Osteoporosis and its consequences are a major public health problem. Osteoporosis is a difficult therapeutic challenge for the endocrinologist. The questions of who needs treatment and what the treatment should be are unresolved. This short review will examine the available therapies for osteoporosis. Based on a mechanistic understanding of a specific therapy indications will be developed for each. A scheme for evaluating the osteoporotic patient and planning a treatment strategy will be proposed.