Vol. 2, Issue 2, Part A (2025)

Background: Older adults with osteoporosis are at high risk of falls and fragility fractures, often accompanied by impaired balance, reduced mobility and fear of falling. Conventional balance physiotherapy reduces falls but may be limited by low engagement and repetitive task design. Virtual reality (VR)-based balance training offers immersive, task-specific practice with real-time feedback and gamified elements that may enhance balance recovery and fall-risk reduction.

Methods: In this single-blind randomized controlled trial, 120 community-dwelling adults aged ≥65 years with densitometrically confirmed osteoporosis and/or prior low-trauma fragility fracture were allocated to either VR-based balance training (n = 60) or dose-matched conventional balance physiotherapy (n = 60) for approximately 10 weeks (three 45-60-minute sessions per week). The primary outcome was a composite fall-risk index (CFRI) derived from Berg Balance Scale, Timed Up and Go (TUG), gait speed and postural sway. Secondary outcomes included prospective falls over 6 months, individual balance and mobility measures, fear of falling, and health-related quality of life. Analyses were performed on an intention-to-treat basis using mixed models and regression techniques.

Results: Both groups improved significantly, but CFRI reduction was greater in the VR group at post-intervention and 6-month follow-up (adjusted between-group difference in change −0.46 and −0.42, respectively; p<0.001). Over 6 months, at least one fall occurred in 23.3% of VR participants versus 41.7% of controls (relative risk 0.56; p = 0.024). The VR group showed larger gains in Berg Balance, TUG and gait speed, alongside greater reductions in fear of falling and small-to-moderate improvements in physical functioning. No serious adverse events or intervention-related fractures were observed.

Conclusion: VR-based balance training produced superior and clinically meaningful improvements in fall risk, balance, mobility and fear of falling compared with conventional balance physiotherapy in older adults with osteoporosis, supporting its integration as a safe, engaging and effective component of comprehensive fall- and fracture-prevention strategies in this high-risk population.