Approximately 45% of all women will suffer at least one osteoporotic fracture during their lifetime. Until recently, 25-50% of postmenopausal women were on hormone therapy often with prevention of osteoporosis as their main motivation. Following the Women's Health Initiative, however, the use of hormone therapy has decreased by 30-40% in several countries. Fortunately, several other options for pharmacological intervention have been demonstrated to decrease the risk of fractures in randomised studies. Anti-catabolic drugs include calcium plus vitamin D, oestrogen, raloxifene, and bisphosphonates (e.g. alendronate, etidronate, ibandronate, pamidronate risedronate and zoledronate). Anabolic drugs include parathyroid hormone (1-34) and (1-84). Finally, strontium ranelate has both anti-catabolic and anabolic effects. Also, evidence suggests that individualised advice on lifestyle modification (e.g. increased physical exercise, cessation of smoking, fall prevention and use of hip protectors) should be offered to most patients.