Vibration transmitted to the whole body or part of it has been extensively studied in relation to the risks to the health and safety of workers. These studies have highlighted the particular danger of lower-back morbidity and spinal trauma arising after prolonged exposure to vibration. However, short-term exposure to whole-body vibration (WBV) or the use of vibrating dumbbells can have beneficial effects on the musculoskeletal system. As a consequence of this encouraging work, many manufacturers have developed exercise devices characterized by vibrating plates transmitting vibration to the whole body and vibrating dumbbells. Preliminary results seem to recommend WBV exercise as a therapeutic alternative for preventing/reversing sarcopenia and possibly osteoporosis. However, there is a paucity of well designed studies in the elderly. In particular, there is a lack of understanding of the physiological mechanisms involved in the adaptive responses to vibration exposure, and of the most appropriate vibration parameters to be used in order to maximize gains and improve safety. The effectiveness of this novel exercise modality on musculoskeletal structures is examined in this review. The physiological mechanisms involved in the adaptive responses to vibration exercise are discussed and suggestions for future studies are made.