Aim: This study aimed to systematically review the existing evidence on the effects of physical exercise on muscle strength, balance, risk of falls, and fractures for older women with osteoporosis. Methods: MEDLINE (PubMed), Cochrane Central Register of Clinical Trials, Web of Science, PEDro, and Lilacs were searched, and the methodological qualities were measured using the Assessing risk of bias—Cochrane Collaboration’s tool scale. Results: Eight controlled clinical trials were included. Conclusion: Multicomponent physical exercise, not only balance, may be considered as an intervention for older women with osteoporosis due to its effects on balance, strength, and functional outcomes. Future new randomized controlled trials should focus on parameters to prescribe physical exercise as the progression of resistance and its effects on skeletal muscle function, balance, strength, risk, and number of falls and fractures for older women with osteoporosis.