This clinical trial aims to evaluate the effectiveness of a smart community-based resistance training program in older adults aged 60 and older with primary osteoporosis. The main questions it aims to answer are:

Does the 32-week smart resistance training improve lumbar spine bone mineral density (BMD)? Does the training improve lower extremity physical function? Researchers will compare the smart resistance training group with a routine health education control group to see if the resistance training effectively improves bone health and physical capabilities.

Participants will:

Be randomly assigned to either the resistance training group or the health education group.

If in the training group: Wear a smart health bracelet and complete 40 to 60 minutes of elastic band resistance training 3 times a week for 32 weeks, with guidance from smart devices and community staff.

If in the health education group: Maintain usual daily activities and attend a monthly group health education lecture on osteoporosis.

Complete clinical assessments, including bone density scans (DXA), physical performance tests, and questionnaires at the start, at 16 weeks, and at 32 weeks.

Enter a 12-month observational follow-up phase after the 32-week intervention to evaluate the long-term sustainability of the outcomes.

Primary osteoporosis presents a significant global public health burden. Resistance training effectively improves bone mineral density (BMD) and physical function in older adults. Traditional supervised training programs face practical barriers regarding spatial accessibility, temporal constraints, and long-term adherence. Mobile health (mHealth) and smart community facilities offer scalable solutions for home-based interventions. The clinical efficacy of high-intensity digital exercise prescriptions and the specific mechanistic role of technology acceptance require rigorous validation through randomized controlled trials.

This study is a single-center, single-blind, parallel-group randomized controlled trial. 98 older adults diagnosed with primary osteoporosis will be recruited from a smart elderly care community. Participants will be randomly assigned to either an intervention group or a control group. The study consists of a 32-week core intervention period followed by a 12-month observational follow-up phase to evaluate long-term effectiveness.

The intervention group will undergo a smart community-based resistance training program. Participants will complete 40 to 60 minutes of structured elastic band training 3 times a week. The protocol applies progressive overload, starting at 50-60% of 1-repetition maximum (1RM) and advancing to 70-80% 1RM. Smart health bracelets and mobile applications will deliver standardized video demonstrations, monitor real-time physiological metrics, and track attendance. Community staff holding fitness certifications will provide periodic offline coaching, error correction, and safety supervision.

The control group will receive routine care. Participants will maintain their usual daily activities and attend a monthly offline group seminar covering osteoporosis prevention, nutrition, and fall prevention strategies.

The primary objective is to evaluate longitudinal changes in lumbar spine BMD and physical performance, measured by the Short Physical Performance Battery (SPPB), at 16 and 32 weeks. Secondary objectives include assessing upper limb handgrip strength, health-related quality of life (SF-36), and dimensions of technology acceptance during the intervention and the subsequent 12-month follow-up period. The study will utilize mediation models and machine learning frameworks to explore whether baseline technology acceptance directly influences clinical outcomes or serves as an antecedent driving initial adherence.

Inclusion Criteria:

• Aged 60 years or older.
• Diagnosed with primary osteoporosis via DXA scan (lumbar spine or hip T-score ≤ -2.5, or ≤ -2.0 with a fragility fracture history).
• Possess basic smartphone operation skills. Normal basic cognitive ability (MMSE score ≥ 24) and capable of independent walking.
• Reside in the designated community without relocation plans within the next year.
• Voluntarily sign the informed consent form.

Exclusion Criteria:

• Diagnosed with secondary osteoporosis.
• Recent major medical events (e.g., fractures or hip/spine surgery within the past 3 months) or uncontrolled severe cardiovascular diseases.
• Completely unable to operate smart devices due to severe sensory or communication impairments.
• Currently participating in similar exercise interventions or clinical trials.
• Terminal illness or life expectancy of less than 1 year.
• Lack of support or consent from children or guardians.

Data sharing is subject to approval by the local Civil Affairs Bureau and the project's cooperating community center. Since the study is integrated into a government-supported community elderly care pilot, individual participant data (IPD) can only be shared after ensuring full compliance with local administrative regulations and obtaining explicit authorization from the relevant authorities. A final decision will be made upon the completion of the project and internal review.

This is an evaluator-blinded study. Due to the nature of the exercise intervention, participants and care providers cannot be masked. However, all clinical assessments (including DXA scans and physical tests) and data analysis are performed by independent researchers who are strictly blinded to the group allocations.