Multicomponent exercise programs are recommended to reduce fracture risk;​ however, their effectiveness in real‐world community settings remain uncertain. This 18‐month randomized controlled trial investigated the effects of a 12‐month, community‐based, supervised multicomponent exercise program followed by a 6‐month “research‐to‐practice” transition on areal bone mineral density (BMD), trabecular bone microarchitecture, functional performance, and falls in older adults at increased fracture risk. One‐hundred and sixty‐two adults aged ≥60 years with osteopenia or at increased falls risk were randomized to the Osteo‐cise:​ Strong Bones for Life multicomponent exercise program (n = 81) or a control group (n = 81). Exercise consisted of progressive resistance, weight‐bearing impact, and balance training (3‐days/week) performed at community leisure centers. Overall 148 (91%) participants completed the trial, and mean exercise adherence was 59% after 12 months and 45% during the final 6 months. After 12 months, there were significant net beneficial effects of exercise on lumbar spine and femoral neck BMD (1.0% to 1.1%, p p p ranging Osteo‐cise 1.5% [−1.2, 4.2];​ controls −1.3% [−2.6, 0.1]) after 18 months due to changes in trabecular number (Osteo‐cise 1.7% [−0.9, 4.3];​ controls −1.1% [−2.4, 0.2]) but not trabecular thickness (Osteo‐cise − 0.2% [−0.5, 0.2];​ controls −0.2% [−0.4, 0.0]). In conclusion, this study supports the effectiveness of the Osteo‐cise:​ Strong Bones for Life program as a real‐world, pragmatic, evidence‐based community exercise program to improve multiple musculoskeletal health outcomes in older adults at increased fracture risk.