Osteoporotic fractures represent a major public health concern due to their increasing prevalence in the aging population and the profound impact on functional independence, morbidity, and mortality. This chapter offers a comprehensive overview of fragility fractures in elderly patients with osteoporosis, focusing on the most affected anatomical sites: the proximal femur, vertebral bodies, distal radius, and proximal humerus. It outlines the pathophysiology of primary and secondary osteoporosis, global epidemiological trends, and major risk factors beyond bone mineral density, such as falls and sarcopenia. Diagnostic strategies, including DXA, FRAX, and advanced imaging techniques, are detailed. Fracture-specific sections explore clinical presentation, classification systems, and current evidence-based approaches to treatment, ranging from conservative management to surgical options such as osteosynthesis, arthroplasty, or vertebral augmentation. Particular attention is given to complications, mortality rates, and the socioeconomic burden of fragility fractures. Emphasis is placed on the importance of prevention strategies, early diagnosis, and multidisciplinary care to improve patient outcomes and reduce healthcare costs.