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  1. Kenneth E S Poole, specialist registrar in rheumatology,
  2. Juliet E Compston, professor of bone medicine
  1. 1Addenbrooke's Hospital, Cambridge CB2 2QQ
  1. Correspondence to: J E Compston jec1001{at}cam.ac.uk
  • Accepted 19 November 2006

Fractures caused by osteoporosis affect one in two women and one in five men over the age of 50, resulting in an estimated annual cost to the health services of around £1.8bn (€2.7bn; $3.5bn) in the United Kingdom and €30bn in all of Europe.1 2 Most patients with osteoporosis are managed in primary care, but a minority will benefit from referral to specialised centres. In recent years considerable advances have been made both in the identification of people at high risk of fracture and in therapeutic options to reduce the risk of fracture. This review focuses on these areas and also on the partnership that is required between primary and secondary care to optimise the management of patients with osteoporosis.

What is osteoporosis?

Osteoporosis results from reduced bone mass and disruption of the micro-architecture of bone (fig 1)⇓, giving decreased bone strength and increased risk of fracture, particularly of the spine, hip, wrist, humerus, and pelvis. The risk of fractures increases steeply with age (fig 2)⇓ and most of those affected are over 75.1 2 Globally, osteoporotic fractures caused an estimated 5.8 million disability adjusted life years in the year 2000w1 and are also associated with increased mortality. Hip fractures (fig 3)⇓ result in loss of independence for at least a third of people with osteoporosis, and vertebral fractures (fig 4)⇓ cause height loss, chronic pain, and difficulty with normal daily activities.

Fig 1 Scanning electron micrographs to show the structure of L3 vertebra in a 31 year old woman (top) and in a 70 year old woman (bottom). Note that many of the plate-like structures have become converted to thin rods

Fig 2 Epidemiology of osteoporotic fractures in men and women. Reprinted with permission28

Fig 3 Fracture of the femoral neck

Fig 4 …

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