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Osteoporosis and Public Health

Osteoporosis is a disease of the bone characterized by a decrease in bone mass and density which causes the bones to become fragile and prone to fracture. According to the World Health Organization the definition of Osteoporosis is a bone mineral density 2.5 standard deviations below the normal young adult mean. The young adult mean is defined as a healthy 30 years old. Those with bone density at 2.5 standard deviations below the mean are at increased risk for fractures, particularly of the hip, spine and wrist. Osteoporosis has recently been acknowledged as one of the most common and serious problems facing postmenopausal women and aging women and men alike.

Millions are affected by Osteoporosis each year and the numbers are growing. Up until fairly recently the diagnosis of Osteoporosis was reserved only for women at menopause or up to 20 years after who had spinal fractures. It was discovered however that the huge numbers of fractures occurring in older persons of both sexes, as well as individuals with very low bone mass who had not yet experienced fractures were being ignored. Today we know that osteoporosis affects everyone, not just postmenopausal women. Osteoporosis affects both women and men and all ethnic groups of all ages. Because fracture risk is higher in older women than in older men, all postmenopausal women should be evaluated for signs of osteoporosis during routine physical examinations. As it stands right now the lifetime risk of hip, spine and wrist factors is about 40 percent for Caucasian women and about 13 percent for men. With age however, the risk for men and women start to balance out the older they get.

Osteoporosis becomes more and more prevalent as the population ages. Of most concern is the consequence of fractures and the mortality rate associated with such fractures. With the continued aging of populations in developed countries and the overwhelming increase of populations in underdeveloped countries the rate of fractures due to osteoporosis will continue to rise exponentially. In the United States alone the number of people age 65 and older is expected to more than double over the first half of the century, this would mean somewhere around 67 million people.

General contributing factors to the rise of instances of osteoporosis may be diets lacking in calcium and less physical activity in the workplace due to advances in technology and labor saving devices. As with so many other public health problems today, education and prevention are less expensive than treatment. Prevention strategies need to be started early and sustained throughout life to be most effective. By integrating a public health awareness and education program people will be aware of the lifestyle changes that they need to make to lower their risk of getting Osteoporosis. Also by targeting those who are most at risk and having intervention programs as well as offering access to screening programs and continued advances in treatment, the number of people affected by this disease could be seriously halted over the next several years.