This clinical trial aims to evaluate the effects of a 12 month gym- and home-based exercise program on bone density and falls risk factors in postmenopausal women with low bone density. It is hypothesised that the exercise program will lead to improvements in bone density and falls risk factors such as balance and muscle strength compared with usual care.

Inclusion Criteria:

• Be aged greater than 50 years
• Be at least 5 years post menopause (defined as the last normal menstrual bleed)
• Have osteopenia of the hip defined as a DXA T-score between -1 and -2.5 in one or more regions of the proximal femur (total hip, neck or trochanter regions).
• Have primary osteopenia
• Be community dwelling (not in residential care)
• Be able to attend an exercise program 3 times per week over the 12-month period
• Be able to read and write English

Exclusion Criteria:

• Secondary causes of bone loss such as osteomalacia, glucocorticoid medication
• Co-morbidities that would interfere with participation in exercise such as severe heart or pulmonary disease, inflammatory joint disease, severe osteoarthritis, psychiatric condition
• Physical or orthopaedic disabilities that would place the subject at risk or limit their ability to perform exercise
• Spinal osteoporosis defined as DXA T-score <-2.5
• A past vertebral fracture
• Body mass index > 35 or < 18.
• Currently on hormone replacement therapy (HRT)
• Current smoker
• Past use of HRT within the past 3 years and for more than 6 months duration
• Taking medication known to affect bone including oestrogen or steroid hormones
• Known clinically significant liver or renal disease
• Cancer within the past 5 years
• Doing regular strength training and/or weight-bearing exercise at least once per week in past 6 months
• Unlikely to comply with the intervention protocol