Osteoporosis is a common condition among postmenopausal women. Several treatments, including bisphosphonates, estrogens, parathyroid hormone receptor 1 agonists, and selective estrogen receptor modulators (SERMs), are effective in preventing and treating fragility fractures.1 In Japan, SERMs are considered a simple, safe, and cost-effective option due to the availability of generic brands and concerns regarding osteonecrosis of the jaw associated with anti-resorptive agents. However, their ability to increase bone mineral density (BMD) is inferior compared to bisphosphonates.2,3

Physical exercise is advocated as an additional preventive measure, as it is believed to enhance lower limb muscle strength and slow the decline in BMD.4 However, adherence to and maintenance of exercises can be challenging.5 Furthermore, the impact of combining medication and exercise on osteoporosis remains unclear.

This study developed an unsupervised home exercise application that incorporates exercise videos and an automatic post-exercise recording calendar (LongLifeSupport). This approach has previously led to a well-sustained exercise program, reduced pain, and improved physical ability in patients with knee osteoarthritis.6 Hence, we hypothesized that this application would enhance BMD improvement when used alongside SERMs (bazedoxifene) in patients with osteoporosis and aimed to evaluate the effects of exercise on BMD, quality of life (QOL), and physical function.