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Osteoporosis is a public health problem affecting more than 40 million people, one-third of postmenopausal women and a substantial portion of the elderly in the United States and almost as many in Europe and Japan. An additional 54% of postmenopausal women have low bone density measured at the hip, spine, or wrist. Osteoporosis results in more than 1,500,000 fractures annually in the United States alone. At least 90% of all hip and spine fractures among elderly women are a consequence of osteoporosis. The direct expenditures for osteoporotic fractures have increased during the past decade from $5 billion to almost $15 billion per year. Thus, family physicians and other primary care providers will (1) frequently care for patients with subclinical osteoporosis, (2) recognize the implications of those who present with osteoporosis-related fractures, and (3) determine when to implement prevention for younger people.

Of the 25 million women in the United States thought to have osteoporosis, 8 million have a documented fracture. The female-to-male fracture ratios are reported to be 7:1 for vertebral fractures, 1.5:1 for distal forearm fractures, and 2:1 for hip fractures. Approximately 30% of hip fractures in persons aged 65 years and older occur in men. Osteoporosis-related fractures in older men are associated with lower femoral neck bone mineral density (BMD), quadriceps weakness, higher body sway, lower body weight, and decreased stature. Osteoporotic fractures are more common in whites and Asians than in African Americans and Hispanics, and more common in women than in men. Little is known regarding the influence of ethnicity on bone turnover as a possible cause of the variance in bone density and fracture rates among different ethnic groups. Significant differences in bone turnover in premenopausal and early perimenopausal women can be documented. The bone turnover differences do not appear to parallel the patterns of BMD. Other factors, such as differences in bone accretion, are likely responsible for much of the ethnic variation in adult BMD.

Finkelstein JS et al: Ethnic variation in bone turnover in pre- and early perimenopausal women: effects of anthropometric and lifestyle factors. J Clin Endocrinol Metab 2002;87:3051.  [PubMed: 12107200]
National Osteoporosis Foundation: 1996 and 2015 osteoporosis prevalence figures: state-by-state report. January 1997. Women's Health Matters 1998;2:1. Available at: Accessed July 29 2010.

Osteoporosis is characterized by microarchitectural deterioration of bone tissue that leads to decreased bone mass and bone fragility. The major processes responsible for osteoporosis are poor bone mass acquisition during adolescence and accelerated bone loss during the perimenopausal period (mid-50s to the sixth decade in women and the seventh decade in men) and beyond. Both processes are regulated by genetic and environmental factors. Reduced bone mass, in turn, is the result of varying combinations of hormone deficiencies, inadequate nutrition, decreased physical activity, comorbidity, and the effects of drugs used to treat various medical conditions.

Primary osteoporosis—deterioration of bone mass not associated with other chronic illness—is related to increasing ...

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