SPECIAL COMMENTARYOsteoporosis epidemiology using international cohortsZhang, Jeana; Dennison, Elainea,b; Prieto-Alhambra, DanielcAuthor Information aMRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK bVictoria University of Wellington, Wellington, New Zealand cNuffield Department of Orthopaedics, Centre for Statistics in Medicine , Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK Correspondence to Daniel Prieto-Alhambra, Nuffield Department of Orthopaedics, Centre for Statistics in Medicine, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. Tel: + 44 1865 612 600; e-mail: firstname.lastname@example.org Current Opinion in Rheumatology: July 2020 - Volume 32 - Issue 4 - p 387-393 doi: 10.1097/BOR.0000000000000722 Buy Metrics Abstract Purpose of review The field of osteoporosis research has been active for the past 20 years and has allowed significant advancement in the management of osteoporosis. This review will give an overview of the latest data from international cohorts that relate to current and recent osteoporosis research. Recent findings The clinical diagnosis of osteoporosis relies heavily on bone mineral density (BMD) measured at femoral neck or spine and although BMD has excellent predictive value for future fractures, fracture risk assessment has evolved over the years, resulting in the birth of fracture prediction tools. Fracture risk factors not currently featured in these tools are being considered for inclusion, including imminent risk fracture following a sentinel fracture, number of falls, and previous vertebral fractures. Data from groups with comorbidities such as chronic obstructive pulmonary disease are helping us understand how to best manage patients with multiple comorbidities. Finally, the prevalence of vertebral fracture in the older general population and other selected populations has been explored, alongside the global burden of osteoporosis and its consequences. Summary Our understanding of osteoporosis continues to expand, but knowledge gaps remain. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.