of the population age 50 and over, having osteoporosis or low bone density that can lead to fractures . About 80% of osteoporosis occurs in
women and 20% in men. The prevalence is increasing, with over 61 million expected to have osteoporosis or
low bone density by 2020. About 30% of Caucasian women age 50 and over have osteoporosis, when defined as a T-score of less than -2.5 at the spine, hip, or mid-forearm In men age 50 and older, the prevalence of osteoporosis is about 19% . There are about 1.5 million fragility fractures in the USA each year, with 700,000 vertebral fractures, 300,000 hip fractures, 250,000
wrist fractures, and 250,000 at other skeletal sites. The lifetime risk of fracture is substantial. Population data from Rochester, Minnesota, estimate that at the age of 50, a Caucasian woman has about a 40% lifetime risk and a Caucasian man a 13% lifetime risk of fracture of fracture at hip, spine, or distal forearm In Malmö, Sweden, the lifetime risk of fracture of the hip, spine, forearm or proximal humerus at age 50 was reported to be 46% in women and 22% in men . The Dubbo study found that at the age 60 there was a residual lifetime fracture risk of 56% for women and 29% for men, assuming average life expectancy [6]. A woman's risk of hip fracture is equal to her combined risk of
breast,
uterine, and
ovarian cancer ]. Fractures of the spine and hip are associated with an increased risk of chronic pain, deformity,
depression, disability, and death. About 50% of those with a hip fracture will be permanently unable to walk without assistance and 25% will require long-term care [8]. The mortality rate five years after a fracture of the hip or a clinical vertebral fracture is about 20% greater than expected [9], with men having higher mortality rates than women, even when standardized for age . The direct cost of osteoporotic fractures in the USA was about $17 billion per year in 2001 [11], extrapolated from 1995 figures using the Medical Index of the Consumer Price Index, with this value expected to rise greatly in future years.
