Epidemiology of Osteoporosis

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Absolute risks for fracture in individuals

Although most American women under the age of 50 years have normal BMD, 27% are osteopenic and 70% are osteoporotic at the hip, lumbar spine, or forearm by the age of 80 years. Epidemiologic studies from North America have estimated the remaining lifetime risk for common fragility fractures to be 17.5% for hip fracture, 15.6% for clinically diagnosed vertebral fracture, and 16% for distal forearm fracture among white women aged 50 years. Corresponding risks among men are 6%, 5%, and 2.5%,

Health impact of osteoporotic fracture

All osteoporotic fractures are associated with significant morbidity, but hip and vertebral fractures also are associated with excess mortality. A recent study estimated that there were 1.31 million new hip fractures in 1990, and the prevalence of hip fractures with disability was 4.48 million. There were 740,000 deaths estimated to be associated with hip fracture and 1.75 million disability-adjusted life-years lost, which represents 0.1% of the global burden of disease worldwide and 1.4% of

Fracture epidemiology

Fracture incidence in the community is bimodal, with a peak in the young and elderly. In youth, fractures usually are associated with substantial trauma, occur in the long bones, and are seen more frequently in boys than in girls. Osteoporotic fractures characteristically occur in those areas of the skeleton with high amounts of trabecular bone after low or moderate trauma. There is increased frequency of fracture with age in both sexes, which reflects a combination of lower bone density with

Clustering of fractures

Previous vertebral deformities increase the risk for subsequent vertebral deformities by 7 to 10 fold (Table 3) [41], [42]. This is similar to the increase in risk for a second hip fracture. In Rochester, Minnesota, residents aged 70 years or younger who had radiologically diagnosed vertebral deformities were followed for the development of subsequent limb fractures. The standardized morbidity ratios of observed/expected fractures for both sexes were 1.7 (95% CI, 1.3–2.2) for the hip, 1.4 (95%

Bone mineral density and fracture

The relationship between BMD and osteoporosis can be compared with that between blood pressure and stroke. Although low BMD is not a prerequisite for osteoporotic fracture, the risk for fracture is elevated considerably in the presence of low bone mass. Therefore, as with blood pressure, appropriate cut-off values can be defined to direct intervention toward “at-risk” individuals. BMD taken at different sites can be used to predict the future risk for fracture at the same, or other, sites.

Falls and fracture

Fractures occur because of an interaction between bone fragility (largely determined by bone mass) and trauma (usually falls). In particular, distal forearm fracture and hip fracture usually follow a fall from standing height or less. The likelihood of fall increases with age, especially for elderly women. In one British study based in Oxford, one in three women, aged 80 to 84 years, had experienced a fall in the previous year. Above this age, one half of the women and one third of the men had

Future projections

Osteoporotic fractures represent a significant public health burden, which is set to increase in future generations. Life expectancy is increasing worldwide, and it is estimated that the number of individuals aged 65 years and older will increase from the current figure of 323 million to 1555 million by the year 2050. These demographic changes alone can be expected to cause the number of hip fractures that occurs worldwide to increase from 1.66 million in 1990 to 6.26 million in 2050 [28].

Summary

Osteoporotic fractures represent a significant public health burden, which is set to increase in future generations. Lifetime risk is high and lies within the range of 40% to 50% in women and 13% to 22% in men. Life expectancy is increasing worldwide, and it is estimated that the number of individuals aged 65 years and older will increase from the current figure of 323 million to 1555 million by the year 2050. These demographic changes alone can be expected to cause the number of hip fractures

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