Osteoporosis therapy includes antiresorptive drugs of varying efficacy (estrogens, raloxifene, bisphosphonates, denosumab) and osteoanabolic agents capable of stimulating bone formation through various mechanisms (teriparatide, abaloparatide, romosozumab). This results in notable differences in bone mineral density gain and antifracture efficacy. Several comparative studies and meta-analyses have demonstrated the superiority of osteoanabolic agents over antiresorptive agents, particularly in high-risk women. For all treatments, the risk of severe adverse events remains very low. However, the reversibility of the effects of most osteoporosis treatments, except for bisphosphonates, makes it essential to consolidate their effects with a bisphosphonate.