Osteoporosis and Fracture Risk

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Osteoporosis is a reduction in bone mass and bone microarchitecture leading to increased bone fragility and fracture risk. The most common cause of osteoporosis is increased bone turnover with excessive bone resorption (destruction) that exceeds bone formation. Among women, this is often caused by estrogen deficiency following menopause. A second large and independent contributor is glucocorticoid use. Later in life, a combination of vitamin D insufficiency, reduced 1,25(OH)2-vitamin D3 production and inadequate calcium nutrition contribute to bone loss in both men and women. Both menopause and glucocorticoid use cause an imbalance between the processes of bone resorption (removal) and formation, leading to bone loss. A woman can experience a loss of up to 5% of her bone mass per year during the first half decade postmenopause. There exists a correlation between the reduction in bone mineral density1-4 and/or increased bone turnover5-7 with increased fracture risk.

Incidence of fracture increases with age, and associated increased risk of trauma with falls, which is an independent contributor. The most common fractures occur in the spine, and their frequency increases progressively in women and men beginning in the sixth and seventh respective decades of life. The most serious fractures are of the hip. The incidence of these increases steadily, reaching a rate of about 5% per year in the ninth decade of life. Approximately 70-75% of all hip fractures occur in women, likely due to their earlier and more dramatic bone loss, gender-based differences in bone mass, and greater longevity. Men reach the fracture threshold about a decade later than women.

With the continued increase in life expectancy due to medical and other advancements it is projected that the incidence of osteoporotic fractures will reach epidemic proportions within the next couple of decades if effective means to combat them are not implemented.


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