Abstract Background Delayed or omitted treatment for osteoporosis represents a recognised challenge within orthogeriatric healthcare. Machine-learning (ML) decision support systems offer a potential solution by enabling osteoporosis treatment recommendations without necessitating specialist intervention. This study seeks to evaluate the efficacy of ML in accurately recommending osteoporosis treatment. Methods Datasets from January to March 2023 in University Hospital Waterford were sourced from the IHFD (N=85). Osteoporosis treatment decisions were obtained from discharge letters. The dataset was entered into the WEKA 3.8.6 environment for ML processing. The Zero-Rule algorithm is selected as a baseline cross-validation technique to estimate ML performance. Results The Correctly Classified Instances (CCI) and Incorrectly Classified Instances (ICI) are 74.12% and 25.86%, respectively. Eight algorithms were selected, with 800 results produced and tested with a paired T-Tester. The significance level is set at 0.05, with the “Percent_correct” metric selected as the performance measure to compare the algorithms. The J48-Tree algorithm showed the best accuracy at 86% and is statistically better than the baseline algorithm; hence, it was selected as the trained model. Application of the trained model on the unseen dataset revealed CCI and ICI of 98.24% and 1.7%, respectively, indicating a high prediction accuracy rate. Conclusion In conclusion, this study has shown promising strides in using ML to assist osteoporosis treatment decisions. The resulting model showed notable predictive performance, indicating the viability of ML in decision-making. Future studies should focus on acquiring larger datasets for validation, algorithm refinement and exploring the integration of clinical expertise to bolster the model's applicability and reliability in real-world scenarios.