Due to its prevalence worldwide, osteoporosis is considered 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 in 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

Vertebral fractures are rarely reported by physicians and remain most of the time remain undiagnosed. Fewer 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 fractures

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.

Age-specific and sex-specific incidence of radiographic vertebral, hip and distal forearm fracturesAge-specific and sex-specific incidence of radiographic vertebral, hip and distal forearm fractures. (Sambrook et al. Lancet 2006;367:2010-8)

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 chronic diseases

Surprisingly, osteoporosis is much more common than other diseases which usually catch 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.

Projections

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.

References

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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