Osteoporosis is extremely common, particularly in the elderly, with one in three women and one in five men over the age of 50 years experiencing a fragility fracture in their lifetime. Osteoporosis management principally takes place in the outpatient setting. However, acute fragility fractures frequently require inpatient care. Although the presence of a fragility fracture typically indicates underlying osteoporosis, this often goes unrecognized and the majority of patients never receive osteoporosis treatment. When presenting with fragility fractures, the hospital setting offers a unique opportunity for patients to be properly identified as having osteoporosis and put on the path to the necessary evaluation and treatment. Laboratory assessment can be performed, and management interventions can be initiated as an inpatient. The safety of continuing osteoporosis therapies in the inpatient setting needs to be considered on an individual basis and has unique implications for each particular class of medications. Arrangement of proper outpatient follow-up is paramount.