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Osteoporosis is estimated to affect million women worldwide - approximately one-tenth of women aged 60, one-fifth of women aged 70, two-fifths of women aged 80 and two-thirds of women aged 90 For the yearthere were an estimated 9 million new osteoporotic fractures, of which 1.

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Worldwide, 1 in 3 women over age 50 will experience osteoporotic fractures, as will 1 in 5 men aged over 50 234. Osteoporosis takes a huge personal and economic toll.

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In Europe, the disability due to osteoporosis is greater than that caused by cancers with the exception of lung cancer and is comparable or greater than that lost to a variety of chronic noncommunicable diseases, such as rheumatoid arthritis, asthma and high blood pressure related heart disease Although low BMD confers increased risk for fracture, most fractures Men above women in postmenopausal women 56, and elderly men at moderate risk. In women over 45 years of age, osteoporosis accounts for more days spent in hospital than many other diseases, including diabetes, myocardial infarction and breast cancer Evidence suggests that many women who sustain a fragility fracture are not appropriately diagnosed and treated for probable Men above women 84 An IOF survey, conducted in 11 countries, showed denial of personal risk by postmenopausal women, lack of dialogue about osteoporosis with their doctor, and restricted access to diagnosis and treatment before the first fracture result in underdiagnosis and undertreatment of the disease Vertebral fractures may cause equal morbidity in men and women.

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Hip fractures in men cause significant morbidity and loss of normal functioning Although the overall prevalence of fragility fractures is higher in women, men generally have higher rates of fracture related mortality 14 As in women, the mortality rate in men after hip fracture increases with age and is highest in the year after a fracture 18 Over the first 6 months, the mortality rate in men approximately doubled that in similarly aged women Forearm fracture is an early and sensitive marker of male skeletal fragility.

In aging men, wrist fractures carry a higher absolute risk for hip fracture than spinal fractures in comparison to women In Sweden, osteoporotic fractures in men account for more hospital bed days than those due to prostate cancer Inthe estimated number of hip fractures occurring worldwide in men will be similar to that observed in women in The peak number of Men above women fractures occurred at years of age for both sexes; for all other fractures, the peak number occurred at years and decreased with age Hip fractures are invariably associated with chronic pain, reduced mobility, disability, and an increasing degree of dependence In white women, the lifetime risk of hip fracture is 1 in 6, compared with a 1 in 9 Men above women of a diagnosis of breast cancer 9.

A 50 year old woman has a 2.

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Scandinavia has the highest reported incidence of hip fracture worldwide Less than half those who survive the hip fracture regain their previous level of function Vertebral fractures due to osteoporosis are common — with one occurring Men above women 22 seconds worldwide in men and women over age 50 Vertebral fractures are associated with an 8-fold increase in age-adjusted mortality, Vertebral fractures can lead to back pain, loss of height, deformity, immobility, increased number of bed days, and even reduced pulmonary function 4243 Their impact on quality of life can be profound as a result of loss of self-esteem, distorted body image and depression 45,46,47, Vertebral fractures also significantly impact on activities of daily living 49, After hospitalization for a vertebral fracture, there is a greatly increased risk of requiring hospitalization for a further fracture in the years following initial hospitalization Vertebral fractures are associated with an increased risk of both further vertebral and nonvertebral fractures 6173839,40 Women who develop a vertebral fracture are at substantial risk for additional fracture within the next years 38 Men above women, It Men above women estimated that only one-third of vertebral fractures come to clinical attention 52 and underdiagnosis of vertebral fracture is a worldwide problem.

The incidence of vertebral fractures increases with age in both sexes. Most studies indicate that the prevalence of vertebral facture in men is similar to, or even greater than, that seen in women to age 50 or 60 years 54 Since the clinical outcome of osteoporosis is bone fracture, attention is now increasingly focused on the identification of patients at high risk of fracture rather than the identification of people with osteoporosis as defined by BMD alone,, Although osteoporosis is defined in terms of BMD and microarchitectural deterioration of bone tissue, BMD is just one component of fracture risk.

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Accurate assessment of fracture risk should ideally take into account other proven risk factors that add information to that provided by BMD,Osteoporosis has been shown in studies to have Men above women large genetic component 57,58 A parental history of fracture particularly hip fracture confers an increased risk of fracture that is independent of BMD Studies have provided evidence that weight in infancy is a determinant of bone mass in Men above women 6061 Physical inactivity and a sedentary lifestyle as well as impaired neuromuscular function e.

