Bone responds to habitual, physiologic stress by increasing mineralization. There is some evidence from studies of adolescents that bone mineralization increases with high impact physical activity, which might translate into increased peak bone mass. Regular weight bearing exercise has been associated with a small, but statistically significant increase in BMD in adults. (3,4)
There are a number of randomized controlled trials that have shown significant benefit in fall reduction with supervised exercise programs (including strength and balance training and Tai Chi) in both community and institution dwelling elderly. (5,6) Other proven strategies include home hazard reduction and decreasing use of psychotropic medication. In institutional settings staff training and patient education have been shown to be useful in fall prevention. (6)
Patients with known gait instability should probably be referred to physical therapy for establishment of a safe exercise regimen. Severely osteoporotic patients should probably take at least three months of bone rebuilding therapy prior to starting an exercise program.