The prevention and treatment of osteoporosis is currently a research hotspot,and the existing treatments pay more attention to the function ofosteoblasts and osteoclasts,while the damage of bone microstructure will lead to the reduction of bone strength,which also plays an important role in the pathogenesis of osteoporosis.In the microstructure of bone,trabecula is the main structure to withstand complex mechanics,while cortical bone mainly maintains the ability to adapt to mechanical changes.The two have different performance in the process of osteoporosis and have different drug responses to conventional anti-osteoporosis therapy.In this paper,we will explore the progress of diagnosis and treatment of osteoporosis from the perspective of bone microstructure.