Osteoporosis is a chronic condition related to low bone mass that can lead to an increased risk of fracture. Pharmacists play a role in identifying patients at risk of osteoporosis and optimizing therapy for those patients on osteoporosis medications. Ensuring patients are on appropriate medications, and are able to adhere to them, is an integral part of the management of osteoporosis. Long-term follow-up including assessment of fractures is key in determining efficacy. Pharmacists can use a multi-faceted approach to determine effectiveness and safety with these medications, as well as determine when it is appropriate to have patients take a drug holiday from these medications.