Jacqui, from an orthogeriatric perspective, how significant is the treatment gap in osteoporosis care after hip fracture, and why is the post-fracture period such an important opportunity for intervention?

So a few things to say on that, Neve.

Like, there is such good evidence that older people benefit from treatment for osteoporosis, um, both in terms of primary and secondary prevention, and that includes after hip fracture.

And if we ignore the osteoanabolics just for now and look at where we are at this point in time after hip fracture, so the last report we released was at the end of twenty twenty-five, and at that time, if you look across Australia and New Zealand, only thirty-five percent of patients leave hospital on treatment for osteoporosis after a hip fracture.

That is woeful.

The best performing hospitals managed to get over eighty percent of patients on treatment, treatment that we know to s- to be effective to substantially reduce their future fracture risk, and it is really important to remember that your risk of future fracture is greatest within that first year of hip fracture.

So that's a huge gap.

Um, so although the guidelines do suggest that anabolics first would be, are better, the big issue is the practicalities, particularly in these admitted patients who are complicated, often have fragmented care, often will see multiple different people before they make it home, and how do you continue this care in the community? Um, so that d- that doesn't mean to say that anti-resorptives are not a useful agent, and certainly in the context of the practicalities, it can actually be still extremely useful to s- to think about those medications for a patient's ongoing care because any treatment is still better than no treatment.