Bone cell metabolism is strongly regulated by estrogens and therefore the risk of osteoporosis is favored by menopause. Fragility fractures define the outcome to be prevented in osteoporosis. Since age adds to menopause as a risk factor, and menopause occurs at a relatively early age, preventive measures during the early postmenopausal period are desirable. Physical activity, balanced nutrition, and restriction of toxics, smoking, and excess alcohol should be universally encouraged. Attention to osteoporosis risk factors should be part of any basic clinical evaluation of menopausal women. Identification of strong risk factors, such as the presence of previous fragility fracture, identification of fracture in first-degree relatives, or age over 65 years, mandates further evaluation, including bone densitometry. When pharmacological treatment is necessary, the range of antiresorptives includes menopausal hormone therapy, which adds further benefits in case of menopausal symptoms affecting quality of life. Selective estrogen receptor modulators (SERMs), bisphosphonates, and denosumab may follow in a strategy resulting from a rational sequence based on the specific profile of each therapeutic option. SERMs add breast cancer risk reduction (raloxifene and perhaps bazedoxifene) and protection against vertebral fractures. Hip fracture risk reduction requires bisphosphonates or denosumab. More recently, anabolic drugs have opened a new field and are now proposed as a first step in the treatment sequence in women at high or very high risk of fragility fracture.