Cover Story

Managing bone loss

By Lois E. Wehren, MD, and Ethel S. Siris, MD

Drug therapy isn't recommended for all women with osteopenia, a precursor to osteoporosis. Clinicians need to identify, early on, the patients with low bone mass at additional risk for future osteoporotic fractures.

Nearly 30 million women have either osteoporosis or low bone mass and the numbers are rising. Preventing osteoporosis is more than an issue of deteriorating quality of life. For an ever-growing number of baby boomers, it may even be a matter of life and death, considering that there's a 20% increase in mortality in the year following hip fracture. And fracture risk is part and parcel of the very definition of this major public health problem: "a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture."¹

A chronic disease, osteoporosis is silent for years or decades before a fracture occurs. Although most common among postmenopausal Caucasian women, it affects women of other races—and men, too. An estimated 43.6 million men and women aged 50 and older currently have osteoporosis or low bone mass, according to the National Osteoporosis Foundation (NOF).² Women make up 29.6 million of this total; 7.8 million have osteoporosis and 21.8 million have low bone mass.

Approximately 1.5 million fragility fractures occur each year, including 700,000 vertebral fractures, 300,000 hip fractures, and 200,000 fractures of the distal forearm.³ Because of increasing life expectancy and rising age-specific fracture rates, the prevalence of both osteoporosis and fracture is expected to soar over the next several decades. For example, by 2020 the prevalence of osteoporosis and low bone mass in the United States will rise by 41%, to 61.4 million, according to NOF estimates.² The incidence of hip fracture worldwide is expected to double in women and triple in men by 2035.⁴