Osteoporosis is a prevalent bone disease with a relevant burden of mortality and comorbidity, especially due to fragility fractures occurring as a result of reduced bone mineral density. In this review we provide a critical digest of the most recent literature regarding the relationship between gut microbiota and osteoporosis, and discuss the role of radiofrequency echographic multi-spectrometry (REMS) and machine learning in the diagnostic work-up and prevention of osteoporosis.