Being a systemic skeletal disease, osteoporosis becomes an important public health and financial issue that is associated with increased mortality and morbidity. Postmenopausal women are susceptible to primary osteoporosis since osteoporosis is closely related to estrogen deficiency. During the menopausal transition period, the drop of estrogen leads to more bone resorption than formation, resulting in osteoporosis. The major health threat of osteoporosis is osteoporotic fractures. The prevalence of osteoporosis and related fractures are higher in postmenopausal women than in older men and is influenced by ethnicity. Since low estrogen levels are the main cause of postmenopausal osteoporosis, menopause hormone therapy is considered as the first line choice for prevention of osteoporosis and its effectiveness has been demonstrated by various studies. However, hormone therapy is recommended for women who are less than 60 years old and/or less than 10 years post-menopausal. For those who are greater than 60 years old and/or greater than 10 years postmenopausal, menopause hormone therapy is not appropriate and other medicines should be considered.