Smoking can lead to lower bone density and higher risk Men above women fracture 63,646566 and this risk increases with age A high intake of alcohol confers a significant risk of future fracture e. The risk of vertebral and hip fractures in men increases greatly with heavy alcohol intake, particularly with long term intake Prolonged use of corticosteroids is the most common cause of secondary osteoporosis.

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Proton pump inhibiting drugs can reduce the absorption of calcium Men above women the stomach and long term use of these drugs can significantly increase the risk of an osteoporosis-related fracture Low body weight and weight loss is associated with greater bone loss and increased risk of fracture 71,7273,74 Some young females, particularly those training for elite athletic competition, exercise too much, eat too little, and consequently experience amenorrhea which makes them at risk for low bone mass and fractures After an initial low trauma fracture from a simple fall, both older men and women have an increased equivalent risk of all types of subsequent fractures, especially in the next years Use of anxiolytics, sedatives, neuroleptics and antidepressants has been shown to increase risk of hip fracture There is a range of drug treatment available for postmenopausal osteoporosis.

Treatment of established Men above women is cost-effective irrespective of age 81 and therapies with proven rapid efficacy may offer important value to healthcare payers, providers and patients Identifying and treating patients at risk of fracture, but who have not yet sustained a fracture, will substantially reduce the long term burden of osteoporosis.

Sunlight exposure can increase Men above women BMD of vitamin D deficient bone and lead to the prevention of nonvertebral fractures Poor compliance is one of the most important treatment problems. In the short term, vertebroplasty and balloon kyphoplasty provide quicker pain relief and mobility recovery than conservative treatment alone.

Both techniques are able to stabilise the fracture and in some cases restore lost vertebral body height. However, further studies are needed with standardised and systematic reporting of health outcomes and complications Childhood and adolescence are particularly valuable times to improve bone mass through exercise 88,8990,9192, Higher levels of leisure time, sport activity, Men above women household chores and fewer hours of sitting daily were associated with a significantly reduced relative risk for hip fracture 93, Physical activity and fitness reduce risk of osteoporosis and fracture 95,96,97 and fall-related injuries 98,99, Epidemiologic evidence suggests that physical activity is associated with reductions in hip fracture in women and men , Strengthening back muscles can reduce the risk of vertebral fractures and kyphosis,Studies have shown that bone mineral density in postmenopausal women can Men above women maintained or increased with therapeutic exercise , In the frail elderly, activity to improve balance and confidence may be valuable in fall prevention.

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Intensive exercise training can lead to improvements in strength and function in elderly patients who have had hip replacement surgery due to hip fracture Adequate levels of calcium intake can maximize the positive effect of physical activity on bone health during the growth period of children Calcium supplementation has been shown to have a positive effect on bone mineral density in postmenopausal women Fruit and vegetable intake Men above women positively associated with bone density in a study in men and women.

The exact components of fruits and vegetables which may confer a benefit to bone are still to be clarifiedIn a study in elderly men and women, higher dietary protein intake was associated with a lower rate of age-related bone loss Good nutrition is an important part of a successful rehabilitation program in patients who have had an osteoporotic fracture.

In frail, elderly, hip fracture patients this is crucially important, as poor nutritional status can slow recovery, and increase susceptibility to further fractures,Lactose intolerance has been shown to be associated with low bone mass and increased risk of fracture Men above women to low milk calcium intake Moderate alcohol intake is not thought to be harmful to bone. However, chronic alcohol abuse is detrimental to bone health, with one of the mechanisms being a direct toxic effect on bone forming cells Studies in children Men above women adolescents have shown that supplementation with calcium, dairy Men above women foods or milk enhances the rate of bone mineral acquisition , The onset of anorexia nervosa frequently occurs during puberty, the time of life when maximal bone mass accrual occurs, thereby putting adolescent girls and boys with anorexia nervosa at high risk for reduced peak bone mass, Calcium and vitamin D supplementation reduces rates of bone loss and also fracture rates in older male and female adults, and the elderly, In institutionalized elderly women, this combined supplementation reduced hip fracture rates Supplementation with vitamin D has improved lower extremity muscle performance and reduced risk of falling in several high-quality double blind randomized control trials During there was an Men above women annual increase of 7.

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