Background: Osteoporosis is a major health concern in postmenopausal women, driven by accelerated bone loss following deficiency. While pharmacological treatments are effective, exercise remains a critical non-pharmacological strategy for improving or maintaining bone mineral density BMD. However, the optimal type, intensity, and duration of exercise interventions remain unclear.

Objective: To systematically evaluate the effects of 6 month exercise interventions on lumbar spine LS and femoral neck FN BMD in postmenopausal women, with a focus on intervention type, effectiveness, and methodological quality.

Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted for studies published from January 2015 to June 2025. Inclusion criteria were randomized controlled trials RCTs involving 6‑month intervention; DXA‑measured LS and or FN BMD; sample  40; published 2015 Jun 2025; RCT or cluster RCT; women 12 post‑menopause; exercise only or exercise standard care). Data were extracted into an evidence table, and risk of bias was assessed using the Cochrane  2 tool.

Results: Twelve RCTs N 988 met inclusion criteria. High-intensity resistance and impact training  demonstrated the greatest BMD improvements, with up to 4.0 percentage at the LS and 2.8 percentage at the FN. Other modalities, including whole-body vibration, weighted-vest training, and mind-body combinations, primarily maintained BMD or attenuated loss. Adherence exceeded 80 percentage in most trials, and no exercise-related fragility fractures were reported. Two trials were judged low risk of bias, seven had some concerns, and three were high risk.

Conclusion: Exercise interventions, particularly performed under supervision, can significantly improve or preserve LS and FN BMD in postmenopausal women. These findings support integrating targeted exercise programs into osteoporosis prevention and management strategies. Further research should compare exercise with pharmacological treatments and assess long-term maintenance and fracture outcomes.