A Joint Position Statement of the American Academy of Orthopaedic Surgeons and the National Osteoporosis Foundation
Osteoporosis is a widespread disease characterized by decreased bone mass and poor bone quality, which leads to increased numbers of fractures typically of the hip, spine and wrist. Osteoporosis is a global public health problem currently affecting more than 200 million people worldwide.1
In the United States alone, osteoporosis affects more than 25 million people,80 percent of whom are women.2 Although the incidence of osteoporotic fractures among African American and Hispanic women is one-half that of Caucasian and Asian women, their risk is still significant. Each year, 1.5 million fractures are attributed to osteoporosis, including 250,000 to 300,000 hip fractures.3, 4 The acute and long-term medical care expenses associated with these fractures costs the nation an estimated $10 billion - $18 billion.4 Due to the dramatic growth of the elderly population and the rise in the incidence of fractures at earlier ages, osteoporosis has become a major public health problem of epidemic proportions.
Osteoporosis can be classified into two broad categories: primary and secondary osteoporosis.5
Primary osteoporosis is, by far, the most common form of the disease and includes:
Secondary osteoporosis is a disease in which an identifiable agent or disease process causes loss of bone tissue and includes:
Osteoporosis reflects the inadequate accumulation of bone during growth and maturation, excessive losses thereafter, or both. Although knowledge of the causes of osteoporosis is incomplete, genetic, endocrine and life style factors are contributory.4 Since today's effective and safe treatments primarily preserve existing bone tissue, prevention, involving maximizing maturational gains in bone density and minimizing post-maturity losses, emerges as the crucial current disease prevention strategy.4
The American Academy of Orthopaedic Surgeons and the National Osteoporosis Foundation believe that increased federal funding for research and education programs are essential to reduce the growth rate of osteoporotic fractures.
Based upon current scientific knowledge about osteoporosis, it is further believed such education programs should include information about:
The care for patients with established osteoporosis should consider: early diagnosis of potentially treatable secondary types of osteoporosis, protection against further bone loss by utilizing medications such as estrogen and calcitonin, exercise and activity programs, and injury prevention strategies.
While there is much to be learned about the causes of osteoporosis, there is sufficient current knowledge to undertake therapeutic action today. Estrogen is the drug of choice for the prevention and treatment of osteoporosis in postmenopausal women. New antiresorptive drugs, such as intranasal calcitonin and biphosphonates, if efficacious, may provide a wider range of therapeutic choices within the next several years. Effective regimens that stimulate bone formation will require increased federal research support if they are to be available by the end of the decade.
To minimize future predicted costs, morbidity, and mortality from increasing numbers of osteoporotic fractures in our rapidly aging population, the American Academy of Orthopaedic Surgeons and the National Osteoporosis Foundation recommend that osteoporosis should become a national public health priority.
National Osteoporosis Foundation
© February 1993 American Academy of Orthopaedic Surgeons
This material may not be modified without the express written permission of the American Academy of Orthopaedic Surgeons.
Document Number: 1113
For additional information, contact Alvin Nagelberg at (847) 384-4138 or email nagelberg@mac.aaos.org