According to the World Health Organisation (WHO), osteoporosis is second only to cardiovascular disease as a leading health care problem. World-wide about one in three women and one in eight men over the age of 50 risk having an osteoporotic fracture during their lifetimes. Moreover, the number of hip fractures is expected to increase from 1.7 million in 1990 to 6.3 million in 2050 because of the increasingly ageing world population.

Annual direct medical costs to treat an estimated 2.3 million osteoporosis fractures in Europe and the United States together amount to US$27 billion.

What is osteoporosis?
Osteoporosis is a disease affecting the bones which is characterised by a decrease in bone mass and density that increases the risk of broken bones, particularly in the spine, wrist, hip, pelvis and upper arm. The disease occurs in women after the menopause.

Unfortunately most people don't know they have osteoporosis until they break a bone. As such, a new WHO study has stated that early detection of low bone density could significantly reduce the impact of osteoporosis.

Osteoporosis can be diagnosed relatively easily by:

• medical history

• basic investigations, including x-rays

• bone mass density
  – QCT (quantitative computed tomography)
  – QUS (quantitative ultrasound scanning)

• DXA (DEXA) dual energy x-ray absorptiometry

• biochemical markers of bone turnover (serum + urine)
  – bone formation
  – bone breakdown

Management of osteoporosis
Strategies for the management of osteoporosis include:

• A diet which maintains normal body weight throughout life and provides a calcium intake of some 1000 mg per day from late childhood onwards

• Encouragement of a physically active lifestyle

• Avoiding smoking and heavy drinking

• Minimisation of cortisone use and potential administration of osteoporosis prophylaxis medication when cortisone is given

• Calcium and vitamin D supplementation

• Drug therapy includes hormone replacement therapy in postmenopausal women, bisphosphonates, and active vitamin D.