukee, WI, USA.
Silverman, Stuart; The OMC Research Center, Beverly Hills, CA, USA. ; Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Pinto, Daniel; Department of Physical Therapy, Marquette University, Milwaukee, USA.
Rehabilitation Working Group of IOF Committee of Scientific, Advisors
The Impact of Sedentary Behavior and Physical Activity on Bone Health: A Narrative Review from the Rehabilitation Working Group of the International Osteoporosis Foundation.
WHO Guidelines on Physical Activity and Sedentary Behaviour. WHO Guidelines Approved by the Guidelines Review Committee. Geneva2020.
C. Mou Z. Wang Z. Ke Association between physical activity and multimorbidity: a population-based cohort study Arch Public Health 83 1 71 40098053 11916932
M.S. Tremblay S. Aubert J.D. Barnes T.J. Saunders V. Carson A.E. Latimer-Cheung et al. Sedentary behavior research network (SBRN) - terminology consensus project process and outcome Int J Behav Nutr Phys Act 14 1 75 28599680 5466781
S. Panahi A. Tremblay Sedentariness and health: is sedentary behavior more than just physical inactivity? Front Public Health 6 258 30250838 6139309
A.B. West K.M. Bittel M.A. Russell M.B. Evans S.K. Mama D.E. Conroy A systematic review of physical activity, sedentary behavior, and substance use in adolescents and emerging adults Transl Behav Med 10 5 1155 1167 33044536 7549408
T. Sugiyama J.S. Price L.E. Lanyon Functional adaptation to mechanical loading in both cortical and cancellous bone is controlled locally and is confined to the loaded bones Bone 46 2 314 321 19733269 2825292
J.B. Koedijk J. van Rijswijk W.A. Oranje J.P. van den Bergh S.P. Bours H.H. Savelberg et al. Sedentary behaviour and bone health in children, adolescents and young adults: a systematic review Osteoporos Int 28 9 2507 2519 1:STN:280:DC%2BC1cnhsFGmsw%3D%3D 28547135 5550522
D.G.D. Christofaro W.R. Tebar B.T.C. Saraiva G.C.R. da Silva A.B. Dos Santos G.I. Mielke et al. Comparison of bone mineral density according to domains of sedentary behavior in children and adolescents BMC Pediatr 22 1 72 1:CAS:528:DC%2BB38XotlClur0%3D 35105341 8805312
M. Behringer S. Gruetzner M. McCourt J. Mester Effects of weight-bearing activities on bone mineral content and density in children and adolescents: a meta-analysis J Bone Miner Res 29 2 467 478 23857721
T.S. Tran T.P. Ho-Le D. Bliuc J.R. Center R.D. Blank T.V. Nguyen Prevention of hip fractures: trade-off between minor benefits to individuals and large benefits to the community J Bone Miner Res 38 11 1594 1602 1:CAS:528:DC%2BB3sXitVCksLnO 37638688
U. Meyer D. Ernst L. Zahner C. Schindler J.J. Puder M. Kraenzlin et al. 3-year follow-up results of bone mineral content and density after a school-based physical activity randomized intervention trial Bone 55 1 16 22 23510752
D. Herrmann C. Buck I. Sioen Y. Kouride S. Marild D. Molnar et al. Impact of physical activity, sedentary behaviour and muscle strength on bone stiffness in 2–10-year-old children-cross-sectional results from the IDEFICS study Int J Behav Nutr Phys Act 12 112 26377674 4574210
L. McMichan M. Dick D.A. Skelton S.F.M. Chastin N. Owen D.W. Dunstan et al. Sedentary behaviour and bone health in older adults: a systematic review Osteoporos Int 32 8 1487 1497 1:STN:280:DC%2BB3sfitlyrug%3D%3D 33768342
S. Chopra M.M. Morrow C. Ngufor E. Fortune Differences in physical activity and sedentary behavior patterns of postmenopausal women with normal vs. low total hip bone mineral density Front Sports Act Living 2 33345074 7739614 83
