Osteoporosis is a potentially devastating illness and causes morbidity and mortality from fragility fractures at the wrist, spine and hip. Currently, the illness can be detected before the fractures occur using dual energy X-ray absorptiometry and many preventive and therapeutic options exist. Efforts should be directed at helping the population at large achieve a healthy peak bone mass and adopt lifestyle habits which benefit bone mass. For those at high risk of fractures or who have already suffered an osteoporotic fracture, many pharmacological agents have been shown to reduce the risk of subsequent fractures. Hormone replacement therapy and bisphosphonates have the best efficacy data at present but there are likely to be more options in the near future. Hence, there is a need for a paradigm shift in that osteoporosis should not be thought of as an illness that starts at the point of fracture. Instead, it should be actively assessed and treated before fractures occur.