Osteoporosis and its complications (low-energy fractures) are one of the significant health problems in many developed countries. Socio-economic costs aimed at the prevention and treatment of this disease are increasing every year due to the increased life expectancy of the population. Almost all drugs with an anti-fracture effect for the treatment of osteoporosis, which are used in the world,   are used in Russia. However, the incidence of fractures in the population is reduced insufficiently, which is due to not so much ineffective treatment as to low adherence to it. The article presents data of the observational study of 154 patients (4 men and 150 women, mean age 65 ± 7 years), who had osteoporotic fractures of four main localizations. Only 36% of the questioned persons started taking pathogenetic drugs. Patients with rheumatic diseases, which were followed up by a rheumatologist, received treatment statistically more often.  When analysing the reasons for the absence of pathogenetic therapy for osteoporosis, it turned out that no recommendations of a traumatologist, a therapist or general practitioner, who followed up patients after a fracture, were provided in 36% of cases.  Not a single patient had their repeated fracture risk estimated using FRAX probabilities, and only 12% of people were referred to densitometric examination. After consultation in a specialized osteoporosis center, the proportion of people who started taking anti-osteoporotic therapy increased almost 2 times.