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Osteoporotic hip fractures have a profound impact on the physical health and psychosocial wellbeing of patients. In addition, osteoporosis has considerable economic implications and is projected to become an increasing burden on developed economies over the coming decades. Nevertheless, the risk factors for both osteoporosis and hip fracture are both well understood and preventable, often with only minor lifestyle changes. This narrative review explores the pathological process underlying osteoporosis and considers how each of the major risk factors contributes to the pathology of this disease. It is hoped that a greater understanding of individual risk factors will result in renewed efforts to promote increased bone density before patients present with hip fracture.