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Osteoporosis is a systemic skeletal disorder that affects bone microarchitecture resulting to fragility fractures. Randomized controlled trials have shown efficacy of antiresorptives and osteoanabolic agents in addressing concerns of osteoporosis especially in the older population. However, published guidance from several organizations started to focus as well on the perceived harms most especially of bisphosphonates considering their persistent effect on the bones. Similar to other chronic diseases, decision on whether or not to continue therapy depends on factors that might persistently provide signal on the individual’s further risk of unwanted but preventable outcomes.