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Recency of fracture represents an imminent risk that deserves prompt recognition. The new FRAXplus calculator accounts for additional risk factors to refine existing risk stratification. Advances in imaging techniques such as trabecular bone score and radiofrequency echographic multi-spectrometry may have potential roles in specific populations. Treatment of osteoporosis requires a multifaceted approach. Non-drug interventions include fall prevention and resistance exercises, supplementation with calcium, vitamin D and possibly vitamin K, and effective bridging of care gaps with fracture liaison services. An overview of drug therapy is provided, drawing attention to the importance of sequential therapy starting with potent anabolic agents for the patients at the highest risk, as opposed to a traditional step-up approach. An individualized, goal directed care plan is necessary for a treat-to-target approach, with total hip bone mineral density being the best specific target. 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