A guidance on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis was recently published in Osteoporosis International as a joint effort of the International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (Kanis et al. Osteoporos Int, https ://doi.org/10.1007/ s0019 8-018-4704-5, 2018). This manuscript updates the previous guideline document, published in 2013 (Kanis et al. Osteoporos Int 24:23–57, 2013) and is written from a European perspective. The present article reports and summarizes the main recommendations included in this 2018 guidance document (Fig. 1).