SummaryThe objective of exercise in the treatment of osteoporosis is to improve axial stability through strengthening of back extensor muscles. Therefore, a back extension exercise program specific to one’s musculoskeletal competence and pain can be performed in a sitting position and later advanced to the prone position. When fragility is resolved, back extension is performed against resistance applied to the upper back. A significant reduction in back pain, kyphosis, and risk of falls and an improvement in the level of physical activity have been achieved through the SPEED (Spinal Proprioceptive Extension Exercise Dynamic) program. In addition, the application of a “Posture Training Support” (PTS) using a backpack may decrease kyphosis and pain related not only to compression fractures but also reduce iliocostal friction. Therapeutic exercise should address osteo - porosis-related deformities of axial posture, which can increase risk of fall and fracture. Thus, the role of a therapeutic exercise program is to increase muscle strength safely, decrease immobility-related complications, and prevent fall and fracture. As with pharmacotherapy, therapeutic exercises are individualized.