Osteoporosis: Pathophysiology and Clinical Aspects

Abstract

Osteoporosis has become a major health issue over the last years due to the steadily increasing life expectancy. Beyond the age of 50 years more than 50 percent of women and 13 percent of men will sustain an osteoporosis-related fracture (1). In line with the demographic development, fractures of the humerus, wrist, or hip will occur noticeably more often during the next four decades (2). The number of patients with hip fractures will increase to 170 % of present-day numbers, and in the age group over 80 years to 250 % (2). In the United States over 10 million have been diagnosed with osteoporosis (1) causing direct medical costs of 17 billion dollars (3, 4). In Germany 7.8 million (6.5 million women) were affected by osteoporosis in 2003 (5). At least one clinical fracture was present in 4.3 % of these patients leading to direct costs of 5.4 billion Euro, although only 21.7 % of the patients were treated with anti-osteoporotic drugs as shown in a recent study from Germany (5). Considering only osteoporosis-attributable hip fractures, 108,341 occurred in Germany in 2002 resulting in costs of almost 3 billion Euro, which will more than double according to estimations in 2050 (6). These already tremendous costs of health care linked to osteoporosis are further alarming, as a care gap with under-diagnosis and under-treatment of the entity has been stressed in several studies (7–13). Improvements in diagnostic strategies, the diagnostic work up in the context of interdisciplinary settings, are warranted in order to optimize the management and care of patients with osteoporosis. The basis of such an aim has to be set up with a better and broader understanding of the pathophysiology, clinical presentation, interactions with other disorders, and the currently available therapeutic possibilities.