Osteoporosis, the most common metabolic skeletal disease, represents a major public health problem due to the increased risk of fragility fractures that lead to considerable morbidity, mortality, and decreased quality of life. It is a chronic degenerative condition that requires long-term management and a personalized approach to treatment. Several efficient therapies are available to lower fracture risk, either by reducing bone resorption or by stimulating bone formation. Antiresorptive agents target osteoclast function and osteoclastogenesis and include bisphosphonates, denosumab, and selective estrogen receptor modulator (SERMs). Osteoanabolic agents stimulate osteoblast differentiation, function and survival, and include teriparatide and abaloparatide. Romosozumab is a novel agent with a dual effect of increasing the formation of bone and decreasing its resorption by blocking the sclerostin pathways. This chapter will provide an overview of the established therapeutic options and new drugs for the prevention and treatment of osteoporosis, describing efficacy, route of administration, and adverse events of current pharmacological interventions.