Reporting absolute fracture risk with and without treatment promises to be most useful in women with osteopenia, a common clinical dilemma in younger postmenopausal women.

Compared with patients who received usual care for osteoporotic fracture, patients participating in a postfracture disease management program had substantially higher rates of medical attention given for osteoporosis; however, the overall yield of the program was low. This low uptake rate was related to factors not previously appreciated: many patients refused participation in the program; a high proportion of younger women-and men of all ages-did not qualify for treatment; and treatment was refused by one in three study-qualified women and by one in seven study-qualified men. Additional efforts are needed to overcome patient barriers to improved osteoporosis evaluation, treatment and participation in postfracture programs.

No abstract

On the cover: "Things That Are Round" by Marsha Balian, NP, is an acrylic on canvas. Ms Balian is self-taught and loves to use highly saturated color. She feels her work can be occasionally confrontational but always has a humorous edge. She is increasingly aware of how the issue of family plays into our lives, not just as it has impacted our pasts but how each of us weaves the desire for family (traditional or not) or connection with the world into the fabric of our lives. This concept leads her as a Nurse Practitioner to a continued focus on the lives of women and children as the subject of her art.

No abstract