Musculoskeletal injuries and diseases are common in the elderly. Muscle weakness, fatigue, limited joint motion, and pain can affect the quality of life. Patients with senile osteoporosis, characterized by decreased bone formation compare to bone resorption, may not have symptoms until they experience a fracture, and frequently the disease is too advanced to have a good outcome. The density of bone mineral alone could not explain osteoporotic fractures, and the bone quality, such as micro-structure, microdamage, calcification and collagen composition, also affect the bone strength in the elderly. Osteoporotic fracture, although can be caused by a minor trauma and usually not unstable, may cause a significant morbidity and even mortality, which is related to a decrease in ambulation, especially in hip fracture. Spine fracture may also deteriorate the lung function slowly and can affect the 5-year survival. Operative treatment is indicated in most hip fractures and ambulation should be tried early to prevent complications. Most of other fractures could be managed conservatively, but percutaneous bone cement augmentation (vertebroplasty or kyphoplasty) may be applied to selective spine fractures. Medical management should be applied to prevent fracture, and a 40~50% reduction of further fracture can be obtained even though BMD improvement is not very significant. Degenerative arthritis is another chronic disorder in the elderly, and can be managed conservatively at first. However, severe disability due to joint pain and limited motion should be managed by total joint replacement, even in patients over 80 years of age, if medical problems be carefully managed.