![]() Bone mineral density is defined as the average concentration of mineral per unit of area (g/cm 2) measured ( Cummings et al 2002). The gold standard for diagnosis of osteoporosis is measurement of bone mineral density (BMD) using central dual-energy x-ray absorptiometry ( Lewiecki et al 2004). The annual cost of osteoporotic fractures to the US healthcare system in 2001 was approximately US$17 billion, with a single hip fracture costing approximately US$40 000 ( NOF 2004). The estimated cost of osteoporotic fractures in females greater than 50 years of age using 1997 figures cost the UK £727 million (US$1.23 billion) or an estimated £942 million (US$1.6 billion) including men, assuming the cost of treatment was the same as females ( Dolan and Torgerson 1998). In Belgium (population ∼10 million), the total cost of hip fractures in 1996 was almost US$126.2 million per year ( Reginster et al 1999). While total world-wide estimates are not readily available, there are data that describe the costs in various countries. The economic consequences of osteoporosis with its associated morbidity and mortality due to fractures are staggering. Vertebral fractures are estimated to increase during this time from 23.7 million to 37.3 million. In the EU, the total number of hip fractures is estimated to increase from 414 000 to 972 000 from year 2000 to 2050 ( Compston et al 1998). In the US, the prevalence of osteoporosis is expected to grow from an estimated 10 million in 2002 to 14 million by 2020 ( NOF 2005a). These fractures lead to numerous adverse sequele include chronic pain, deformity, and disability, decreased quality of life, decreased mobility, increased risk of pressure ulcers, and decreased pulmonary function ( Nevitt et al 1998 Schlaich et al 1998 Lips et al 1999 Fink et al 2003 Margolis et al 2003 Hallberg et al 2004).Īs the global population ages, the prevalence of age-related osteoporosis (ie, postmenopausal osteoporosis, male osteoporosis) and related fractures is likely to increase considerably. In the US, it is estimated that wrist fractures occur at almost the same rate as hip fractures with approximately 250 000 annually, and the vertebral fracture rate is more than double that of hip fractures with approximately 700 000/year ( NOF 2005b). While hip fractures are considered to be the most debilitating osteoporosis-related facture, other fracture types are common. In the US alone, it is estimated that over 1.5 million fractures occur annually due to osteoporosis, with over 300 000 occurring at the hip ( NOF 2005b). These fractures were associated with 740 000 deaths and 1.75 million disability adjusted life-years lost, with the highest rates occurring in established market economies such as North America, Japan, Australia, and Western Europe. In 1990 it was estimated that approximately 1.3 million hip fractures occurred globally ( Johnell and Kanis 2004). Hip fractures, considered to be the most debilitating fragility fracture secondary to osteoporosis, are associated with an approximately 2-fold increased risk of mortality the year following the fracture ( Center et al 1999 Empana et al 2004). Osteoporosis, defined as a skeletal disorder characterized by decreased bone strength and increased susceptibility of fractures ( NIH 2001), is a significant health concern for the international community. In addition, further research is needed to identify ideal regimens in special populations such as nursing home patients and men. Data are beginning to emerge supporting various combination therapies (eg, bisphosphonate plus an estrogen receptor stimulator), though more data are needed to identify combinations which are most effective and confer added fracture protection. Drugs which have been shown to decrease the risk of age-related osteoporotic fractures include oral bisphosphonates (alendronate, ibandronate, and risedronate), intranasal calcitonin, estrogen receptor stimulators (eg, estrogen, selective estrogen receptor modulators ), parathyroid hormone (teriparatide), sodium fluoride, and strontium ranelate. Agents which increase BMD and have been shown to decrease fractures, particularly at the hip, should be considered preferentially over those for which only BMD data are available. Efforts should be made to screen those at risk for osteoporosis, identify and address various risk factors for falls and associated fractures, ensure adequate calcium and vitamin D intake, and institute pharmacological therapy to increase BMD when indicated. ![]() ![]() As the population continues to age, morbidity and mortality from fractures due to low bone mineral density (BMD) will likely continue to increase. ![]() Osteoporosis and related fractures are a significant concern for the global community. ![]()
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