The International Society for Clinical Densitometry (ISCD) periodically issues Official Positions (OPs) on the assessment of skeletal health in adults and children. OPs are recommendations regarding topics that include nomenclature, indications, acquisition, analysis, quality control, interpretation, reporting, and clinical utility of measuring bone density using different technologies. The purpose of these directives is to assist health care professionals in the practice of clinical densitometry. The OPs are established through a rigorous process of scientific literature review by ISCD task forces, each assigned to address a group of clinically relevant questions. The findings and recommendations of each task force are assessed and revised, as needed, by an international panel of experts. Recommendations that are felt to be appropriate for inclusion as ISCD OPs are sent to the ISCD Board of Directors for final approval. Despite having a major impact in the clinical application of bone densitometry, the ISCD OPs have not been universally adopted, in part because of misunderstanding of the process used to establish them and the way that they are intended for use in clinical practice. This is a review of the benefits and limitations of the ISCD OPs with emphasis on areas of controversy.