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. The former is most effectively addressed before peak bone mass has been attained, so that the latter is the primary option for the older, osteoporotic individual. Intense animal and human research activity over the last 20 years has generated a wealth of data that has led to recommendations for exercise prescriptions to both enhance bone strength and minimize risk of falling. Whether those exercise protocols will be shown to effectively reduce actual fracture incidence requires the analysis of longer term data than is currently available.