The prevention of osteoporotic fracture by exercise intervention requires a two-pronged approach, that is, the maximization of bone strength and the minimization of falls. Intense animal and human research activity over the last 30 years has generated a wealth of evidence that has led to a recommended exercise prescription for optimizing bone health. The incorporation of exercise as a fracture prevention strategy should commence before peak bone mass has been attained and continue throughout life, and can be enhanced by adequate calcium consumption. Osteogenic exercise follows certain training principles, including site specificity, requirement for overload, reversibility, and greatest efficacy in the weakest bones. The minimally effective exercise regime would consist of twice-weekly, high-intensity, weight-bearing impact loading, and resistance training; however, a precise optimum dose remains to be determined. Falls present a formidable risk to an osteoporotic skeleton; therefore, neuromuscular strength training and balance training strategies should be incorporated in exercise programs to minimize fracture risk, particularly in old age. Although trials with fractures as an outcome have been limited, there is a growing body of indirect evidence that supports exercise as a powerful strategy to reduce the incidence of osteoporotic fracture. While exercise appears to be a safe and effective fracture prevention approach, future work must identify strategies that promote the adoption and uptake of osteogenic exercise across the life span.