The crippling consequences of fractures and their impact on quality of life.

Around 40% of white women and 13% of white men in the United States have at least one fragility fracture after the age of 50 years. The risk of fracture increases with advancing age and progressive loss of bone mass, and varies with the population being considered. The age-adjusted incidence of fragility fractures in both sexes is 25% lower in Britain and many areas of Europe than in the United States. Mortality 5 years after hip or vertebral fracture is about 20% in excess of that expected; mortality rate is highest in men > 75 years suffering from a variety of chronic diseases. Most excess deaths occur in the first 6 months after hip fracture. One year after hip fracture, 40% of patients are still unable to walk independently, 60% have difficulty with at least one essential activity of daily living, and 80% are restricted in other activities, such as driving and grocery shopping. Moreover, 27% of these patients enter a nursing home for the first time. Less is known of the epidemiology of vertebral fractures and of the associated mortality and morbidity. Although an estimated 30% of postmenopausal U.S. white women have osteoporosis, and 1 in 4 has at least one vertebral deformity, two thirds of vertebral fractures remain undiagnosed. After a clinically diagnosed vertebral fracture, survival rate decreases gradually from that expected without fracture. Women with severe vertebral deformities have a consistently higher risk of back pain and height loss. An accurate assessment of the risk of fractures associated with osteoporosis and of their impact on quality of life is essential if appropriate and cost-effective interventions are to be designed for different populations.