The field of osteoporosis may be coming full circle, and that is not good for the millions of older women and men who will suffer painful and disabling spine and hip fractures—fractures that might have been prevented. As physicians, we are now watching as the fundamental progress made to reduce fractures and dramatically improve the quality of life of our patients during the past 30 years unravels. Osteoporosis was long considered an inevitable consequence of aging, in which the typical scenario played out with remarkable consistency:“Grandma” developed the characteristic “dowagerLs hump,” later fractured her hip, was forced to leave her home and languish in pain and immobility in a nursing home, where she finally succumbed to the complications of that existence with a premature and avoidable death. However, over the course of the lifetimes of at least some of us, the scientific and medical community made remarkable advances in the diagnosis and treatment of osteoporosis. Epidemiological studies clearly defined the patterns and risk factors for age-related bone loss. Systematic studies conducted in animals and in humans defined the mechanisms of bone loss due to estrogen deficiency, aging, glucocorticoids, and many other factors. These fundamental advances in the understanding of the pathogenesis of osteoporosis drove the development of new treatments including estrogen, SERMs, teriparatide, and denosumab, with abaloparatide, romosozumab, and odanacatib on the horizon. The field also benefited by the fortuitous discovery that bisphosphonates, which were originally developed for other purposes,(1) also turned out to disable osteoclasts and were developed into the most widely-used drugs today to prevent and treat osteoporosis. In 2016, we should be celebrating these triumphs of science and medicine because, by these criteria, we have made remarkable progress toward our goal of markedly decreasing the burden of a devastating disease. We should be viewing the future for our patients with osteoporosis with unparalleled optimism, because we now have several drugs that can substantially reduce fracture incidence, by as much as 70% in the case of vertebral fractures.(2) Thus, although physicians still struggle to treat many other conditions that are currently intractable, including AlzheimerLs disease and many cancers, the good news is that the prevention of fractures is clearly within our reach. And yet, despite the development of several effective drugs to prevent fractures, many patients, even those who unequivocally need treatment, are either not being prescribed osteoporosis medications at all, or when prescribed, refuse to take them.