Exercise is widely recommended to prevent osteoporosis and reduce the risk of falls and fractures, but not all forms are equally effective. At present the optimal type, intensity, frequency and duration of exercise that can preserve skeletal integrity and prevent fractures is not known, but it is recognized that the effects of exercise on musculoskeletal health and function are modality and intensity-dependent. Regular walking alone has little or no effect on preventing bone and muscle loss, and may even increase the risk of falls and fractures. Most of the available evidence from intervention trials in middle-aged and older adults without osteoporosis indicates that programs incorporating weight-bearing exercise involving moderate- to high- and odd-impact activities that become progressively more difficult or varied over time in combination with high-intensity progressive resistance training (PRT) can increase (1-4%) or maintain hip and spine BMD. Traditional PRT is also very effective at improving muscle strength and mass, but has mixed effects on balance and functional performance. However, high-velocity PRT (or power training), which involves rapid concentric muscle contractions, can improve muscle function, power and BMD in older adults. For falls prevention, high-challenging balance training performed for at least 50 hours in total (e.g. twice a week for 25 weeks) appears to be most effective in community-dwelling older adults. Whether exercise can prevent fractures remains uncertain because there have been no long-term and adequately powered RCTs. However, a recent systematic review and meta-analysis reported that exercise reduces overall fractures and, to a lesser degree, vertebral fractures in the elderly by up to 50% This presentation will review the latest evidence with regard to the optimal mode and dose of exercise that can enhance bone health as well as improve muscle function and reduce falls and fracture risk in the elderly.