Abstract Purpose To explore the understanding of osteoporosis in the context of adult spinal deformity (ASD) surgery with a focus on diagnosis, surgical risks, non-operative, and operative treatment techniques. Methods A comprehensive literature search was performed. Articles were identified using the search terms “osteoporosis,” “adult spinal deformity,” “scoliosis,” and “spine surgery.” Relevant studies were selected based on their focus on the intersection of these topics with an emphasis on utility in spine surgery. Results This review discusses osteoporosis diagnosis, surgical risks, and non-operative, and surgical treatments in the context of ASD surgery with a focus on clinical applications. Areas for future growth are highlighted. Conclusion As adult spinal deformity (ASD) patients increase globally, the Scoliosis Research Society (SRS) formed a task force to improve understand ing of osteoporosis and its impact on this vulnerable population. This review brings together the latest research on the topic and highlights this area as one of critical importance and growth in the field.