Contributors: Dr. Lora Giangregorio, Dr. Adrian Lau, Dr. Claudia Gagnon, Dr. Laëtitia Michou, Dr. Alan Low, Dr. Emma Billington, Dr. Zahra Bardai, Dr. Vithika Sivabalasundaram, Dr. Rowena Ridout, Dr. Sandra Kim.

Recommendations from Osteoporosis Canada Rapid Response Team.

In February 2025, a new article was published in the Journal of Clinical Endocrinology and Metabolism (JCEM) regarding OsteoStrong.  Osteoporosis Canada released a rapid response position statement to address the publication on March 26, 2025.

Several researchers wrote letters to the editor asking for it to be retracted because of problems with the research and reporting.  On June 24, 2025, the article was replaced with a new article that was edited by the authors in response to the letters.  Our team revised our rapid response, below, in response to the new article.  

OsteoStrong is described as “a bone-strengthening system implementing 4 devices and incorporating brief (10-minute), weekly, low-impact, and high-intensity osteogenic loading exercises”.  This study claims that participation in OsteoStrong for 10 minutes, once a week for 12 months resulted in modest improvements in bone mineral density (BMD) at the lumbar spine for women, whether they were on anti-resorptive therapies or not.  It also reported changes in left total hip BMD in people who participated in OsteoStrong.  In addition, there is a statement about potential changes in other outcomes, but the authors expressed caution in interpreting them because they were not significant in their main statistical analysis.

There may be concerns about the validity and reliability of this study.  These include flaws in the study design and analyses, and misleading reporting of results.

Some concerns about the OsteoStrong study include:

• No evidence that the trial’s study protocol was registered online, for transparency
• The main conclusions of the study suggest that improvements in BMD are due to OsteoStrong.  However, the only groups where notable changes were reported (based on the main analyses) were in groups that received osteoporosis medications (whether they participated in OsteoStrong or not). Osteoporosis medications can increase BMD.  More importantly, there was no notable change in BMD in the group that participated in OsteoStrong without osteoporosis medication.  The report does not acknowledge that it is possible that the BMD improvements could be due to medication, and not OsteoStrong.  In other words, there was a lack of considerations for confounding variables, such as the parallel use of osteoporosis medications, and the duration and adherence to their use. There is also no discussion about why the group receiving OsteoStrong without concurrent osteoporosis medication did not see an improvement in BMD.  
• There are a lot of statistical analyses, and the number and types of statistical analyses used to interpret the data are not well justified. The analysis plan should be decided upon in advance of data collection and data review, to reduce potential for bias (e.g., completing analysis in a way that gives you the most favourable results).  The statistical methods for analysis used in the original paper published in February 2025 is different than the revised paper published in June 2025, suggesting that the methods for analysis were changed after they looked at the data and received feedback, and the report does not state that. 
• Lack of efforts to reduce the risk of bias, such as randomization of participants and blinding of assessors
• There is no information about protocols for BMD assessments or how safety or fractures were monitored.
• Many participants did not complete the final assessment, or their data was missing at the end of the study. The number of missing participant assessments was unequal between groups (e.g., 4% missing in one group and over 50% missing in another), which can bias the data.

Prior studies of OsteoStrong are limited to observational studies with small sample sizes that are also at high risk of bias and are industry funded.  There is one randomized controlled trial that compared devices like those used in OsteoStrong facilities to a high intensity strength and impact exercise program.  The devices did not increase bone mineral density compared to high intensity strength and impact exercise.  Five people in the group that used the devices had spine fractures, compared to none in the exercise group.

The existing evidence regarding the benefits and harms of OsteoStrong is of very low certainty and thus, Osteoporosis Canada cannot support recommendations regarding its use for fracture prevention based on existing research. There is a cost to participating.

A research review (written for academic audiences) of all of the available research on OsteoStrong was recently published, and you can find it here: https://link.springer.com/article/10.1007/s00198-025-07614-x.  

Osteoporosis Canada also encourages health care professionals to analyze and assess these studies for themselves.

Those living with osteoporosis who are considering OsteoStrong are encouraged to seek guidance from their health care professionals.