Osteoporotic fractures are a frequent cause of functional disabilities and loss of quality of life. Preventive measurements need to focus on training of muscle function and coordination, and adequate daily calcium and vitamin D supplementation; furthermore a regular check up for drugs associated with falls and osteoporosis. The German guideline recommends that a specific osteoporosis medication should be initiated in individuals with a 10-year risk for hip and vertebral fractures of 30%. This article presents the current guideline for osteoporosis including the actual updates.