The risk for a second fracture within two years after a first one is high. Ten years denosumab treatment show favorable results with a risk of early vertebral fractures in patients with prevalent vertebral fractures when treatment is stopped. Teriparatide is more effective than risedronate to prevent vertebral and clinical fractures in high risk patients. Romosozumab acts as an anabolic agent in osteoporosis. Atypical femoral fractures associated with bisphosphonate treatment could be more frequent in patients with particular anatomical features. Management of osteoporosis treatment depends on the drug which is used and on the risk of fracture of the patient.