Osteoporosis is characterized by a reduction of bone mass and changes in bone micro-architecture. The resulting reduction in bone strength leads to the well recognized increase in the risk of fracture, particularly at the radius, hip, and spine. The treatment of osteoporotic fractures is challenged by the reduced mechanical capacity of osteoporotic bone, reflected in reduced holding power and increased fragility. The aim of successful fracture treatment in individuals with osteoporosis is early fixation of the fracture with immediate and almost unrestricted weight-bearing capacity. The key factor for effective fracture treatment is strict adherence to the basic principles of stable fracture fixation: reposition, compression, long, wide supports, as well as additive techniques such as angular stability and bone augmentation. Modern osteosynthesis implants effectively support the application of these principles. Modifications in implant design and techniques enable the surgeon to apply and combine the essential components of the basic principles for the treatment of mechanically impaired bone. The key components employed in modern implants include integrated compression techniques, multidirectional angular stability, expandable support surfaces, as well as multiple augmentation options. However, despite modern implant technology, osteoporotic bone fractures remain a significant challenge for the orthopaedic surgeon and require meticulous planning and implementation of the basic principles.