Worldwide, osteoporosis causes more than 8.9 million fractures annually, resulting in an osteoporosis fracture every 3 seconds [1]
Johnell, O. and J.A. Kanis, An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int, 2006. 17(12): p. 1726-33.
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Using the WHO definition of osteoporosis, the disease affects approximately 6.3% of men over the age of 50 and 21.2% of women over the same age range globally [2]
Kanis, J.A. et al., A reference standard for the description of osteoporosis. Bone 2008. 42: p. 467-75
. Based on the world population of men and women, this suggests that approximately 500 million men and women worldwide may be affected.
Across Europe in 2019 (European Union, plus Switzerland & UK) 32 million individuals aged 50+ are estimated to have osteoporosis, equivalent to 5.6% of the total European population aged +50, or approximately 25.5 million women (22.1% of women aged +50) and 6.5 million men (6.6% of men aged +50). [3]
Kanis JA, et al., SCOPE 2021: a New Scorecard for Osteoporosis in Europe, Arch Osteoporos, 2021, 16(1):82.
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For the year 2000, there were an estimated 9 million new osteoporosis fractures, of which 1.6 million were at the hip, 1.7 million were at the forearm and 1.4 million were clinical vertebral fractures. Europe and the Americas accounted for 51% of all these fractures, while most of the remainder occurred in the Western Pacific region and Southeast Asia [1]
Johnell, O. and J.A. Kanis, An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int, 2006. 17(12): p. 1726-33.
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By 2050, the worldwide incidence of hip fracture in men is projected to increase by 310% and 240% in women, compared to rates in 1990 [4]
Gullberg, B., O. Johnell, and J.A. Kanis, World-wide projections for hip fracture. Osteoporos Int, 1997. 7(5): p. 407-13.
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In 2010 there were estimated to be 158 million individuals at high fracture risk. Demographic shifts mean that this figure is likely to double by 2040 [5]
Oden, A., et al., Burden of high fracture probability worldwide: secular increases 2010-2040. Osteoporos Int, 2015. 26(9): p. 2243-8.
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Worldwide, 1 in 3 women over age 50 will experience osteoporosis fractures, as will 1 in 5 men aged over 50 [6]
Kanis, J.A., et al., Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int, 2000. 11(8): p. 669-74.
[7]
Melton, L.J., 3rd, et al., Bone density and fracture risk in men. J Bone Miner Res, 1998. 13(12): p. 1915-23.
[8]
Melton, L.J., 3rd, et al., Perspective. How many women have osteoporosis? J Bone Miner Res, 1992. 7(9): p. 1005-10
[9]
Curtis, E.M., et al., Epidemiology of fractures in the United Kingdom 1988-2012: Variation with age, sex, geography, ethnicity and socioeconomic status. Bone, 2016. 87: p. 19-26.
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80%, 75%, 70% and 58% of forearm, humerus, hip and spine fractures, respectively, occur in women. Overall, 61% of osteoporosis fractures occur in women, with a female-to-male ratio of 1.6 [1]
Johnell, O. and J.A. Kanis, An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int, 2006. 17(12): p. 1726-33.
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Nearly 75% of hip, spine and distal forearm fractures occur among patients 65 years old or over [10]
Melton, L.J., 3rd, C.S. Crowson, and W.M. O'Fallon, Fracture incidence in Olmsted County, Minnesota: comparison of urban with rural rates and changes in urban rates over time. Osteoporos Int, 1999. 9(1): p. 29-37.
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A 10% loss of bone mass in the vertebrae can double the risk of vertebral fractures, and similarly, a 10% loss of bone mass in the hip can result in a 2.5 times greater risk of hip fracture [11]
Klotzbuecher, C.M., et al., Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res, 2000. 15(4): p. 721-39.
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The combined lifetime risk for hip, forearm and vertebral fractures coming to clinical attention is around 40%, equivalent to the risk for cardiovascular disease [12]
Kanis, J.A., Diagnosis of osteoporosis and assessment of fracture risk. Lancet, 2002. 359(9321): p. 1929-36.
