Osteoporosis is a major public health issue, with fragility fractures of the hip, vertebrae, and distal radius considered the most important consequences. These lead to increased morbidity, mortality, hospital care, and dependency. The risk factors for the development of fragility fractures are numerous and involve genetic and environmental influences, as well as an interaction between the two. In this review, the recent literature examining genetic factors, possible candidate genes, the evolving area of intrauterine fetal programming, and anthropometric and environmental factors will be reviewed.