Background. Osteoporosis is a disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk. In prevention and treatment of osteoporosis, the issue of main interest is prevention of fractures, especially prevention of the first fracture. In recent years, especially after the result of the randomised control trial of Women’s Health Initiative (WHI) was published in the literature, attitudes toward prevention and treatment of osteoporosis have been changed. Hormonal replacement therapy (HRT) use is no longer recommended as a first line treatment, but only a possibility for treatment perimenopausal and early-postmenopausal women with climacteric symptoms and increased risk for fracture, only when therapy benefits outweigh the risks. Today, independent risk factors are taken into account in treatment of osteoporosis, with or without BMD measurement, but including the 10-years risk probability (FRAX – fracture risk assessment tool). There are new possibilites for treatment including a Osteoprotegerin (OPG)/ Receptor Activator of Nuclear factor kappa B (RANK) / Receptor Activator of Nuclear factor kappa B ligand (RANKL) remodelation bone model. Conclusions. Treatment of osteoporosis is going to be a complex task including all fracture risk factors, polypragmazia which is very common in elderly patents, adherence problems, and last but not least, the economic aspects.