Osteoporosis is now recognized as an important public health problem in men. One in three osteoporotic fractures occur in men and the consequences of a fracture in men tend to be more severe than in women. There is now more knowledge about the risk factors and the secondary causes of osteoporosis and fractures in the male population. However, osteoporosis in men still remains under-diagnosed and under-treated. Therapeutic approaches to osteoporosis in men are less well defined than in women. Most of the pharmacologic agents that are currently available, are licensed for use in men on the basis of BMD end points and extrapolation of previous fracture data in women. Drugs now approved for treatment of male osteoporosis in most countries include the anti-resorptive amino-bisphosphonates alendronate, risedronate and zoledronic acid, the anti-resorptive monoclonal antibody denosumab, and the bone-anabolic agent teriparatide. In recent randomized controlled trials most of these compounds were demonstrated to improve BMD and reduce vertebral fracture incidence in men with primary and/or secondary osteoporosis, but there remains an evidence gap concerning the effectiveness of these treatments in reducing hip and nonvertebral fractures. More research is needed to address this gap and to optimize the effectiveness of available antiresorptive and anabolic compounds on fracture prevention in the male, particularly over a long-term.