PREVALENCE

Osteoporosis is a significant public health problem, affecting more than 44 million Americans.⁵ This is not unlike the incidence of hypertension, hyperlipidemeia, or impaired glucose tolerance. Although osteoporosis can be found in persons of all nationalities and ethnicities, it is most commonly encountered in Scandinavia, New Zealand, and the United States, intermediate in England and Southern European and Asian countries, and least often in South Africa.

The prevalence of osteoporosis increases with age.⁴ In the U.S. today, 10 million individuals have the disease and 34 million more have low bone mass, an increased risk for osteoporosis.⁵ Eighty percent of those with osteoporosis in the United States are women.⁵ By age 60 to 70years, only 1 of 9 women in the United States has "normal" bone mineral density, and about 1 of 3 women has osteoporosis. After age 80, approximately 70 percent of women have osteoporosis. Of those women currently with osteoporosis, approximately 50 percent have already suffered a fracture.⁴

PREVALENCE OF OSTEOPOROSIS IN ELDERLY FEMALES

Osteoporosis is considered a woman's disease, but the prevalence in men also increases exponentially with age. Approximately, 25 to 30% of hip fractures occur in men.⁶ By the age of 90, about 17% of males have had a hip fracture, compared to 32% of females.⁷ Men have a shorter life span than women, so they account for only 21% of all hip fractures.^6,7 Vertebral fracture prevalence in men is close to that in women. A European study showed a higher incidence in the younger men, raising the possibility that some of the fractures were not related to osteoporosis, but to trauma sustained durin g their working life.⁶

Important racial differences in both bone mass and prevalence of fractures are seen. African Americans have higher bone mass and lower rates of fractures. Asian women have lower bone mass than Caucasian women, but the rate of hip fractures is not proportionally higher.⁸ Theories to explain this discrepancy include shorter hip-axis length in the Asian women, previous activity levels that were higher, or the cultural practice of taking care of the elderly and not allowing them to leave their beds, reducing the opportunity for falling. Hispanic women have approximately half as many fractures as Caucasian women, but this is not explained by any difference in bone density.⁸ In Europe, the prevalence of vertebral deformities showed substantial geographical variation (6 to 20%).^7,8The highest rates were in Scandinavian countries.

Nursing home residents in the US have a higher prevalence of low Bone Mineral Density (BMD).⁹,¹⁰,¹¹ The prevalence of osteoporosis for white female residents increased from 64% for women aged 65-74 years to 85.8% for women aged 85 years of age.⁹ Both in the nursing homes and in the community, a high prevalence of low femoral neck BMD was reported among the elderly in Europe. In a small series of very old nursing home residents, all had osteoporosis (T-score below —2.5) and 68% had a fracture.¹¹

Since increasing age is a significant risk factor for osteoporosis and the world's population is growing older, the number of individuals affected with osteoporosis can be expected to increase.²

return to top of page