Y.A. Kim Y. Lee J.H. Lee J.H. Seo Effects of physical activity on bone mineral density in older adults: Korea National Health and Nutrition Examination Survey, 2008–2011 Arch Osteoporos 14 1 103 1:CAS:528:DC%2BB3cXhtlSqtb%2FF 31655946
C.A. Ng D. Scott M. Sim K. Zhu A. Siafarikas N.H. Hart et al. Physical activity estimated by osteogenic potential and energy expenditure has differing associations with bone mass in young adults: the Raine study Arch Osteoporos 17 1 67 35434777 9013684
C.A. Ng D. Scott M.J. Seibel R.G. Cumming V. Naganathan F.M. Blyth et al. Higher-impact physical activity is associated with maintenance of bone mineral density but not reduced incident falls or fractures in older men: the Concord Health and Aging in Men Project J Bone Miner Res 36 4 662 672 1:CAS:528:DC%2BB3MXoslGnsrc%3D 33278306
R.D.J. de Oliveira R.G. de Oliveira L.C. de Oliveira S.D. Santos-Filho D.C. Sa-Caputo M. Bernardo-Filho Effectiveness of whole-body vibration on bone mineral density in postmenopausal women: a systematic review and meta-analysis of randomized controlled trials Osteoporos Int 34 1 29 52 36282343
R. Mohebbi M. Shojaa M. Kohl S. von Stengel F. Jakob K. Kerschan-Schindl et al. Exercise training and bone mineral density in postmenopausal women: an updated systematic review and meta-analysis of intervention studies with emphasis on potential moderators Osteoporos Int 34 7 1145 1178 36749350 10282053
M. Shojaa S. von Stengel M. Kohl D. Schoene W. Kemmler Effects of dynamic resistance exercise on bone mineral density in postmenopausal women: a systematic review and meta-analysis with special emphasis on exercise parameters Osteoporos Int 31 8 1427 1444 1:STN:280:DC%2BB38vmtFanug%3D%3D 32399891 7360540
C. Ricci F. Gervasi L. Havemann Nel C.M. Smuts S.H. Kruger M.F. Leitzmann Substitution of sedentary time with light physical activity is related to increased bone density in U.S. women over 50 years old. An iso-temporal substitution analysis based on the national health and nutrition examination survey Eur J Sport Sci 19 10 1404 1413 30998435
R.A. Mekary W.C. Willett F.B. Hu E.L. Ding Isotemporal substitution paradigm for physical activity epidemiology and weight change Am J Epidemiol 170 4 519 527 19584129 2733862
C.A. Ng A. Gandham J. Mesinovic P.J. Owen P.R. Ebeling D. Scott Effects of moderate- to high-impact exercise training on bone structure across the lifespan: a systematic review and meta-analysis of randomized controlled trials J Bone Miner Res 38 11 1612 1634 1:CAS:528:DC%2BB3sXhvVOhu73N 37555459
D. Bliuc T. Tran D. Alarkawi W. Chen D.A. Alajlouni F. Blyth et al. Patient self-assessment of walking ability and fracture risk in older Australian adults JAMA Netw Open 7 1 e2352675 38261318 10807297
M.J. LaMonte J. Wactawski-Wende J.C. Larson X. Mai J.A. Robbins M.S. LeBoff et al. Association of physical activity and fracture risk among postmenopausal women JAMA Netw Open 2 10 e1914084 31651972 6822158
D. Feskanich W. Willett G. Colditz Walking and leisure-time activity and risk of hip fracture in postmenopausal women JAMA 288 18 2300 2306 12425707
Howe TE, Shea B, Dawson LJ, Downie F, Murray A, Ross C, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. 2011(7):CD000333.
F. El-Khoury B. Cassou M.A. Charles P. Dargent-Molina The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials BMJ 347 24169944 3812467 f6234
Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019;1(1):CD012424.
