The breadth of this review does not allow a systematic review of all of the topics covered. Generally, we emphasise recent, rigorous, and population-based studies. We also did a systematic Medline search for studies of the prevalence of vertebral fractures, and included community-based studies that used the same radiographic method for diagnosis of vertebral fractures.
SeriesEpidemiology and outcomes of osteoporotic fractures
Section snippets
Epidemiology of fractures
Fractures of the vertebrae (spine), proximal femur (hip), and distal forearm (wrist) have long been regarded as the quintessential osteoporotic fractures. Osteoporosis is a systemic condition, however, and results of large prospective studies3, 4 have shown that almost all types of fracture are increased in patients with low bone density, and, irrespective of type of fracture, adults who sustain a fracture are 50–100% more likely to have another one of a different type5, 6. In this review, we
Vertebral fractures
Compared with hip fractures, the epidemiology of vertebral fractures is less well established because there is no universally accepted definition and because a substantial proportion of these fractures escape clinical diagnosis. Indeed, the prevalence of vertebral fractures could vary by up to three-fold, dependent on the criteria used to define vertebral fracture.41, 42, 43 Only about a third of all vertebral deformities noted on radiographs come to medical attention, and less than 10%
Other fractures
Most other types of fracture have also been associated with low bone density3, 4 even if they occur as a result of pronounced trauma.47 Each fracture has its own unique pattern of occurrence with age.3 Wrist fractures are the most common breakage in perimenopausal women.
Although incidence rates vary geographically in parallel with those for hip fracture (panel 4),64 the age-related changes in wrist fracture differ considerably from those reported for hip and vertebral fractures: the incidence
Fracture outcomes
The adverse outcomes of osteoporotic fractures fall into three broad categories: mortality, morbidity, and cost.
Conclusions
Osteoporotic fractures are a frequent and important cause of disability and medical costs worldwide. Fortunately, as a later article in this series will review, osteoporotic fractures are preventable. An understanding of the epidemiology of these fractures could help focus efforts on prediction of fractures in those at greatest risk. Wealthy countries with high fracture risk might be able to reduce fractures by aggressive implementation of programmes to assess and treat high risk individuals,
Search strategy
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