Patients who present with osteoporotic fracture are at highest risk of further fractures and their associated morbidity. Despite the availability of several evidence-based therapeutic options, which have the potential to reduce the incidence of fractures by up to 50%, it is paradoxical that these high-risk patients are seldom assessed for osteoporosis and offered treatment. Secondary prevention of osteoporotic fractures should now be the priority for osteoporosis services; the challenge that remains is to devise new models of patient care that can deliver strategies for the secondary prevention of osteoporotic fractures in different healthcare settings.