Principles of bone and joint disease control programs--osteoporosis.

During the past decade osteoporosis has emerged as a major public health problem. In societies with aging populations, an increasing number of persons are at risk of fracture, the most detrimental outcome of osteoporosis. Osteoporosis was initially identified as a problem of westernized countries, but a rising number of fractures are occurring in Asia and South America, and the global estimates show steep increases in these regions. Over the age of 70 years, only 31-36% of people are estimated to have normal bone mass. The lifetime risk for hip fracture for 50-year-old women is 18 to 25% and the risk for men 6 to 7%. Hip fractures affect the most aged, and are a contributing factor to death, with up to 20% of patients having died within the first year. Rehabilitation is needed, but only 30% regain pre-fracture function. The lifetime risk of vertebral fracture has been estimated to be 15.4% after age 45 years, but this most likely largely underestimates the true risk. The demand on the health care system is therefore increasing, as are costs for society. Prevention of osteoporosis and fracture must be considered particularly for the elderly at highest risk. Awareness is needed at all levels, including decision making bodies, in order to raise the priority of, and effectively implement, strategies to reduce the number of persons suffering. Interventions for prevention of fractures must be cost-effective; therefore strategies are needed to identify those who will benefit most from more costly secondary measures.