Amidst the continuum of internal and external changes associated with aging, there is a persistent decline in bone mass and strength. This progressive weakening of bone tissue exposes individuals aged above 60 to a considerable lifetime fracture risk of 25-44 percent. To alleviate the disease burden and reduce associated healthcare costs of age-associated osteoporosis (AAOP), an expanding array of prevention and treatment strategies targeting primary contributing factors has emerged.

However, the management of AAOP is intricate, given the influence of a myriad of variables on its development. Through a narrative review, we explored the intricate interplay between main intrinsic and extrinsic factors, and illuminate the interconnected nature of individual contributors. Through this analysis, it becomes apparent that every patient has an unique disease etiology that requires personalized care. Looking ahead, a deeper and more nuanced understanding of the multifaceted pathogenesis of AAOP allows development of more precise, sustainable, and patient-specific management strategies.