There is a wide variety of drugs for the treatment of osteoporosis, with different characteristics of action, making clinical selection and application more complex. In addition to the more familiar calcium and vitamin D, there are several other major classes of drugs for the treatment of osteoporosis, including bone turnover inhibitors, bone formation promoters, and uncoupling agents. Calcium and vitamin D are currently the basic drugs used for the prevention and treatment of osteoporosis. Based on the patient’s age, gender, condition, presence of comorbidities, and affordability, suitable drugs such as diphosphonates, selective estrogen receptor modulators, calcitonin, parathyroid hormone, and strontium salts can be selected for anti-osteoporosis treatment. Diphosphonates are synthetic compounds that have a high affinity for calcium and have an inhibitory effect on bone resorption. Alunphosphate is a third generation drug that is commonly used today. Studies have shown that alunphosphate not only significantly increases vertebral and hip bone density in postmenopausal women, but also reduces the incidence of vertebral and nonvertebral fractures by about 50%. Similarly, similar effects were observed in men with osteoporosis and secondary osteoporosis. However, because of their weak lipophilicity and low intestinal absorption, these drugs must be taken separately from food, at least 30 minutes before a meal. Do not lie down within 30 minutes after taking the drug to prevent reflux into the esophagus. The main adverse effects of these drugs are nausea, vomiting, abdominal pain and diarrhea. Therefore, patients suffering from esophagitis, esophageal ulcers and erosions, gastric ulcers, etc. should be cautiously used or prohibited. Sex hormones have been used in the treatment of osteoporosis for more than 40 years, and estrogen is mainly used in clinical practice. Estrogen can promote the secretion of calcitonin, inhibit bone resorption, increase the activity of hepatic and renal hydroxylase, raise the level of active vitamin D, and promote calcium absorption. Commonly used drugs include ethylene estradiol, nil estrol and estradiol valerate. However, estrogens can cause vaginal bleeding, uterine cancer, and breast cancer, so caution should be exercised in their use, and regular checkups should be performed to prevent the development of cancer. The Chinese Society of Obstetrics and Gynecology recommends that estrogens should be used for no more than four years. Phytoestrogens come from plants, and isoflavones are a type of phytoestrogen found in soybeans that can inhibit bone resorption and promote bone formation, effectively preventing postmenopausal osteoporosis. Eptiflavine is a synthetic isoflavone derivative mainly used for the treatment of postmenopausal osteoporosis. Selective estrogen receptor modulator (SERM) is a synthetic non-hormonal agent that inhibits bone resorption in postmenopausal women and promotes bone resorption in women with low estrogen levels, and has a therapeutic effect on breast cancer but can cause uterine cancer. This drug is mainly indicated for postmenopausal patients with osteoporosis without significant menopausal symptoms and thromboembolic disease. Common adverse effects are hot flashes and painful leg cramps. Calcitonin is mainly secreted by thyroid C cells and has the effect of inhibiting bone resorption and lowering blood calcium. Calcitonin is not only effective in treating osteoporotic pain, but also in increasing bone density in the lumbar spine and reducing vertebral fracture rates. Commonly used drugs include calcitriol and calcitonin. The effects of calcitonin may diminish or even disappear as the duration of use increases, so it should not be used for a long time. Calcitonin is mainly used for high conversion osteoporosis with significant pain, and its adverse effects are mild, including flushing of the skin on the face or body, nausea, vomiting, etc. PTH can regulate bone metabolism, directly stimulate osteoblasts and osteoclasts, promote bone reconstruction and reduce fractures in low doses, but can cause bone loss and fibrous osteitis in high doses. Contraindications to PTH use include Paget’s disease, children, history of bone metastases and bone malignancies, hypercalcemia, and pregnant and lactating women. Adverse effects include nausea, headache, arthralgia, and other minor discomforts. Fluoride Fluoride stimulates osteoblast activity. At high concentrations, it has a toxic effect on osteoblasts, reducing bone mineralization and leading to chondromalacia, while at low concentrations it promotes bone formation and mitosis of osteoblasts, rapidly and effectively increasing bone density in the mesial bone and reducing the incidence of fractures. Fluoride therapy should be administered at low doses of extended-release preparations whenever possible to achieve better results. Strontium salts maintain the rate of bone renewal, reduce bone resorption while maintaining bone formation, and improve the mechanical strength of bones without affecting bone mineralization or altering the crystalline structure of the bone. Strontium salts are therefore a bi-directional regulator of bone metabolism. Strontium ranelate has been used in Europe for the treatment of osteoporosis. Strontium salts have fewer side effects, mainly gastrointestinal discomfort, than the anti-osteoporosis drugs. However, they are now less commonly used.