Purpose of Review <p>This review evaluates current management options for managing ankle fractures in geriatric patients with osteoporosis. It addresses the challenges posed by compromised bone integrity and examines operative and non-operative approaches to promote early mobility and functional recovery in elderly individuals.</p> Recent Findings <p>Recent studies show that both surgical and non-surgical management can yield comparable functional outcomes, but complication profiles differ. Studies have assessed advanced fixation options such as standard and extended ORIF, hindfoot nailing, and fibular nailing, with growing interest in methods that accommodate poor bone quality and enable early weightbearing. Individualised care pathways and the need for standardisation in rehabilitation protocols are important.</p> Summary <p>Personalised and multidisciplinary treatment is essential for this group of patients. No single intervention is optimal; treatment must consider patient frailty, comorbidities, and functional demands. Future research should focus on randomised controlled trials to refine surgical indications and rehabilitation strategies, improving outcomes and reducing complications.</p>