IOF believes this is the single most important thing that can be done to directly improve patient care, for women and men, and reduce spiralling fracture-related health care costs worldwide. The need for a global campaign Half of women and a fifth of men will suffer a fragility fracture in their lifetime [23, 27–29]. In year 2000, there were an estimated 9 million new fragility fractures including 1.6 million at the hip, 1.7 million at the wrist, 0.7 million at the humerus and 1.4
million symptomatic vertebral fractures . More recent studies suggest that 5.2 million fragility fractures occurred during 2010 in 12 industrialised countries in North America, Selleckchem SCH772984 Europe and the Pacific region  alone, and an additional 590,000 major osteoporotic fractures occurred in the Russian Federation . Hip fracture rates are increasing rapidly in Beijing in China; between 2002 and 2006 rates in women rose by 58 % and by 49 % in men . The costs associated with fragility fractures are currently enormous for Western populations and expected to dramatically increase in Asia, Latin America
and the Middle East as these populations age: In 2005, the total direct cost of osteoporotic fractures in Europe was 32 billion EUR per year , which is projected to rise to 37 billion EUR by 2025  In 2002, the combined cost of all osteoporotic fractures in the USA was 20 billion USD  In 2006, China spent 1.6 billion USD on hip fracture care, which is projected to rise to 12.5 billion USD by 2020 and Small molecule library 265 billion USD by 2050
 A challenge on this scale can be both daunting Glycogen branching enzyme and bewildering for those charged with developing a response, whether at the level of an individual institution or a national health care system. Fortuitously, nature has provided us with an opportunity to systematically identify almost half of individuals who will break their hip in the future. Patients presenting with a fragility fracture today are twice as likely to suffer future fractures compared to peers that haven’t suffered a fracture [38, 39]. Crucially, from the obverse view, amongst individuals presenting with a hip fracture, almost half have previously broken another bone [40–43]. A broad spectrum of effective agents are available to prevent future fractures amongst those presenting with new fractures, and can be administered as daily [44–46], weekly [47, 48] or monthly tablets [49, 50], or as daily [51, 52], quarterly , six-monthly  or annual injections . Thus, a clear opportunity presents to disrupt the fragility fracture cycle illustrated in Fig. 1, by consistently targeting fracture risk assessment, and treatment where appropriate, to fragility fracture sufferers . Fig.