Osteoporosis constitutes a major public health problem through its association with age-related fractures. Life expectancy is increasing around the globe. Assuming constant age-specific incidence rates for fracture, the number of hip fractures occurring worldwide among people aged 65 years and over will rise from 1.66 million in 1990 to 6.26 million in 2050. Among current risk factors for low bone density and trauma (low body mass index, cigarette smoking, alcohol consumption, physical inactivity and dietary calcium intake) the trends are best explained by physical inactivity. Debate continues on the role of more aggressive osteoporosis therapeutic strategies; although pharmacologic intervention might be efficacious, only a minority of hip fracture patients remain so treated, and the scope for even greater reductions in incidence remains an enticing prospect.