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Osteoporosis takes a huge personal and economic toll. In Europe, the disability due to osteoporosis is greater than that caused by cancers (with the exception of lung cancer) and is comparable or greater than that lost to a variety of chronic noncommunicable diseases, such as rheumatoid arthritis, asthma and high blood pressure related heart disease [1]
Johnell, O. and J.A. Kanis, An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int, 2006. 17(12): p. 1726-33.
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A prior fracture is associated with an 86% increased risk of any fracture [13]
Kanis, J.A., et al., A meta-analysis of previous fracture and subsequent fracture risk. Bone, 2004. 35(2): p. 375-82.
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The risk of a subsequent fracture is particularly elevated in the first two years after an initial fracture [14]
Kanis, J.A., et al., Characteristics of recurrent fractures. Osteoporos Int, 2018. 29(8): p. 1747-1757.
[15]
Johansson, H., et al., Imminent risk of fracture after fracture. Osteoporos Int, 2017. 28(3): p. 775-780.
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Although low BMD confers increased risk for fracture, most fractures occur in postmenopausal women [16]
Siris, E.S., et al., Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med, 2004. 164(10): p. 1108-12.
[17]
Pasco, J.A., et al., The population burden of fractures originates in women with osteopenia, not osteoporosis. Osteoporos Int, 2006. 17(9): p. 1404-9.
[18]
Sornay-Rendu, E., et al., Identification of osteopenic women at high risk of fracture: the OFELY study. J Bone Miner Res, 2005. 20(10): p. 1813-9.
and elderly men without a densitometric diagnosis of osteoporosis [19]
Szulc, P., et al., Bone mineral density predicts osteoporotic fractures in elderly men: the MINOS study. Osteoporos Int, 2005. 16(10): p. 1184-92.
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Fragility fractures are the fourth leading cause of chronic disease morbidity in Europe, after ischemic heart disease, dementia and lung cancer, however before chronic obstructive pulmonary disease and ischemic stroke [20]
Hernlund, E., et al., Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos, 2013. 8: p. 136.
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Evidence suggests that many women who sustain a fragility fracture are not appropriately diagnosed and treated for probable osteoporosis [21]
Freedman, K.B., et al., Treatment of osteoporosis: are physicians missing an opportunity? J Bone Joint Surg Am, 2000. 82-A(8): p. 1063-70.
[22]
Siris, E.S., et al., Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA, 2001. 286(22): p. 2815-22.
[23]
International Osteoporosis Foundation: Broken bones, broken lives: a roadmap to solve the fragility fracture crisis in Europe. 2018;
See link
[24]
Shah, A., et al., Geographic variation in secondary fracture prevention after a hip fracture during 1999-2013: a UK study. Osteoporos Int, 2017. 28(1): p. 169-178
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The great majority of individuals at high risk (possibly 80%), who have already had at least one osteoporosis fracture, are neither identified nor treated [20]
Hernlund, E., et al., Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos, 2013. 8: p. 136.
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An IOF survey, conducted in 11 countries, showed denial of personal risk by postmenopausal women, lack of dialogue about osteoporosis with their doctor, and restricted access to diagnosis and treatment before the first fracture resulting in under-diagnosis and under-treatment of the disease [25]
International Osteoporosis Foundation: How fragile is her future? 2000;
See link
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Between 1990 and 2000, there was nearly a 25% increase in hip fractures worldwide. The peak number of hip fractures occurred at 75-79 years of age for both sexes; for all other fractures, the peak number occurred at 50-59 years and decreased with age [1]
Johnell, O. and J.A. Kanis, An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int, 2006. 17(12): p. 1726-33.
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Nearly 75% of all hip fractures occur in women [26]
Jordan, K.M. and C. Cooper, Epidemiology of osteoporosis. Best Pract Res Clin Rheumatol, 2002. 16(5): p. 795-806.
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Men account for 25% of hip fractures occurring in the over 50 population [27]
Cooper, C., G. Campion, and L.J. Melton, 3rd, Hip fractures in the elderly: a world-wide projection. Osteoporos Int, 1992. 2(6): p. 285-9.
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Hip fractures are invariably associated with chronic pain, reduced mobility, disability, and an increasing degree of dependence [28]
Keene, G.S., M.J. Parker, and G.A. Pryor, Mortality and morbidity after hip fractures. BMJ, 1993. 307(6914): p. 1248-50.
