We unraveled the mysteries of bone turnover and developed medications to reduce the risk of fractures. Our results are good: the incidence of hip fractures is dropping in several countries [1] [2] [3] [4] [5] [6] [7] : it is best of times, the age of wisdom. And yet, many patients with osteoporosis, even those who have sustained fragility fractures are neither diagnosed nor treated: it is the worst of times, the age of foolishness...We can identify patients at risk of fractures [8] and target

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... ose most likely to benefit from treatment. We can diagnose easily osteoporosis [9], DXA scans are widely available, and mobile units' service medically underserved rural areas: it is best of times, the age of wisdom. And yet, reimbursement for the test has significantly decreased, and many DXA Centers are no longer operational: it is the worst of times, the age of foolishness. Osteoporosis is a very common disease [10]. One in two women and one in five men over the age of 50 years are at risk of sustaining osteoporotic fractures [11] . It is silent until a fracture occurs. The oneyear mortality after an osteoporotic hip fracture is increased by 20 to 24% in women and even more in men; as much as 50% of those who were previously ambulant are unable to walk independently and about 20% need long-term institutional care [12] . Vertebral fractures, although often silent, are associated with increased mortality and morbidity. They lead to loss of height, kyphosis, sleep disturbances, back pain, protuberant abdomen, loss of self-esteem, and depression. Fractures of the humerus, and distal radius often impair the patient's ability to perform activities of daily living, a particularly distressing situation for those living alone. Osteoporotic fractures are life-changing events.