Osteoporosis and associated low-impact fractures are common. There is associated morbidity and mortality with low-impact fractures. It is critical to identify which patients would benefit from therapy. General treatment considerations are reviewed. Currently available treatment options are discussed. Certain patient populations pose challenges in the treatment of osteoporosis. An in-depth review of clinically challenging scenarios is presented: Treatment of patients with severe osteoporosis, Treatment of Premenopausal women with low bone density, Treatment of osteoporosis in patients with kidney disease, Treatment of Osteoporosis in patients on glucocorticoid therapy, Treatment of osteoporosis in patients with a fracture.