Osteoporosis is a progressive skeletal disease characterized by a decrease in bone strength and an increase in the number of fractures. This disease is considered by the World Health Organization to be the second most important health problem in the world after cardiovascular disease. The prevalence of osteoporosis is increasing due to population aging. With age, the loss of bone mass in the spine and hip, which starts at menopause in women and around the age of 60 years in men, continues. Old age is when most fragility fractures occur and the incidence of these fractures is increasing exponentially in persons aged more than 75 years. Several treatments with demonstrated effectiveness in decreasing fracture risk and increasing bone mineral density are currently available for osteoporosis. Nevertheless, the scientific evidence on the safety and efficacy of these treatments is much more scarce in older people than in young populations. There are few reports on the efficacy of these treatments in non-vertebral--specifically hip--fractures in the elderly. Consequently, the present review aims to analyze the scientific evidence on the diagnosis and treatment of osteoporosis, and particularly the evidence on the antifracture efficacy of distinct antiresorptive agents and anabolic drugs in people older than 75 years.