Patients often start treatment to reduce fracture risk because of a bone mineral density T-score consistent with osteoporosis (≤−2.5). Others with a T-score above −2.5 may be treated when there is a history of fragility fracture or when a fracture risk algorithm categorizes them as having high fracture risk. It is common to initiate therapy with a generic oral bisphosphonate, unless contraindicated, and continue therapy if the patient is responding as assessed by stability or an increase in bone mineral density.