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Since the NOF first published the guide in 1999, it has become increasingly clear that many patients are not being given appropriate information about prevention; many patients are not having appropriate testing to diagnose osteoporosis or establish osteoporosis risk; and, once diagnosed (by testing or by the occurrence of a fracture), too many patients are not being prescribed any of the FDA-approved, effective therapies.   All postmenopausal women and older men should be evaluated clinically for osteoporosis risk in order to determine the need for BMD testing. In general, the more risk factors that are present, the greater the risk of fracture. Osteoporosis is preventable and treatable, but because there are no warning signs prior to a fracture, many people are not being diagnosed in time to receive effective therapy during the early phase of the disease.   Hip fractures result in 10% to 20% excess mortality within one year; additionally, about 10% of patients with a hip fracture will have another osteoporosis-related fracture within a year. Up to 25% of hip fracture patients may require long-term nursing home care, and only 40% fully regain their pre-fracture level of independence. Mortality is also increased following vertebral fractures, which cause significant complications including back pain, height loss and kyphosis. Postural changes associated with kyphosis may limit activity, including bending and reaching. Multiple thoracic fractures may result in restrictive lung disease, and lumbar fractures may alter abdominal anatomy, leading to constipation, abdominal pain, distention, reduced appetite, and premature satiety. Wrist fractures are less globally disabling but can interfere with specific activities of daily living as much as hip or spine fractures.