Although considerable progress has been made to determine the various factors that increase a woman's risk of fracture, many women who have or are prone to osteoporosis are not being identified or receiving intervention.1 Bone mineral density (BMD) has traditionally been used for the diagnosis of osteoporosis and as a measure of fracture risk. However, relying only on BMD to identify those at risk neglects a considerable proportion of women in need of therapy.2 Improved strategies for fracture risk assessment are therefore needed. To optimize patient outcomes, initiation of and long-term compliance with effective therapies is necessary. Primary care physicians are in a unique position to address these issues. This article will outline potential strategies for improving the identification of postmenopausal women at risk of fracture and discuss the currently available pharmacologic therapies effective in fracture prevention.