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After sustaining a hip fracture 10-20% of formerly community dwelling patients require long term nursing care [29]
Autier, P., et al., Costs induced by hip fractures: a prospective controlled study in Belgium. Belgian Hip Fracture Study Group. Osteoporos Int, 2000. 11(5): p. 373-80.
[30]
Cree, M., et al., Mortality and institutionalization following hip fracture. J Am Geriatr Soc, 2000. 48(3): p. 283-8.
[31]
Kiebzak, G.M., et al., Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med, 2002. 162(19): p. 2217-22
,with the rate of nursing home admission rising with age [30]
Cree, M., et al., Mortality and institutionalization following hip fracture. J Am Geriatr Soc, 2000. 48(3): p. 283-8.
[32]
Reginster, J.Y., et al., Direct costs of hip fractures in patients over 60 years of age in Belgium. Pharmacoeconomics, 1999. 15(5): p. 507-14.
. According to the ICUROS Europe study, the proportion in long term care at 12 months remains close to 10%, with admissions also significantly increasing with age, going from 2% for 50-60 year-olds to 35% for 90 year-olds and above [23]
International Osteoporosis Foundation: Broken bones, broken lives: a roadmap to solve the fragility fracture crisis in Europe. 2018;
See link
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In white women, the lifetime risk of hip fracture is 1 in 6, compared with a 1 in 9 risk of a breast cancer diagnosis [33]
Cummings, S.R. and L.J. Melton, Epidemiology and outcomes of osteoporotic fractures. Lancet, 2002. 359(9319): p. 1761-7.
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A 50-year-old woman has a 2.8% risk of death related to hip fracture during her remaining lifetime, equivalent to her risk of death from breast cancer and 4 times higher than that from endometrial cancer [34]
Cummings, S.R., D.M. Black, and S.M. Rubin, Lifetime risks of hip, Colles', or vertebral fracture and coronary heart disease among white postmenopausal women. Arch Intern Med, 1989. 149(11): p. 2445-8.
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5-10% of patients experience a recurrent hip fracture, of these, 23% occurred in the year following their first hip fracture, and 70% within the first five years [35]
Melton, L.J., 3rd, et al., Secular trends in hip fracture incidence and recurrence. Osteoporos Int, 2009. 20(5): p. 687-94.
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Hip fractures cause the most morbidity with reported mortality rates up to 20-24% in the first year after a hip fracture [36]
Cooper, C., et al., Population-based study of survival after osteoporotic fractures. Am J Epidemiol, 1993. 137(9): p. 1001-5.
[37]
Leibson, C.L., et al., Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc, 2002. 50(10): p. 1644-50.
, and greater risk of dying may persist for at least 5 years afterwards [38]
Magaziner, J., et al., Excess mortality attributable to hip fracture in white women aged 70 years and older. Am J Public Health, 1997. 87(10): p. 1630-6.
. Loss of function and independence among survivors is profound, with 40% unable to walk independently, 60% requiring assistance a year later [39]
Magaziner, J., et al., Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol, 1990. 45(3): p. M101-7.
. Because of these losses, 33% are totally dependent or in a nursing home in the year following a hip fracture [37]
Leibson, C.L., et al., Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc, 2002. 50(10): p. 1644-50.
[40]
Kannus, P., et al., Epidemiology of osteoporotic ankle fractures in elderly persons in Finland. Ann Intern Med, 1996. 125(12): p. 975-8.
[41]
Riggs, B.L. and L.J. Melton, 3rd, The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone, 1995. 17(5 Suppl): p. 505S-511S.
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Scandinavia has the highest reported incidence of hip fracture worldwide [42]
Kanis, J.A., et al., International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res, 2002. 17(7): p. 1237-44.
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Up to 20% of patients die in the first year following hip fractures, mostly due to pre-existing medical conditions. Less than half those who survive the hip fracture regain their previous level of function [28]
Keene, G.S., M.J. Parker, and G.A. Pryor, Mortality and morbidity after hip fractures. BMJ, 1993. 307(6914): p. 1248-50.
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The overall mortality is about 20% in the first 12 months after hip fracture and is higher in men than women [43]
Center, J.R., et al., Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet, 1999. 353(9156): p. 878-82.
