Postmenopausal osteoporosis (PMOP) is a prevalent chronic condition that severely compromises both the physical and psychological well-being of aging women. Beyond its skeletal implications, PMOP exhibits a profound psychosomatic interplay, intimately linked with elevated rates of depression and anxiety that frequently impair treatment adherence and functional recovery. This psychological vulnerability arises from a complex web of hormonal shifts, fear of fracture, and significant global sociocultural determinants that restrict care access. This comprehensive narrative review synthesizes current evidence through a biopsychosocial framework, critically examining the underlying psychoneuroimmunology (PNI) mechanisms that govern the bone-mood axis. Furthermore, we evaluate evidence-based psychological therapies (including cognitive behavioral therapy and mindfulness-based interventions) and propose an innovative, hierarchical stepped-care model for long-term patient management. Finally, we identify critical gaps in existing pharmacological and behavioral strategies, offering a multidisciplinary roadmap to advance mental health equity and integrated psychosomatic care for aging female populations.