Exercise is commonly recommended in the prevention and management of osteoporosis. The most common method to monitor bone mass and its response to interventions is bone densitometry. While closely associated with risk of fracture, densitometry-derived areal bone mineral density (aBMD) does not provide a reliable indication of bone geometry or morphological adaptation to stimuli. In fact, the effects of exercise interventions on aBMD are frequently modest, and may not fully represent the benefit of exercise to bone. Animal models suggest that mechanical loading indeed influences bone geometry and thus strength. Such an effect in humans has the potential to reduce osteoporotic fracture. The aim of the current narrative review is to provide an overview of what is known about the effects of exercise on bone geometry, with a focus on relevance to osteoporosis.
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