Premenopausal osteoporosis is often overlooked because fragility fractures and low bone mass are uncommon in premenopausal women. The definition and diagnostic criteria for premenopausal osteoporosis are less well defined than for postmenopausal women. Diagnostic procedures should be initiated in premenopausal women with existing fragility fractures or diseases and drug therapies that cause bone loss. Recent studies have shown that lifestyle and dietary habits influence bone mass in the premenopausal phase. Bone mass can be improved by an adequate intake of calcium and vitamin D in combination with increased physical activity in premenopausal women with idiopathic osteoporosis. Secondary causes of osteoporosis should be corrected or treated if possible. In women with recurrent fractures or secondary causes that cannot be reversed, e.g. glucocorticoids or oncological treatments, pharmacological intervention with bisphosphonates or teriparatide (the latter not in patients with carcinomas) may be considered. Antiresorptive and osteoanabolic agents have been shown to effectively increase bone mass; however, no studies have been conducted to date with fractures as the primary endpoint.