Postmenopausal osteoporosis has been found to be a health threat in most developed countries and is an emerging problem of countries in Asia Pacific region. It is estimated that half of all hip fractures worldwide will occur in this region by 2050. The consequences of osteoporosis are fractures which may have a highly impact on quality of daily life. The current conceptual understanding of osteoporosis is emphasized on bone strength. It is defined as an integration of bone density and bone quality. Assessment of treatment efficacy is more accurate by looking at fracture risk reduction over an increase of bone mineral density. The premature termination of the Women's Health Initiative study in July 2002 has limited the osteoprotective role of hormone replacement therapy (HRT). It is a general recommendation to give HRT to symptomatic women in their perimenopause or climacteric midlife. Non-HRTanti-osteoporotic medication eg., raloxifene, bisphosphonates, calcitonin, and intermittent PTH is considered to be the first line therapy in asymptomatic women over 60 years. Other innovative anti-osteoporotic regimens are being under research development.