Elsevier

The Lancet

Volume 359, Issue 9319, 18 May 2002, Pages 1761-1767
The Lancet

Series
Epidemiology and outcomes of osteoporotic fractures

https://doi.org/10.1016/S0140-6736(02)08657-9Get rights and content

Summary

Bone mass declines and the risk of fractures increases as people age, especially as women pass through the menopause. Hip fractures, the most serious outcome of osteoporosis, are becoming more frequent than before because the world's population is ageing and because the frequency of hip fractures is increasing by 1–3% per year in most areas of the world. Rates of hip fracture vary more widely from region to region than does the prevalance of vertebral fractures. Low bone density and previous fractures are risk factors for almost all types of fracture, but each type of fracture also has its own unique risk factors. Prevention of fractures with drugs could potentially be as expensive as medical treatment of fractures. Therefore, epidemiological research should be done and used to identify individuals at high-risk of disabling fractures, thereby allowing careful allocation of expensive treatments to individuals most in need.

Section snippets

Epidemiology of fractures

Fractures of the vertebrae (spine), proximal femur (hip), and distal forearm (wrist) have long been regarded as the quintessential osteoporotic fractures. Osteoporosis is a systemic condition, however, and results of large prospective studies3, 4 have shown that almost all types of fracture are increased in patients with low bone density, and, irrespective of type of fracture, adults who sustain a fracture are 50–100% more likely to have another one of a different type5, 6. In this review, we

Vertebral fractures

Compared with hip fractures, the epidemiology of vertebral fractures is less well established because there is no universally accepted definition and because a substantial proportion of these fractures escape clinical diagnosis. Indeed, the prevalence of vertebral fractures could vary by up to three-fold, dependent on the criteria used to define vertebral fracture.41, 42, 43 Only about a third of all vertebral deformities noted on radiographs come to medical attention, and less than 10%

Other fractures

Most other types of fracture have also been associated with low bone density3, 4 even if they occur as a result of pronounced trauma.47 Each fracture has its own unique pattern of occurrence with age.3 Wrist fractures are the most common breakage in perimenopausal women.

Although incidence rates vary geographically in parallel with those for hip fracture (panel 4),64 the age-related changes in wrist fracture differ considerably from those reported for hip and vertebral fractures: the incidence

Fracture outcomes

The adverse outcomes of osteoporotic fractures fall into three broad categories: mortality, morbidity, and cost.

Conclusions

Osteoporotic fractures are a frequent and important cause of disability and medical costs worldwide. Fortunately, as a later article in this series will review, osteoporotic fractures are preventable. An understanding of the epidemiology of these fractures could help focus efforts on prediction of fractures in those at greatest risk. Wealthy countries with high fracture risk might be able to reduce fractures by aggressive implementation of programmes to assess and treat high risk individuals,

Search strategy

The breadth of this review does not allow a systematic review of all of the topics covered. Generally, we emphasise recent, rigorous, and population-based studies. We also did a systematic Medline search for studies of the prevalence of vertebral fractures, and included community-based studies that used the same radiographic method for diagnosis of vertebral fractures.

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