We previously reported that high-intensity resistance and impact training (HiRIT) is safe and improves risk factors for osteoporotic fracture in postmenopausal women and older men with low bone mass under trial conditions (LIFTMOR and LIFTMOR-M trials). We have now established a translational research Clinic implementing HiRIT in practice alongside systematic longitudinal monitoring of musculoskeletal and functional outcomes to determine effectiveness and feasibility as osteoporosis prevention and therapy in the ‘real world’. PURPOSE: The aim of the current report is to present 4 year outcomes from the Clinic. METHODS: All Clinic clients undergo testing for height, weight, spine (LS), total hip (TH) and femoral neck (FN) bone mineral density (BMD), lean and fat mass, back extensor strength (BES), and functional indices of fall risk at their baseline visit, and annually thereafter. Twice-weekly supervised HiRIT with balance training and a dietary consult is provided. Compliance and injuries are comprehensively monitored. In the absence of a control group, program effectiveness is determined from one-sample t-tests of percent change from baseline. RESULTS: We report outcomes from 275 clients (94.9% female) who have completed a minimum of 12 months HiRIT (63.6±7.1 yrs, 162.3±6.8 cm, 60.6±10.0 kg, LS T-score -2.0±1.1, FN T-score -2.0±0.7, compliance 69.1±39.6%). 70 clients were on bone medications at baseline but only 18 at follow-up. Improvement was observed in weight (0.8±3.8%, P<0.0001), LS (2.2±5.1%, P<0.0001), TH (1.0±3.7%, P<0.0001) and FN BMD (1.4±4.8%, P<0.0001), lean mass (2.3±5.5%, P<0.0001), fat percent (-4.5±10.7%, P<0.0001), functional reach (7.2±13.4%, P<0.0001), timed up and go (-9.8±12.0%, P<0.0001), tandem walk (-20.6±35.1%, P<0.0001), sit to stand (-9.9±15.9%, P<0.0001), BES (20.6±35.1%, P<0.0001), and kyphosis (5.1±54.8%, P<0.05). Clients increased daily dietary calcium (23±67%, P<0.0001) and total calcium (19±68%, P<0.0001). 20 injuries were sustained in a total of 31,483 training sessions, the majority being minor muscle strains. CONCLUSION: We show that, when supervised in clinical practice, an evidence-based, targeted, high-intensity resistance and impact training program is safe and highly effective osteoporosis therapy for older men and women with low bone mass.