About half of postmenopausal women have a bone density T score at the femoral neck between −1.0 and −2.5. Bone density in this range was termed “osteopenia” by a World Health Organization working group. Osteopenia is not a disease and the label can cause unnecessary anxiety. Osteopenia encompasses a wide range of fracture risks; an individual patient's risk can be estimated from her age, bone mineral density, and clinical risk factors. Regardless of bone mineral density, regular exercise and adherence with vitamin D and calcium intake may reduce the risk of hip fracture. Osteopenia by itself is not an indication for treatment. Decisions about pharmacological treatment to prevent fractures should be based on the patient's risk of fractures, evidence about the efficacy and nonskeletal effects of the specific treatment, and the patient's preferences.