Osteoporosis prevalence is increasing with an ageing demographic. Osteoporosis and fracture risk increases with age due to falls, frailty and comorbidities. Although there is a paucity of data in older populations over 70 years of age, the available evidence suggests that they benefit from multifactorial intervention including management of comorbidities, polypharmacy, fall risk, vitamin D and calcium optimisation and pharmacological interventions. Although the reduction in risk from these strategies is similar to younger people, the absolute risk reduction is greater in older people due to higher absolute fracture risk. Older people, however, present unique challenges. Although the imperative to treat is greater, there are multiple competing factors: frailty, comorbidities, drug interactions, greater likelihood of medical interventions for periodontal and dental disease, gastrointestinal issues limiting oral therapies and cognitive issues affecting adherence. Pharmacists are well placed as a key member of the multidisciplinary team to optimise management of this cohort.