Osteoporosis affects about 10 million individuals in the United States, a number that is expected to increase substantially in coming decades as the elderly population burgeons. The chief debilitating consequence of osteoporosis, fracture, will affect about half the women and a third of the men in their lifetime, posing a daunting challenge to managed healthcare systems in terms of delivering optimal care and restraining cost. By encouraging optimal postfracture follow-up care and identifying those members at higher risk for fracture and in need of prompt treatment, managed care organizations can enhance the cost-effective management of osteoporosis, dampening downstream costs. This manuscript reviews the pathophysiology of osteoporosis, examines issues related to the diagnosis of osteoporosis, especially the role of bone mineral density measurement, and focuses on the impact of various treatment options in reducing fracture risk. Early assessment and treatment emerge as medically prudent steps in reducing the risk for osteoporosis-related fracture.