The recent developments in the field of osteoporosis have opened a new era in the management of the disease and warrant a similar change in our therapeutic paradigms. After being one of medicines most untreatable disorders, osteoporosis is following the steps of hypertension being amenable to treatment through defining the patients most likely to develop fractures; and better assessment of their prognosis for defining the most appropriate intervention thresholds. This review will highlight the new concepts published about fracture prediction and how risk factors can be incorporated into the algorithm to determine the absolute risk of a patient having a fracture. Also the results from recently published clinical trials about the novel therapeutic approaches for treatment of osteoporosis, such as the first bone forming agent parathyroid hormone; the potent antiresorptive agent zoledronate, as well as agents such as statins and strontium ranelate that are currently under investigation, and were found able to dissociate between reduced bone resorption and increase bone formation offering a perspective on their role in fracture prevention and treatment of osteoporosis. Lastly this article will discuss the yet unanswered question; will the dream of combination therapy be true?