Osteoporosis is a chronic disease with a projected escalation in fracture prevalence and costs as the population ages. Osteoporosis care aims to prevent fractures and ultimately improve health-related quality of life. Despite significant evidence-based advances in testing and treatment, a large proportion of patients with fragility fracture or other osteoporosis risk factors are never evaluated with bone mineral density measurement testing and never receive therapy. This suboptimal quality of care can be attributed to barriers at the patient, provider, and health system levels. In addition, significant disparities in care exist across age, ethnicity, and gender. Recent studies have indicated that restructuring care at the system level is more likely to be successful, dependable, and durable than traditional quality improvement interventions focusing predominantly on physicians. Copyright © 2008 by Current Medicine Group LLC.