Background Osteoporotic fractures are a major public health issue. The literature suggests there are variations in occurrence of fractures by ethnicity and race. Questions/purposes My purpose is to review current literature related to the influence of ethnicity and race on the (1) epidemiology of fracture; (2) prevalence of osteoporosis by bone mineral density; (3) consequences of osteoporotic hip fracture; (4) differences in risk fracture for fracture; and (5) disparities in screening, diagnosis, and treatment of osteoporosis. Methods Current literature was selectively reviewed related to osteoporosis, ethnicity, and race. Results Ethnicity and race, like sex, influence the epidemiology of fractures, with highest fracture rates in white women. Bone mineral density is higher in African Americans; however, these women are more likely to die after hip fracture, have longer hospital stays, and are less likely to be ambulatory at discharge. Consistent risk factors for fracture across ethnicity include older age, lower bone mineral density, previous history of fracture, and history of two or more falls. Ethnic and racial disparities exist in the screening, diagnosis, and treatment of osteoporosis. Conclusions Across ethnic and racial groups, more women experience fractures than the combined number of women who experience breast cancer, myocardial infarction, and coronary death in 1 year. Prevention efforts should target all women, irrespective of their race/ethnicity, especially if they have multiple risk factors.