Osteoporotic fractures are the most serious consequence of osteoporosis. Due to the reduced bone strength, fractures can be caused by minor injuries Common fracture sites are the spine, thoracolumbar segment of the spine, proximal humerus, and distal radius. Due to the poor quality of the bone, internal fixation and implant fixation after fracture is poor and prone to loosening, the bone healing process after fracture is delayed, and osteoporosis itself makes the risk of re-fracture significantly higher. Osteoporotic fractures are a serious threat to the physical and mental health of the elderly and reduce the quality of life during survival, especially hip fractures and multiple vertebral fractures, with significantly higher rates of disability and death. Active treatment of osteoporosis should not be neglected in the surgical treatment of osteoporotic fractures in the elderly. The main clinical manifestations of osteoporotic fractures are fractures, shortening of height, hunchback and pain. Bone mineral density should be routinely measured in patients with proposed osteoporosis or osteoporotic fractures to make an objective assessment of osteoporosis and the degree of osteopenia, and to help monitor and evaluate the effectiveness of treatment. Attention should be paid to differentiate fractures caused by primary osteoporosis from those caused by bone tumors (including multiple myeloma and metastases of bone) and other metabolic bone diseases. Treatment includes surgical treatment of the fracture and anti-osteoporosis treatment. The former includes three stages of fracture reduction (closed or incision), fixation (braking or internal fixation), and functional exercise and functional rehabilitation, with the aim of preventing complications, reducing mortality, improving rehabilitation, and improving quality of life. The latter can increase bone mass and improve bone quality on the one hand, and has the important clinical significance of reducing the risk of re-fracture on the other. In the acute phase, bone loss is accelerated due to bed rest and braking, so it is appropriate to use bone resorption inhibiting agents. In the rehabilitation period, it is also advisable to combine agents that promote bone formation with those that improve neuromuscular coordination and reduce the risk of falls in the elderly, based on the inhibition of bone loss. In addition, necessary calcium, vitamin D (including food and calcium preparations), sunlight exposure, outdoor activities, and functional exercises are all meaningful comprehensive prevention and treatment measures. While treating fractures, orthopedic surgeons should be aware of the need to determine the presence of osteoporosis in their patients and to assess the degree of osteoporosis and take effective measures to prevent patients from re-fracturing. In patients with osteoporosis who have suffered a fragility fracture, treatment with anti-osteoporotic drugs is completely necessary to reduce the risk of re-fracture.