Osteoporosis is characterized by low bone mass and deterioration of microarchitectural structure. It is a very common disease; in 2007 it was estimated that 1.9 in 1,000 men and 16.1 in 1,000 women had diagnosed osteoporosis in the Netherlands. However, the true number is expected to be 2-3 times higher, since osteoporosis often goes undetected because it causes no symptoms until a fracture occurs. Whether one develops osteoporosis is determined by multiple factors; for instance, high age, female sex, low body weight, smoking, limited physical activity and use of medication such as glucocorticoids are all risk factors. In addition, osteoporosis is highly heritable; bone mineral density (BMD), the parameter obtained by dual-energy X-ray absorptiometry (DXA) scanning to diagnose osteoporosis, has an estimated heritability of 50-85%. Recently, 56 genetic determinants have been identified that influence BMD . Fractures are the most important possible consequence of osteoporosis. They form a major health care burden. For example, in 2005, more than 2 million fractures were reported in the United States only, leading to 17 billion dollars of costs [7]. Moreover, fractures lead to morbidity and mortality. In the Netherlands, a striking 25% of persons who sustained a hip fracture dies within one year [8]. The problem of osteoporosis and fractures is expected to increase over time because of global demographic changes due to improved health; the number of people aged ≥65 years is expected to increase from 506 million in 2008 to 1.3 billion in 2040 .

A.G. Uitterlinden (André)
Erasmus University Rotterdam
The publication of this thesis was financially supported by the Anna Foundation NOREF in Leiden, the Netherlands Consortium for Healthy Ageing (NCHA), and Stichting IWO.
Erasmus MC: University Medical Center Rotterdam

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