[44]
Seeman, E., The dilemma of osteoporosis in men. Am J Med, 1995. 98(2A): p. 76S-88S.
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It is estimated that, in men, the lifetime risk of fragility fracture is greater than that of prostate cancer [45]
Cooley, H. and G. Jones, A population-based study of fracture incidence in southern Tasmania: lifetime fracture risk and evidence for geographic variations within the same country. Osteoporos Int, 2001. 12(2): p. 124-30.
[46]
T Lloyd et al., Lifetime risk of being diagnosed with, or dying from, prostate cancer by major ethnic group in England 2008–2010. BMC Med. 2015; 13: 171
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Although the overall prevalence of fragility fractures is higher in women, men generally have higher rates of fracture related mortality [43]
Center, J.R., et al., Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet, 1999. 353(9156): p. 878-82.
[47]
Hasserius, R., et al., Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: a 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study. Osteoporos Int, 2003. 14(1): p. 61-8.
. This is true for hip fractures, where a reduction in life expectancy and excess mortality was observed at a higher level in men compared to women, even after considering co-morbidities, medications and changes in background mortality [48]
Frost, S.A., et al., Excess mortality attributable to hip-fracture: a relative survival analysis. Bone, 2013. 56(1): p. 23-9.
[49]
Kannegaard, P.N., et al., Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing, 2010. 39(2): p. 203-9.
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As in women, the mortality rate in men after hip fracture increases with age and is highest in the year after a fracture [50]
Kanis, J.A., et al., The components of excess mortality after hip fracture. Bone, 2003. 32(5): p. 468-73.
[51]
Trombetti, A., et al., Survival and potential years of life lost after hip fracture in men and age-matched women. Osteoporos Int, 2002. 13(9): p. 731-7
. Over the first 6 months, the mortality rate in men approximately doubled that in similarly aged women [50]
Kanis, J.A., et al., The components of excess mortality after hip fracture. Bone, 2003. 32(5): p. 468-73.
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Forearm fracture is an early and sensitive marker of male skeletal fragility. In aging men, wrist fractures carry a higher absolute risk for hip fracture than spinal fractures in comparison to women [52]
Haentjens, P., et al., Evidence from data searches and life-table analyses for gender-related differences in absolute risk of hip fracture after Colles' or spine fracture: Colles' fracture as an early and sensitive marker of skeletal fragility in white men. J Bone Miner Res, 2004. 19(12): p. 1933-44.
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Vertebral fractures due to osteoporosis are common – with one occurring every 22 seconds worldwide in men and women over age 50 [1]
Johnell, O. and J.A. Kanis, An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int, 2006. 17(12): p. 1726-33.
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Vertebral fractures are associated with an 8-fold increase in age-adjusted mortality [53]
Cauley, J.A., et al., Risk of mortality following clinical fractures. Osteoporos Int, 2000. 11(7): p. 556-61.
[54]
Jalava, T., et al., Association between vertebral fracture and increased mortality in osteoporotic patients. J Bone Miner Res, 2003. 18(7): p. 1254-60.
[55]
Kado, D.M., et al., Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med, 1999. 159(11): p. 1215-20.
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A 50-year-old white woman has a 16% lifetime risk of experiencing a vertebral fracture whereas a 50 year old white man’s lifetime risk is 5% [8]
Melton, L.J., 3rd, et al., Perspective. How many women have osteoporosis? J Bone Miner Res, 1992. 7(9): p. 1005-10
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A woman 65 years of age with one vertebral fracture has a one in four chance of another fracture over 5 years, which can be reduced to one in eight by treatment [56]
Kaptoge, S., et al., When should the doctor order a spine X-ray? Identifying vertebral fractures for osteoporosis care: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res, 2004. 19(12): p. 1982-93.
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Vertebral fractures can lead to back pain, loss of height, deformity, immobility, increased number of bed days, and even reduced pulmonary function [57]
Lips, P., et al., Quality of life in patients with vertebral fractures: validation of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Working Party for Quality of Life of the European Foundation for Osteoporosis. Osteoporos Int, 1999. 10(2): p. 150-60.
[58]
Nevitt, M.C., et al., The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med, 1998. 128(10): p. 793-800
[59]
Pluijm, S.M., et al., Effects of gender and age on the association of apolipoprotein E epsilon4 with bone mineral density, bone turnover and the risk of fractures in older people. Osteoporos Int, 2002. 13(9): p. 701-9.
