Clearly osteoporosis is a major scourge of Western society but interest in the condition has risen exponentially in the last 10 years partly because of advances in our understanding of the disease process, the ability to predict its onset, to reverse the process of bone loss and to measure the consequences of treatment, but also in part due to increased public awareness. Further advances are likely, especially in our understanding of the genetic background of the disorder and our ability, not only to reduce bone resorption, but also to enhance bone formation. The challenge will be how to target our improved therapies at the expanding elderly population to reduce the impact and costs of fracture.