Osteoporosis increases fracture risk, a cause of crippling morbidity and mortality. The immuno-skeletal interface (ISI) is a centralization of cell and cytokine effectors shared between skeletal and immune systems. Consequently, the immune system mediates powerful effects on bone turnover. Physiologically, B cells secrete Osteoprotegerin (OPG), a potent anti-osteoclastogenic factor that preserves bone mass. However, activated T-cells and B-cells secrete pro-osteoclastogenic factors including receptor activator of NF-kB ligand (RANKL), IL-17A and TNF-alpha (TNF) promoting bone loss in inflammatory states such as rheumatoid arthritis (RA). Recently, ISI disruption has been linked to osteoporosis in HIV infection/AIDS, where elevated B cell RANKL and diminished OPG drives bone resorption. HIV-antiretroviral therapy paradoxically intensifies bone loss during disease reversal as immune reconstitution produces osteoclastogenic cytokines. Interestingly, in estrogen deficiency activated T cells secrete RANKL, TNF and IL-17A that amplify bone resorption and contribute to postmenopausal osteoporosis. T cell-produced TNF and IL-17A further contributes to bone loss in hyperparathyroidism while T cell production of the anabolic Wnt-ligand, Wnt10b, promotes bone formation in response to anabolic parathyroid hormone (PTH) and the immunomodulatory costimulation inhibitor cytotoxic T-lymphocyte-associated protein-4-IgG (CTLA-4Ig) (Abatacept). These findings provide a window into the workings of the ISI and suggest novel targets for future therapeutic interventions to reduce fracture risk.