Recent advances in understanding skeletal metabolism has expanded the pharmacological options for treating osteoporosis in women. The antiresorptive or anticatabolic drugs are the oldest class known for their positive benefits in therapy. A better appreciation of their mode of action reveals much broader effects than formerly realized. It provides an entrée into understanding the actions of drugs on the qualitative elements of bone in addition to the quantitative ones on density. New bisphosphonates make for better patient adherence to therapy, a continuing problem in long-term care. A new class of drugs called anabolic agents, typified by teriparatide usher, has the potential to reconstitute destroyed bone and bring it to its pristine state. This article briefly focuses on where we were in this arena a mere decade ago and then highlights the new elements in therapy and physiology of the skeleton. A brief exposé on osteoporosis in men is also provided.