Based on the accumulation of evidence gathered from cross-sectional, prospective, and exercise intervention studies over the past several decades, numerous public health and governmental bodies [9–16] now recognize and promote physical activity and exercise as a means of aiding in the development and maintenance of musculoskeletal health and fitness and the prevention of osteoporotic fracture. However, when prescribing activity it is important to distinguish between the terms physical activity and exercise. Physical activity refers to any body movement produced by skeletal muscle contractions resulting in an increase in energy expenditure. In contrast, exercise represents a planned, structured, and repetitive movement designed to improve or maintain one or more components of fitness [17]. Importantly, it is the muscle forces resulting from physical activity and exercise which place the greatest loads on the skeleton [18]. Numerous reviews focusing on the prevention and management of osteoporosis include exercise or physical activity as a preventive and treatment strategy [19–21]. In addition, exercise is recognized to have beneficial effects on multiple risk factors for falls, including impaired balance and gait, loss of muscle mass, strength, and power, as well as cognitive function. However, many questions still remain as to what type, intensity, frequency, and duration of physical activity or exercise is optimal to benefit the aging skeleton and prevent osteoporotic-related fractures.