Objective: This comprehensive review aims to synthesize and critically evaluate the existing body of scientific literature from 2000 to 2025 regarding the effects of resistance training on bone mineral density (BMD) and bone health indicators in older adults (≥60 years). Methods: A systematic literature search was conducted using major scientific databases, including PubMed, Scopus, Web of Science, and ScienceDirect. Keywords included "resistance training," "strength training," "bone mineral density," "osteoporosis," "bone health," "elderly," and "older adults." The review prioritized randomized controlled trials (RCTs), longitudinal studies, and meta-analyses published in JCR-indexed journals. Findings: The evidence overwhelmingly supports the efficacy of RT in attenuating or even reversing age-related bone loss. The osteogenic effect is primarily mediated by mechanical loading, which stimulates bone formation through mechanotransduction pathways. Key training variables determining the osteogenic potential of RT include intensity (load), progression, exercise type, and site-specificity. High-intensity, progressive resistance training targeting major muscle groups has consistently been shown to be superior for increasing BMD at clinically relevant sites such as the lumbar spine and femoral neck. Furthermore, RT provides the dual benefit of concurrently combating sarcopenia, which improves physical function and reduces fall risk, thereby indirectly decreasing fracture incidence. The synergistic effects of RT with adequate nutritional support (protein, calcium, vitamin D) and its potential to complement pharmacological therapies are also highlighted. Conclusion: Resistance training is a safe, feasible, and effective non-pharmacological intervention for preserving and enhancing bone density in the elderly. It should be considered a cornerstone of public health strategies for the prevention and management of osteoporosis. Future research should focus on long-term adherence, optimal programming for the very frail and oldest-old populations, and the intricate molecular crosstalk between muscle and bone.
