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The objective of this study was to investigate the relationship between health-related quality of life (HRQOL) and physical fitness levels (PFLs) in elderly women with low bone mass and without fractures, with a further goal of developing preventive programs involving efficient exercises for osteoporotic fractures and falls. The subjects comprised 133 females over 65 years of age whose quantitative ultrasound (QUS) values were < 90% of the young adult means (YAM). Muscle strength (knee extensors, hand grip, and trunk flexors), flexibility, one-leg standing time with eyes open (one-leg stand), time required for a 10-m walk while stepping over six obstacles (10-m walk), and 6-min walking distance (6-min walk) were measured to assess PFL. The subjects' HRQOL scores were relatively high (122.5 ± 15.5; maximum, 160 points) despite their low PFLs, as compared to the Japanese standard PFL in a similar age group. An age-adjusted stepwise multiple regression analysis between PFLs and QUS or HRQOL in 115 subjects which all measurements were performed, revealed that the 10-m walk significantly contributed to the QUS (R2 = 0.152, p = 0.001) and to the total HRQOL score (R2 = 0.025, p = 0.039). With regard to the PFLs, the 6-min walk and one-leg stand contributed to the 10-m walk (R2 = 0.470, p = 0.012). In conclusion, the 10-m walk was observed to be a good indicator for the estimation ofHRQOL and PFLs; subsequently, balance exercise, brisk walking, and endurance walking are good exercises that can be included in preventive programs to maintain a high HRQOL.