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Commentary: Opportunities to prevent fracture are being missed

BMJ 2013; 346 doi: (Published 21 January 2013) Cite this as: BMJ 2013;346:f278
  1. M Kassim Javaid, Norman Collison lecturer in metabolic bone disease,
  2. Cyrus Cooper, professor of rheumatology
  1. 1Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
  1. kassim.javaid{at}

Improving the management of osteoporosis remains important given the high cost of fragility fracture for patients, carers, clinicians, and healthcare systems.1 The availability of a wide range of effective oral, intravenous, and subcutaneous therapies that can be administered at varying intervals (daily, weekly, monthly, six monthly to annually) should make treatment the envy of other chronic disease specialties such as diabetes or hypertension, which have more limited dosage portfolios.

Yet the care of patients at high risk of fracture remains poor, as shown by the aptly titled, recent audit of services in England, Wales, and Northern Ireland, Falling Standards, Broken Promises.2 One of the reasons is that many different professionals are involved in the care pathway and no one has …

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