Many guidelines for the assessment and treatment of osteoporosis recommend that intervention be considered in men and women who have sustained a fragility fracture. Guidelines in North America specifically refer to a prior hip fracture (and spine fracture) as a condicio sine qua non for treatment because of the marked effect of fractures at these sites on both morbidity and mortality. In addition, hip fractures have large economic consequences. For example, hip fractures account for 17% of all osteoporotic fractures in Europe but comprise 54% of the direct cost of fractures. The need for treatment arises because of the increased risk of a second fracture, which is particularly acute in the immediate postfracture period when fracture rates are substantially increased.