This session positions bone health as a core part of orthopedic practice and addresses the three populations in which orthopedic clinicians encounter compromised bone: patients who present with a fragility fracture, patients preparing for elective spine and joint surgery, and younger patients with unexpected or repeated fractures. It opens with the scope and consequences of fragility fracture, noting that more than two million occur annually in the United States, that half of these patients will sustain a second fracture, and that only a minority are placed on osteoporosis therapy after the index event. The session distinguishes osteoporosis from low bone mass and explains why patients with osteopenia account for a large share of fractures. It frames the point of contact as the moment for intervention, including naming the diagnosis, shifting the conversation from fracture to function and independence, beginning the workup, and connecting the patient to ongoing care. The session reviews contemporary diagnostic criteria that allow many patients to be identified without dual-energy x-ray absorptiometry, including a hip or spine fragility fracture, a FRAX major osteoporotic fracture probability above twenty percent or hip fracture probability above three percent, and a T-score of negative 2.5 or lower in the geriatric patient. It distinguishes antiresorptive from anabolic agents, summarizes six month bone mineral density gains across the major therapies, explains the rationale for leaning toward anabolic therapy when bone strength is the goal, and reviews the evidence that osteoporosis medications, including romosozumab, do not impair fracture healing. For the surgical population, the session describes the aging surgical candidate, the high prevalence of osteoporosis and low bone mass among total joint and spine surgery patients, and the complications associated with poor bone quality, including intraoperative fracture, implant subsidence, periprosthetic fracture, adjacent segment fracture, pedicle screw loosening, and stress shielding. It outlines a practical perioperative pathway built on standard laboratory evaluation, calcium and vitamin D optimization, densitometry, FRAX, and timely initiation of therapy, and it highlights opportunistic computed tomography and artificial intelligence applied to routine radiographs as emerging tools for case finding. The session also reviews special considerations, including type 2 diabetes, unrecognized adult hypophosphatasia signaled by low alkaline phosphatase, and bone and muscle loss associated with GLP-1 use, and it closes with the principle that bone health optimization should be standard of care across orthopedic practice.