The World Health Organization (WHO) defines osteoporosis as the condition of having a bone mineral density ≥2.5 standard deviations below that of a young person's bone mass.[6]Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organization technical report series. Osteoporosis Int. 1994 Nov;4(6):368-81.
http://www.ncbi.nlm.nih.gov/pubmed/7696835?tool=bestpractice.com
In 2010, it was estimated that a total of 54 million US adults aged ≥50 years were affected by osteoporosis and low bone mass.[7]Wright NC, Looker AC, Saag KG, et al. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res. 2014 Nov;29(11):2520-6.
https://onlinelibrary.wiley.com/doi/full/10.1002/jbmr.2269
http://www.ncbi.nlm.nih.gov/pubmed/24771492?tool=bestpractice.com
In the US, between 2017 and 2018, 43.1% of people aged ≥50 years had low bone mass at the femur neck or lumbar spine; 12.6% of people ≥50 years had osteoporosis at the femur neck or lumbar spine.[8]Sarafrazi N, Wambogo EA, Shepherd JA. Osteoporosis or low bone mass in older adults: United States, 2017-2018. NCHS Data Brief. 2021 Mar;(405):1-8.
http://www.ncbi.nlm.nih.gov/pubmed/34029181?tool=bestpractice.com
The prevalence of osteoporosis at either skeletal site was higher among women (51.5%) compared with men (33.5%).[8]Sarafrazi N, Wambogo EA, Shepherd JA. Osteoporosis or low bone mass in older adults: United States, 2017-2018. NCHS Data Brief. 2021 Mar;(405):1-8.
http://www.ncbi.nlm.nih.gov/pubmed/34029181?tool=bestpractice.com
Although osteoporotic fractures affect women more frequently than men, the risk of osteoporotic fracture in men is still significant.[9]American College of Radiology. ACR Appropriateness Criteria: management of vertebral compression fractures. 2022 [internet publication].
https://acsearch.acr.org/docs/70545/Narrative
It is thought that 50% of white women and 20% of white men aged >50 years will sustain an osteoporotic fracture at some point during their lifetime.[10]Cosman F, de Beur SJ, LeBoff MS, et al. Clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014 Oct;25(10):2359-81.
https://link.springer.com/article/10.1007/s00198-014-2794-2
http://www.ncbi.nlm.nih.gov/pubmed/25182228?tool=bestpractice.com
Rates of fracture differ by ethnic/racial population and skeletal site.[11]LeBoff MS, Greenspan SL, Insogna KL, et al. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022 Oct;33(10):2049-102.
https://link.springer.com/article/10.1007/s00198-021-05900-y
http://www.ncbi.nlm.nih.gov/pubmed/35478046?tool=bestpractice.com
For fracture at any site in women, after adjusting for bone mineral density, weight, and other co-variates, non-Hispanic white and Hispanic-American women have the highest risk for fracture, followed by Native Americans, African Americans, and Asian Americans. For hip fracture in men, the age-adjusted incidence is highest for non-Hispanic white men, similar among Hispanic-American and black men, and lowest in Asian men.[11]LeBoff MS, Greenspan SL, Insogna KL, et al. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022 Oct;33(10):2049-102.
https://link.springer.com/article/10.1007/s00198-021-05900-y
http://www.ncbi.nlm.nih.gov/pubmed/35478046?tool=bestpractice.com
[12]Cauley JA, Lui LY, Ensrud KE, et al. Bone mineral density and the risk of incident nonspinal fractures in black and white women. JAMA. 2005 May 4;293(17):2102-8.
https://jamanetwork.com/journals/jama/fullarticle/200820
http://www.ncbi.nlm.nih.gov/pubmed/15870413?tool=bestpractice.com
[13]Liu XS, Walker MD, McMahon DJ, et al. Better skeletal microstructure confers greater mechanical advantages in Chinese-American women versus white women. J Bone Miner Res. 2011 Aug;26(8):1783-92.
https://asbmr.onlinelibrary.wiley.com/doi/10.1002/jbmr.378
http://www.ncbi.nlm.nih.gov/pubmed/21351150?tool=bestpractice.com
Osteoporotic vertebral compression fractures are a leading cause of disability and morbidity in older people.[11]LeBoff MS, Greenspan SL, Insogna KL, et al. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022 Oct;33(10):2049-102.
https://link.springer.com/article/10.1007/s00198-021-05900-y
http://www.ncbi.nlm.nih.gov/pubmed/35478046?tool=bestpractice.com
[14]Johnell O. Advances in osteoporosis: Better identification of risk factors can reduce morbidity and mortality. J Intern Med. 1996;239:299-304.
http://www.ncbi.nlm.nih.gov/pubmed/8774383?tool=bestpractice.com
[15]Iqbal MM, Sobhan T. Osteoporosis: a review. Mo Med. 2002 Jan;99(1):19-24.
http://www.ncbi.nlm.nih.gov/pubmed/11816351?tool=bestpractice.com
The consequences of these fractures include pain, which may be incapacitating, and progressive vertebral collapse with resultant spinal kyphosis. These fractures have been shown to adversely affect quality of life, physical function, mental health, and survival.[16]Gold DT. The clinical impact of vertebral fractures: quality of life in women with osteoporosis. Bone. 1996 Mar;18(3 Suppl):185-9S.
http://www.ncbi.nlm.nih.gov/pubmed/8777086?tool=bestpractice.com
[17]Silverman SL. The clinical consequences of vertebral compression fracture. Bone. 1992;13 Suppl 2:S27-31.
http://www.ncbi.nlm.nih.gov/pubmed/1627411?tool=bestpractice.com
[18]North American Menopause Society. Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause. 2021 Sep 1;28(9):973-97.
https://journals.lww.com/menopausejournal/Fulltext/2021/09000/Management_of_osteoporosis_in_postmenopausal.3.aspx
http://www.ncbi.nlm.nih.gov/pubmed/34448749?tool=bestpractice.com