Eating disorders, especially anorexia nervosa (AN) but also eating disorders not otherwise specified and sometimes bulimia nervosa, are associated with low bone density, bone microarchitectural deterioration, and increased fracture risk.1-7 Low bone density may not reverse readily following recovery from AN, and chronic deficits and increased fracture risk often persist many years after recovery.1, 2, 7-9 Oestrogen deficiency is a key contributing factor to osteoporosis in women with AN.10 Women with AN have been shown to have lower bone density in comparison to age-matched normal weight women with hypothalamic amenorrhoea and comparable duration of amenorrhea, prior oestrogen use, and age of menarche.11 Low lean body mass and nutritional deficiencies are also important predictors of low bone density in women with AN.11 Similarly, low lean body mass, nutritional deficiencies, and low testosterone levels are the key contributing factors to osteoporosis in men with AN.12, 13 Nutrition therapy, psychological interventions, and avoidance of excessive exercise are crucial to improving bone health in people with eating disorders. Weight restoration results in the most robust improvement to bone mineral density (BMD) in people with osteoporosis secondary to AN.10 At present, there is no consensus on the optimal pharmacological approach to treat osteoporosis in those living with eating disorders. In this clinical update, we will review the available data to date from the literature and discuss our own evidence-based practice.