Bone turnover involves 2 processes:bone resorption and bone formation, and it can be evaluated by bone turnover markers (BTM). In menopausal women, estrogen level decreases, the number of bone remodeling units increases, bone resorption is greater than bone formation, and the level of BTM changes, resulting in bone mass and bone density decrease, and even osteoporosis. Changes in BTM may contribute to the diagnosis of osteoporosis and the evaluation of responses and adherence to treatments promoting synthesis and inhibiting absorption. This article reviews the research progresses of BTM in the process of osteoporosis in menopausal women, the diagnosis of osteoporosis, the prediction of fracture risk and the response to drug treatments.