From clinical evidence to primary care practice: group exercise and nutrition interventions to support bone density, fall prevention, and fracture risk reduction.

Fragility fractures, falls, and age-related bone loss remain major contributors to morbidity, loss of independence, and healthcare utilization among older adults. Although Canadian clinical guidelines provide clear recommendations for fracture risk assessment and prevention, practical guidance for implementing evidence-based, group-based lifestyle interventions in primary care settings remains limited, particularly in rural contexts. Strong Bones is a 13-week, primary care-linked group exercise and nutrition program designed to translate osteoporosis and bone health evidence into scalable clinical practice. The program integrates progressive resistance training, balance and posture education, spine-sparing movement strategies, and nutrition education, delivered in a group fitness format by an interdisciplinary team. Implementation insights on referral pathways, program redesign, rebranding, and hybrid delivery are summarized. Limitations include lack of long-term outcome data and challenges in monitoring exercise progression. Overall, Strong Bones represents a scalable model for delivering osteoporosis-focused, group-based exercise and education within primary care-linked settings, offering guidance for clinicians and exercise professionals seeking to improve fracture prevention in rural communities.