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and July 2016. We examined whether osteoporosis tests (BMD and/or bone metabolism marker measurement) were performed after the injury and whether osteoporosis treatment was adminis-tered. We found that the proportions of patients in whom BMD and/or bone metabolism markers were measured after fracture were: OVF, 58.8%; PFF, 34.0%; PHF, 15.4%; and DRF, 50%. Similarly, the proportions of patients who received osteopo-rosis treatment after fracture were 75.0%, 36.2%, 38.5%, and 50.0%, after OVF, PFF, PHF and DRF respectively. In Japan, the rate of treatment for secondary fracture prevention after osteoporotic fracture has been reported to be around 15%5, 6), so our results were an improvement. However, we considered that it was necessary to be more proac-tive in preventing secondary fractures, and thus further strengthen measures against osteoporosis. Consequently more appropriate treatment was commenced according to the guidelines. Then, after the measures were initiated, the same survey was conducted again. The subjects of this survey were patients with the same fractures as above between October 2018 and April 2019. The results showed that the proportions of patients in whom BMD and/or bone metabolism markers were measured after fracture were 54.1%, 11.8%, 14.3%, and 0%, respectively, in the OVF, PFF, PHF and DRF groups, and the proportions given osteopo-rosis treatment after fracture were 70.3%, 23.5%, 28.6% and 8.3%, respectively. All percentages were below those recorded in the first survey, which made us keenly aware of the difficulty of counter-measures. This depended on the doctor’s enthu-siasm for treating osteoporosis, so it is necessary to create a system that can be continued regardless of the doctor in charge.There have been other reports of the difficulty of continuing osteoporosis treatment. In a survey of 67,101 patients who received initial administration of osteoporosis drugs in Hokkaido, Japan, from January 2014 to December 2015, it was reported that the retention rate after 1 year was 38.7% and that after 2 years it had fallen to only 7.7%7). At our institution, we surveyed patients who planned to continue weekly osteoporosis treatment for two years in principle, and found that 36.7% of patients quit in just one month, and only 6.7% were able to continue for two years. To understand why patients could not continue with the treatment, we conducted a telephone survey of 39 patients who had stopped taking the medication. The result revealed that elderly people are often unable to attend their appointments due to other diseases. Interestingly, it was also found that 11 patients had discontinued their medication on their own initiative due to concerns about COVID-19. This is a very important issue, because some treatments for osteoporosis can lead to a reduction in BMD and even an increased risk of fractures if left untreated after discontinua-tion8, 9). Therefore, it is important to continue treat-ment for osteoporosis. However, the essence of osteoporosis treatment is not to take medicine to increase BMD, but to prevent fractures and prevent immobility due to fractures. Treatment of osteopo-rosis is not limited to drugs, but there have been studies involving interventions such as reducing the incidence of OVF by strengthening the back muscles and increasing BMD by walking10, 11).The incidence of OVF has been found to increase rapidly after age 6512). Patients with OVF suffer from two stages of pain. At first, about two months after the injury, the patient complains of sharp pain upon waking, but says it doesn’t hurt much if they are sleeping or upright. This is because the frac-tured part moves when they wake up. Treatment at this stage is to put on a brace to stabilize the fracture and to start medication to promote bone formation. It should be noted that OVF can some-times be severe, and the collapsed vertebral body can compress the spinal cord and cauda equina nerves, causing paralysis and requiring major surgery. However even if this is not the case and the fracture can be stabilized, the second stage of pain will inevitably follow. Many of the patient’s complaints at this time are “I get stiff, hurt, and lean forward when I’m standing or walking for a long time. I want to hold something. It’s easier to have a cart for shopping.” This is a low back pain due to muscle fatigue caused by a rounded back due to OVF. This pain is related to the structure of the pelvis and spine. In Japanese patients, the pelvis is tilted forward at approximately 45 degrees. The lumbar spine is lordotic when standing straight in that state. The angle of lordosis is approximately 45 degrees, which is the same as the tilt of the 33Osteoporotic vertebral fractures (OVF)