. Their impact on quality of life can be profound as a result of loss of self-esteem, distorted body image and depression [60]
Gold, D.T., The nonskeletal consequences of osteoporotic fractures. Psychologic and social outcomes. Rheum Dis Clin North Am, 2001. 27(1): p. 255-62.
[61]
Lyles, K.W., Osteoporosis and depression: shedding more light upon a complex relationship. J Am Geriatr Soc, 2001. 49(6): p. 827-8.
[62]
Robbins, J., et al., The association of bone mineral density and depression in an older population. J Am Geriatr Soc, 2001. 49(6): p. 732-6.
[63]
Tosteson, A.N., et al., Impact of hip and vertebral fractures on quality-adjusted life years. Osteoporos Int, 2001. 12(12): p. 1042-9.
. Vertebral fractures also significantly impact on activities of daily living [64]
Adachi, J.D., et al., The impact of incident vertebral and non-vertebral fractures on health related quality of life in postmenopausal women. BMC Musculoskelet Disord, 2002. 3: p. 11.
[65]
Hall, S.E., et al., A case-control study of quality of life and functional impairment in women with long-standing vertebral osteoporotic fracture. Osteoporos Int, 1999. 9(6): p. 508-15.
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After hospitalization for a vertebral fracture, there is a greatly increased risk of requiring hospitalization for a further fracture in the years following initial hospitalization [66]
Johnell, O., et al., Acute and long-term increase in fracture risk after hospitalization for vertebral fracture. Osteoporos Int, 2001. 12(3): p. 207-14
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Vertebral fractures are associated with an increased risk of both further vertebral and nonvertebral fractures [11]
Klotzbuecher, C.M., et al., Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res, 2000. 15(4): p. 721-39.
[47]
Hasserius, R., et al., Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: a 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study. Osteoporos Int, 2003. 14(1): p. 61-8.
[67]
Black, D.M., et al., Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res, 1999. 14(5): p. 821-8.
[68]
Lindsay, R., et al., Risk of new vertebral fracture in the year following a fracture. JAMA, 2001. 285(3): p. 320-3.
[69]
Ross, P.D., et al., Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med, 1991. 114(11): p. 919-23.
[70]
Roux, C., et al., Mild prevalent and incident vertebral fractures are risk factors for new fractures. Osteoporos Int, 2007. 18(12): p. 1617-24.
. Women who develop a vertebral fracture are at substantial risk for additional fracture within the next 1-2 years [68]
Lindsay, R., et al., Risk of new vertebral fracture in the year following a fracture. JAMA, 2001. 285(3): p. 320-3.
[70]
Roux, C., et al., Mild prevalent and incident vertebral fractures are risk factors for new fractures. Osteoporos Int, 2007. 18(12): p. 1617-24.
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It is estimated that only one-third of vertebral fractures come to clinical attention [71]
Cooper, C., et al., Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985-1989. J Bone Miner Res, 1992. 7(2): p. 221-7.
and under-diagnosis of vertebral fracture is a worldwide problem. The proportion of vertebral fractures that go unrecognized, during the local assessment of a thoracolumbar lateral radiograph, is as high as 46% in Latin America, 45% in North America, and 29% in Europe/South Africa/Australia [72]
Delmas, P.D., et al., Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT study. J Bone Miner Res, 2005. 20(4): p. 557-63
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The incidence of vertebral fractures increases with age in both sexes. Most studies indicate that the prevalence of vertebral fracture in men is similar to, or even greater than, that seen in women to age 50 or 60 years [73]
Davies, K.M., et al., Prevalence and severity of vertebral fracture: the Saunders County Bone Quality Study. Osteoporos Int, 1996. 6(2): p. 160-5.
[74]
O'Neill, T.W., et al., The prevalence of vertebral deformity in european men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res, 1996. 11(7): p. 1010-8.
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Over 55% of patients with hip fracture have evidence of a prior vertebral fracture [75]
Gonnelli, S., et al., The assessment of vertebral fractures in elderly women with recent hip fractures: the BREAK Study. Osteoporos Int, 2013. 24(4): p. 1151-9.
