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IOF World Congress Abstracts What is osteoporosis, who gets it and why? (LISBON, May 10, 2002) – Osteoporosis, the subject of a major world congress beginning today in Lisbon, is a disease in which the density and quality of bone are reduced, leading to weakness of the skeleton and increased risk of bone fractures, particularly of the spine, wrist, hip, pelvis and upper arm. Osteoporosis and associated fractures are an important cause of morbidity and mortality, and their incidence is on the rise. Understanding the Disease The human skeleton is a highly specialized and dynamic organ that is continuously regenerated through the processes of modeling and remodeling. Two specialized classes of cells are implicated in these processes. Osteoclasts, or bone-eroding cells, invade the bone's surface and create small cavities that are subsequently filled in by osteoblasts, or bone-forming cells. During childhood and adolescence, new bone is formed more quickly than old bone is resorbed, causing bones to become larger, heavier and denser (the process of modeling). This pace normally continues until the mid-20s, when peak bone mass is typically obtained. When the skeleton has reached maturity, regeneration continues with new bone replacing old (the process of remodeling), such that the entire adult skeleton is renewed approximately every ten years. Through remodeling, material fatigue and microfractures are repaired. After age 30, however, the pace of bone resorption in basic microcellular units (BMUs) begins to overtake that of new bone formation, resulting in negative bone balance. In women and men over age 50, approximately 1-3% of bone mass is lost each year. Physiological Process The loss of bone occurs normally throughout life but becomes more severe when increasing numbers of osteoclasts are formed. Osteoclasts destroy the typical honeycomb structure of trabecular bone, causing the spine to lose its "shock absorber" springiness. In long bones, which are weight-bearing pillars, osteoporosis causes bones to become abnormally porous, with a "Swiss cheese" appearance. The result: these structures can no longer support the load properly and may crack. The bone thinning process associated with aging is like a melting block of ice that disappears most rapidly in the latest stages of melting. Bones become more fragile more quickly during old age. Bone fragility in old age has its origins in youth, perhaps even during the intrauterine growth period. Scientists now know that the basic plan of the skeleton is hidden in the genetic code and passed down from one generation to the next. Abnormalities in structure or variations in size and density probably originate in the genes, although they are modifiable through environmental factors acting throughout life. Affected Population Osteoporosis affects an estimated one-third of women aged 60 to 70 years and two-thirds of those aged 80 years or older. Worldwide more than 200 million women are affected by osteoporosis and low bone mass, including 30 million in the U.S. alone. According to the World Health Organization (WHO), osteoporosis is second only to cardiovascular disease as a leading heathcare problem. The lifetime risk for a woman of dying from a hip fracture complication is equal to that of dying from breast cancer. Men are also affected by osteoporosis: about 1.5 million men in the U.S. have osteoporosis, and another 3.5 million men are at risk. Several risk factors for osteoporosis have been identified including female gender, menopause (especially premature menopause), family history, slight body build, eating disorders, cigarette smoking and race (Caucasians and Asians are most susceptible, while those of African decent are less susceptible). Patients identified with risk factors are advised to practice preventive strategies such as eating a balanced diet rich in calcium and vitamin D, getting regular weight-bearing exercise, limiting alcohol intake and avoiding cigarette smoking. Regular consultation with a doctor and early diagnosis using non-invasive bone density scans are also recommended. Cost The costs associated with osteoporosis are also significant, although national healthcare organizations have not yet effectively confronted this reality. Osteoporosis costs European national treasuries more than €4.8 billion per year in hospital healthcare costs alone, and studies conducted in Sweden and the U.K. have shown that the total cost for caring for someone with a hip fracture (i.e., primary care, outpatient care, institutional care) is 2.5 times greater than the direct hospital costs. In the U.S., the current estimated price tag for direct medical costs of treating osteoporotic fractures amounts to US$17 billion annually. "Obviously osteoporosis is serious and devastating," notes Professor Pierre D. Delmas, President of IOF. "So why haven't governments done more to stop this silent epidemic? That's the question that millions of voters and taxpayers are increasingly asking. Why don't the policy makers listen to peoples' voices and change government policies on paying for appropriate diagnosis and treatment? Why don't government agencies do more to promote awareness about the disease?"
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