Official recommendations are available for detecting osteoporosis and initiating osteoporosis medications in postmenopausal women. However, there are no recommendations about the management of patients with incident fractures despite osteoporosis therapy. Second-line osteoporosis treatments have been evaluated only based on laboratory and absorptiometry criteria. Nevertheless, we will try to answer the following questions: (1) What criteria should be used to determine whether a fracture during osteoporosis treatment indicates treatment failure (low-energy fracture, fracture not due to an intercurrent health condition, fracture of the type targeted by the osteoporosis treatment, sufficient treatment duration at occurrence of the fracture, and good adherence to the treatment and to vitamin D supplementation)? (2) In patients with treatment failure or an inadequate clinical response, defined as a fracture despite adherence to osteoporosis therapy for at least 1 year, what are the best treatment strategies?