Osteoporosis is the most common metabolic bone disorder in the United States. The spine is frequently involved, so that elderly women with kyphosis due to multiple compression fractures ("dowager's hump") are commonly seen in a geriatric practice. However, the most serious manifestations of osteoporosis is hip fracture. Whereas vertebral crush fractures are painful and cause spinal deformity, hip fractures cause significant morbidity and mortality. Some 250,000 hip fractures occur each year in the United States, with a mortality of 12% to 20%. For those who survive the acute event, nearly half have their life-style dramatically changed. Many become chair-bound. Some need to enter nursing homes. Many become so despondent that they lose their will to live. The direct and indirect cost of caring for these patients is +7 billion to +12 billion a year. In the absence of adequate treatment of established osteoporosis, prevention takes on heightened importance. Several strategies require consideration, from dietary measures to hormonal treatments to the newest possibility, bisphosphonate therapy.