In the United States, approximately 30 million women and 10 million men aged 50 years or older have osteoporosis, low bone mineral density, or both, placing them at risk for disabling fractures. Despite the high prevalence and serious medical consequences of osteoporosis, many at-risk patients are inadequately screened and diagnosed before symptomatic fractures occur. Osteopathic physicians are in a unique position to promote a multifactoral approach to patient evaluation, disease prevention, and treatment. The author evaluates aspects of such an approach through a review of the literature. A number of screening tools based on easily assessed factors are available to identify at-risk patients. Interventions for fracture reduction should include nonpharmacologic strategies such as risk factor modification, nutrition guidance and dietary supplementation, physical exercise, and osteopathic manipulative treatment. Pharmacologic intervention should be considered for patients with low bone mineral density as well as those who have sustained vertebral or hip fracture. A holistic multifactoral assessment and intervention strategy are recommended to reduce substantially the risk of fracture and to improve long-term patient outcomes.