Due to its prevalence worldwide, osteoporosis is considered as a serious public health concern. Currently it is estimated that over 200 million people worldwide suffer from this disease1. Approximately 30% of all postmenopausal women have osteoporosis in the United States and in Europe. At least 40% of these women2 and 15-30% of men3 will sustain one or more fragility fractures in their remaining lifetime. Ageing of populations worldwide will be responsible for a major increase of the incidence of osteoporosis in postmenopausal women4.
It has been shown that an initial fracture is a major risk factor for a new fracture. An increased risk of 86% for any fracture has been demonstrated in people that have already sustained a fracture5. Likewise, patients with a history of vertebral fracture have a 2.3-fold increased risk of future hip fracture and a 1.4-fold increase in risk of distal forearm fracture6.
Vertebral fractures are rarely reported by physicians and remain most of the time ignored. Less than 10% of vertebral fractures result in hospitalisation, even if they cause pain and substantial loss of quality of life7, 8.
In Europe, the prevalence defined by radiological criteria increases with age in both sexes and is almost as high in men as in women: 12% in females (range 6-21%) and 12% in males (range 8-20%)9. This fact could be explained by occupation-associated trauma in men10.
New fractures are most likely in nearby vertebrae, and they occur more frequently in the mid-thoracic or thoracolumbar regions of the spine7.
In Europe, the age-standardized incidence of morphometric fracture is 10.7 and 5.7 per 1000 person-years in women and men, respectively11. These figures increase markedly with age in both women and men.
Hip fracture is associated with serious disability and excess mortality. Women who have sustained a hip fracture have a 10-20% higher mortality than would be expected for their age12. The worldwide annual incidence of hip fracture is approximately 1.7 million.13.
Hip fracture rates vary markedly between populations. After age adjustment, hip fracture rates are more common in Scandinavian and North America than these observed in southern European, Asian and Latin American countries. There are wide discrepancies between the incidence rate in women and men: the sex ratio F/M is 4/5 and 90% of the hip fractures occur in people over 50 years old10.
Distal forearm (wrist) fractures
Wrist fractures are most likely to occur in women over 65 years old. An increase in age-adjusted incidence in white women between 45 and 60 years of age has been observed. Then the trend stabilises or slightly increases. Only 15% of wrist fractures occur in men and this rate does not increase much with age14.
In Europe, the annual incidence of distal forearm fractures in male and female were estimated 1.7 and 7.3 per 1000 person-years, respectively15.
It is important to notice that distal forearm fractures are an early and sensitive marker of male skeletal fragility. Aging men carry a higher absolute risk for hip fractures than spinal fractures in comparison to women16.
Comparison with other chronicle diseases
Surprisingly, osteoporosis is much more common than other diseases which usually catch the public attention, even though the consequences of certain fractures can lead to death. A one-in-nine risk of developing breast cancer has been observed in white women, which is lower than the one-in-six lifetime risk of hip fracture in this population17.
As well, the combined lifetime risk of hip, forearm and vertebral fractures coming to clinical attention is around 40%, which is equivalent to the risk of cardiovascular diseases8.
In women over 45 years of age, osteoporosis accounts for more days in hospital than may other diseases, including diabetes, myocardial infarction and breast cancer9. In Sweden, osteoporotic fractures in men account for more hospital bed days than those due to prostate cancer20.
It is estimated that the lifetime risk of experiencing an osteoporotic fracture in men over the age of 50 (in Sweden) is 30%2, which is similar to the risk of developing prostate cancer21.
By 2050, the worldwide incidence of hip fracture in men is projected to increase by 240% in women and 310% in men (22). The estimated number of hip fractures worldwide will rise from 1.66 million in 1990 to 6.26 million in 2050, even if age-adjusted incidence rates remain stable10.
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2. Melton III LJ, Chrischilles EA, Cooper C, Lane AW, Riggs BL: Perspective: How many women have osteoporosis? J Bone Miner Res 1992;7:1005-10
3. Randell A, Sambrook PN, Nguyen TV, Lapsey H, Jones G, Kelly PJ, Eisman JA. Direct clinical and welfare costs of osteoporotic fractures in elderly men and women. Osteoporosis Int 1995;5:427-32
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10. Sambrook P, Cooper C. Osteoporosis. Lancet 2006;367:2010-18
11. EPOS Group. Incidence of vertebral fracture in Europe: Results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res. 2002;17:716-24
12. Cummings SR, Melton III JR. Epidemiology and outcomes of osteoporotic fractures. Lancet 2002;359:1761-7
13. Cooper C, Campion G, melton III LJ. Hip fractures in the elderly: a world-wide projection. Osteoporosis Int 1992;2:285
14. Owen RA, Melton III LJ, Johnson KA, Ilstrup DM, Riggs BL. Incidence of Colles' fracture in a North American Community. Am J Public Health 1982;72:605-7
15. EPOS Group. Incidence of limb fracture across Europe: Results from the European Prosepective Osteoporosis Study (EPOS). Osteoporosis Int 2002;13:565-71
16. Haentjens P, Johnell O, Kanis JA, Bouillon R, Cooper C, Lamraski G, Vanderschueren D, Kaufman JM, Boonen S, On behalf of the Network on Male Osteoporosis in Europe (NEMO). Evidence From Data Searches and Life-Table Analyses for Gender-Related Differences in Absolute Risk of Hip Fracture After Colles' or Spine Fracture: Colles' Fracture as an Early and Sensitive Marker of Skeletal Fragility in White Men. J Bone Miner Res 2004:19:1933-44
17. Van Staa TP, Dennison EM, Leufkens HE, Cooper C. Epidemiology of fractures in England and Wales. Bone 2001;29:517-22
18. Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet 2002;359:1929-36
19. Kanis JA, Delmas PD, Burckhardt P, Cooper C, Torgerson P. Guidelines for diagnosis and management of osteoporosis. The European Foundation for Osteoporosis and Bone Disease. Osteoporosis Int 1997;7:390-406
20. Kanis JA, Johnell O, Oden A, De Laet C, Mellstrom D. Epidemiology of osteoporosis and fracture in men. Calcif Tissue Int. 2004;75:90-9
21. Merrill RM, Weed DL, Feuer EJ. The lifetime risk of developing prostate cancer in white and black men. Cancer Epidemiol Biomarkers Prev 1997;6:763-8
22. Gullberg B, Johnell O, Kanis JA. Worldwide projections for hip fracture. Osteoporosis Int. 1997;7:407-13
- What is Osteoporosis?
- Who's at Risk?
- Living with Osteoporosis