• Osteoporosis is a common chronic bone disorder signifying bone failure. It frequently manifests as fragility or minimal trauma fractures. • Osteoporosis is underdiagnosed and undertreated in the very old, particularly in the most frail. Chronological age alone should not disqualify very old patients from treatment. • Many older people will be diagnosed with osteoporosis after a fracture has occurred. The recovery phase is an ideal time to consider the diagnosis as well as strategies for preventing fractures in future. • Recognition of risk factors for osteoporosis and falls should help identify the most appropriate intervention for individual patients. • Specific pharmacotherapy for osteoporosis in very old patients includes calcium and vitamin D supplements, bisphosphonates and raloxifene. Lifestyle factors should be addressed in all patients.