Introduction. Osteoporosis and its severe complication - low-traumatic fractures - is one of the most widespread age-associated diseases, which is a huge medical and social burden of modern society. In this regard, the prevention and treatment of low bone density (BMD) and falls in elderly and senile people are a priority in medicine. Objective: To evaluate the effect of a combination of anti-osteoporotic therapy and fall prevention education on BMD, bone metabolism, vitamin D levels, new falls and fractures in older patients with osteopenia. Materials and methods: The study included 123 patients with osteopenia (mean age 83.54 ± 2.99 years), who were divided into two groups: group 1 (experimental) - 62 women (mean age 83.16 ± 3.09) , group 2 (control) - 61 participants (mean age 83.92 ± 2.85). As an anti-osteoporotic therapy, group 1 received zoledronic acid, both groups received calcium carbonate and alfacalcidol. All patients were given instructions to prevent falls. All patients before the start of the study, and after 12 months of therapy, laboratory parameters, parameters of physical and functional activity, BMD were determined. A monthly telephone survey of patients was conducted to clarify the implementation of the treatment regimen and measures to prevent falls. Falls, low-traumatic fractures, treatment adherence, and drug side effects were recorded. Results: After treatment in group 1, the levels of bone metabolism markers (P1NP, β-CTx) significantly decreased (p=0.000), and BMD of the lumbar spine and proximal femur increased (p=0.000). The frequency of falls decreased in both groups after treatment compared with that before treatment (33.9% vs. 54.8% and 36.7% vs. 54.1%, respectively; p