Osteoporosis is a common, systematic chronic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue. Condition is clinically silent and most fractures occur in patients who do not have osteoporosis as there are many more patients with low bone mass/osteopenia. Not only bone mineral density (BMD) but also assessment of osteoporosis clinical risk factors are important for fracture risk prediction and prevention. Excessive caffeine intake, especially in women may contribute to osteoporosis. Given the widespread consumption of caffeine, any of its impact on BMD would affect the vast majority of the population for a significant time. In this chapter, the reader will find a scoping review including clinical factors for osteoporotic fracture risk assessment, molecular caffeine effects and its clinical impact on bone metabolism, and a review of selected studies investigating coffee consumption and risk of osteoporotic fracture.