J. Zhou R. Tang X. Wang H. Ma X. Li Y. Heianza et al. Frailty status, sedentary behaviors, and risk of incident bone fractures J Gerontol A Biol Sci Med Sci 39190316 11664257 10.1093/gerona/glae186
I.B. Rodrigues P. Ching M. Kalra R. Zheng A. Rabinovich A. Papaioannou et al. Exploring the perspectives of older adults who are pre-frail and frail to identify interventions to reduce sedentary behaviour and improve mobility: a thematic content analysis BMC Public Health 24 1 1582 38872140 11170854
H.P. van der Ploeg F.C. Bull Invest in physical activity to protect and promote health: the 2020 WHO guidelines on physical activity and sedentary behaviour Int J Behav Nutr Phys Act 17 1 145 33239047 7688396
C. Glavas D. Scott One day at a time: understanding how 24-hr physical activity, sedentary behavior and sleep patterns influence falls and fracture risk J Bone Miner Res 40 1 1 2 39561109
L.S. Roe E.S. Strotmeyer P.M. Cawthon N.W. Glynn Y. Ma S. Ancoli-Israel et al. 24-hour activity composition is associated with lower fall and fracture risk in older men J Bone Miner Res 40 1 27 37 39348414
C.O. Akosile C.K. Igwemmadu E.C. Okoye A.C. Odole U.G. Mgbeojedo A.A. Fabunmi et al. Physical activity level, fear of falling and quality of life: a comparison between community-dwelling and assisted-living older adults BMC Geriatr 21 1 12 33407211 7788713
B.J. Jefferis S. Iliffe D. Kendrick N. Kerse S. Trost L.T. Lennon et al. How are falls and fear of falling associated with objectively measured physical activity in a cohort of community-dwelling older men? BMC Geriatr 14 114 25348492 4223846
M. Liu T. Hou Y. Li X. Sun S.L. Szanton L. Clemson et al. Fear of falling is as important as multiple previous falls in terms of limiting daily activities: a longitudinal study BMC Geriatr 21 1 350 34098904 8185919
Y. Jiang M. Wang S. Liu X. Ya G. Duan Z. Wang The association between sedentary behavior and falls in older adults: a systematic review and meta-analysis Front Public Health 10 1019551 36438277 9691853
M. Adams K. Gordt-Oesterwind M. Bongartz S. Zimmermann S. Seide V. Braun et al. Effects of physical activity interventions on strength, balance and falls in middle-aged adults: a systematic review and meta-analysis Sports Med Open 9 1 61 37466877 10356733
J. Baj-Korpak K. Zaworski M. Wochna S. Chmara M.J. Stelmach Physical fitness and body build parameters of children and adolescents participating in the physical activity promotion programme "Athletics for all!" Arch Public Health 82 1 206 39517023 11545620
J. Salmon L. Arundell E. Cerin N.D. Ridgers K.D. Hesketh R.M. Daly et al. Transform-Us! cluster RCT: 18-month and 30-month effects on children's physical activity, sedentary time and cardiometabolic risk markers Br J Sports Med 57 5 311 319 36428089
D. Commissaris M.A. Huysmans S.E. Mathiassen D. Srinivasan L.L.J. Koppes I.J.M. Hendriksen Interventions to reduce sedentary behavior and increase physical activity during productive work: a systematic review Scand J Work Environ Health 42 3 181 191 26683116
S. Michie M. Richardson M. Johnston C. Abraham J. Francis W. Hardeman et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions Ann Behav Med 46 1 81 95 23512568
I.B. Rodrigues S. Tariq A. Kouroukis R. Swance J. Adachi S. Bray et al. Mapping sedentary behaviour (MAPS-B) in winter and spring using wearable sensors, indoor positioning systems, and diaries in older adults who are pre-frail and frail: a feasibility longitudinal study PLoS ONE 19 5 1:CAS:528:DC%2BB2cXht1Gnu77N 38753692 11098368 e0290197
M.B. Pinheiro J. Oliveira A. Bauman N. Fairhall W. Kwok C. Sherrington Evidence on physical activity and osteoporosis prevention for people aged 65+ years: a systematic review to inform the WHO guidelines on physical activity and sedentary behaviour Int J Behav Nutr Phys Act 17 1 150 33239014 7690138
