Postmenopausal osteoporosis (PMO) is a systemic skeletal disorder characterized by reduced bone mass and microarchitectural deterioration of bone tissue, leading to increased fragility and fracture risk. The decline in estrogen levels after menopause accelerates bone remodelin, favoring osteoclastic bone resorption over osteoblastic bone formation. Osteoporotic fractures remain a major cause of morbidity, mortality, and healthcare expenditure worldwide. While dual- energy X- ray absor Ptiometry (DXA) remains the gold standard for diagnosis and monitoring, growing evidence suggests that molecular laboratory techniques can provide earlier and more sensitive insights into bone metabolism, treatment response, and fracture risk. Recent advances in molecular diagnostics, including bone turnover biomarkers, genomics, epigenomics, transcriptomics, proteomics, metabolomics, and liquid biopsy approaches, are transforming the laboratory follow-up of postmenopausal osteoporosis.