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Osteoporosis is a leading public health threat affecting approximately 44 million people in the United States. Most of the therapies for this disease work to prevent further bone loss, improve bone mineral density, and reduce the risk of fractures. These agents, however, have not been proved to increase bone formation significantly. Therefore, the ideal agent would not only improve bone strength by decreasing bone breakdown, but also promote bone formation in the ultimate quest to prevent fractures. The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) have become an area of research in the battle against osteoporosis. Two mechanisms for beneficial effects of statins on bones have been proposed, and although in vitro, in vivo, and animal studies have shown positive effects on bone mineralization and reductions in bone resorption, clinical data on surrogate markers and fracture rates are conflicting. The inherent problems with observational studies also must be addressed. Until that time, the use of statins in the prevention of fractures or the treatment of osteoporosis requires further study.