BackgroundOsteoporotic bone poses significant challenges for fixation of fractures due to its compromised bone quality. This issue impacts patient outcomes and, necessitate proper understanding of the biomechanical limitations and the adequacy of current fixation devices.ObjectiveThis article aims to address the gaps in literature by examining both the biomechanical and biological factors that contribute to fixation failure in osteoporotic bone, and by analyzing the limitations of current management strategies, with the aim of identifying effective interventions for this vulnerable patient group.What is Already KnownLiterature acknowledges that osteoporotic bones have reduced bone density and compromised structural integrity, making fixation devices less effective. Fixation failure frequently occurs in these patients due to diminished bone strength and insufficient fixation support, which collectively hinder optimal stabilization and healing.Gap in LiteratureDespite recognition of the high failure rates associated with osteoporotic bone fixation, there is limited literature detailing a comprehensive approach that integrates biomechanical, biological, and technological advancements to improve fixation outcomes. This article reviews current diagnostic techniques and explores potential innovations in materials and regenerative strategies aimed at enhancing fixation success. Which also guide us about need for future research to focus on developing and validating multifaceted approaches that combine advanced fixation materials and bone regeneration technologies to mitigate failure risks and improve patient outcomes.ConclusionWith increasing life expectancy, the incidence of osteoporosis and hence osteoporotic fractures steadily increasing there are multiple fractures which are responsible for this, however as orthopedic surgeon we are required to deal with these fractures in increasing numbers so we need to develop a comprehensive approach to prevention of these fractures' adequate treatment and also the prevention of refractures which are far too common.