Postmenopausal osteoporosis management has evolved beyond a simple focus on T-score thresholds. The Endocrine Society guideline update provides an evidence-based framework for identifying women at high or very high fracture risk and choosing pharmacologic therapy accordingly. The recommendations cover antiresorptive drugs, anabolic options for selected very-high-risk patients, calcium and vitamin D, monitoring and reassessment. One of the most useful clinical concepts is risk stratification: patients with recent fractures, multiple fractures or other markers of very high risk may require a different therapeutic strategy from patients with lower absolute risk. The guideline also emphasises reassessment during long-term therapy rather than treating osteoporosis as a one-time prescription. For orthopaedic teams, the relevance is immediate because many patients are identified only after a fragility fracture. The postoperative visit can therefore become an important point for initiating or coordinating osteoporosis care. The document reinforces that pharmacologic treatment should be considered alongside fall prevention, exercise and optimisation of modifiable risk factors. For HCPs, the practical lesson is to treat the patient’s fracture risk profile, not simply the scan result, and to create a follow-up plan that addresses persistence, adherence, treatment response and future fracture risk.