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Osteoporosis is a skeletal condition characterized by low bone mass and fragility resulting in an increased risk for fracture. It affects all bones, but fractures most often occur in the hip and spine. Osteoporosis is common in postmenopausal women, with estrogen deficiency thought to be a major contributing factor. Screening for osteoporosis with bone densitometry is recommended in all women 65 years of age or older and in postmenopausal women younger than 65 who are at increased risk. In 2023, the Ñî¹óåú´«Ã½ published updated guidance on the pharmacologic treatment of osteoporosis. Among the recommendations was for clinicians to take an individualized approach regarding whether to start treatment with a bisphosphonate in women older than 65 years with osteopenia (a lesser degree of bone loss) to reduce the risk for fractures. Here, 2 bone endocrinologists debate how to manage a patient with both osteopenia and osteoporosis on bone densitometry. They discuss how to interpret and address these findings.