Skeletal and genetic determinants of osteoporosis

Osteoporosis, one of the critical diseases facing the ageing population and along with cardiovascular disease, diabetes and cancer, is a major concern for public health in western countries. Fractures, the clinical endpoint of osteoporosis, contribute considerably to overall morbidity, mortality and healthcare costs. It has been estimated that the lifetime risk to suffer a fracture is 40% for a 50-year-old white woman and 15% for men. Of those who have suffered a fracture of the hip, 50% are subsequently unable to walk unassisted and 20 % die within the first year after the hip fracture occurred. The total health care expenditures attributable to osteoporotic fractures in the United States was estimated at US$ 13.8 billion in 1995. In the Netherlands direct medical cost of osteoporosis-related fractures was estimated to be over 400 million guilders each year. Due to ageing, fractures from osteoporosis occurring each year are projected to increase world-wide from 1.7 million in 1990 to 6.3 mil1ion in 2050. Osteoporosis is defined as a systemic skeletal disease, characterised by low bone mass and microarchitectural detoriation of bone tissue with a consequent increase in bone fragility and susceptibility to fracture.

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