Abstract

     Osteoporosis is a disease characterized by impaired bone microarchitecture and reduced bone mineral density (BMD) resulting in bone fragility and increased risk of fracture. In western societies, one in three women and one in five men will sustain an osteoporotic fracture in their remaining lifetime from the age of 50 years. Fragility fractures, especially of the spine and hip, commonly give rise to increased morbidity and mortality. In the five largest European countries and Sweden, fragility fractures were the cause of 2.6 million disability-adjusted life years in 2016 and the fracture-related costs increased from €۲۹٫۶ billion in 2010 to €۳۷٫۵ billion in 2017. In the European Union and the USA, only a small proportion of women eligible for pharmacological treatment are being prescribed osteoporosis medication. Secondary fracture prevention, using Fracture Liaison Services, can be used to increase the rates of fracture risk assessment, BMD testing and use of osteoporosis medication in order to reduce fracture numbers. Additionally, established primary prevention strategies, based on case-finding methods utilizing fracture prediction tools, such as FRAX, to identify women without fracture but with elevated risk, are recommended in order to further reduce fracture numbers.

Postmenopausal osteoporosis

     Osteoporosis is a disease characterized by impaired bone microarchitecture and reduced bone mineral density (BMD) resulting in bone fragility and increased risk of fracture [1,2]. BMD measured using dual-energy X-ray absorptiometry to a large extent reflects bone strength [3], and for each standard deviation (SD) decrease in femoral neck BMD, the fracture risk is increased two-fold to three-fold [4] in postmenopausal women. In 1994, the World Health Organization (WHO) defined osteoporosis using a BMD threshold of −۲٫۵ SDs or lower than the mean value for young adult women, referred to as a T-score of −۲٫۵ SD or less. A measurement of BMD at the femoral neck, and derivation of the T-score using the National Health and Nutrition Examination Survey (NHANES) III reference database with women aged 20–۲۹ years, has been proposed as the reference standard for describing osteoporosis. However, other sites such as the total hip, lumbar spine and radius are frequently used in clinical practice [5,6]. Aging leads to bone loss, and, particularly, the first few years after menopause represent a period of accelerated bone loss [7]. Thus, the prevalence of osteoporosis increases with age [2].

Concluding remarks

     Bone fragility and the resulting fractures are very common in postmenopausal women and projections indicate that, due to the aging population, an increase in the number of osteoporotic fractures, accompanied by substantially increased DALYs and financial costs, is to be expected globally. Secondary fracture prevention, orchestrated via implementation of FLS, so that a growing proportion of women at risk are evaluated and treated with osteoporosis medications is a crucial step in reducing fracture numbers. In addition, established primary prevention strategies, based on case-finding methods utilizing fracture prediction tools, such as FRAX, to identify women without fracture but with elevated risk, could be increasingly used in order to further reduce fracture numbers.