Osteoporosis, which is specifically common among postmenopausal women, is a worldwide major healthcare problem. Etiologies of postmenopausal osteoporosis include hormonal, nutritional, mechanical and toxic causes. Postmenopausal osteoporosis remarkably increases the risk of fractures. Osteoporotic fractures, especially spine and hip fractures, lead to impairments of mobility and vital functions, consequently are associated with high morbidity and mortality in postmenopausal women. Therefore, the primary goal of osteoporosis therapy is prevention of fractures. Osteoporotic fractures occur due to qualitative and quantitative deterioration in trabecular and cortical bone. Preventing fractures can be accomplished by stopping or decelerating bone loss, preserve bone strength, and minimizing factors contributing to fractures. Management of postmenopausal osteoporosis requires a thorough patient evaluation, including careful history taking, physical examinations, and laboratory tests, thereby physicians can make a risk assessment and guide the therapeutic decisions. Therapy of postmenopausal osteoporosis starts with general measures, such as maintaining mobility and fall prevention, a balanced diet, and adequate calcium, vitamin D and vitamin K2 intake. If additional pharmacological therapy is indicated, many effective treatments are available. Osteoporotic pharmacological therapy is classified as antiresorptive agents (e.g. bisphosphonates, selective estrogen-receptor modulators, parathyroid hormone, denosumab, estrogens, and vitamin D derivatives), and anabolic agents (e.g. teriparatide). Combination therapy including the concomitant or sequential use of agents may also provide protective benefits.