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A systematic search of the medical literature was conducted between March 7, 2007, and March 20, 2007. A search update was conducted between February 13, 2008, and March 11, 2008. The search, limited to human subjects and English language journals, included the National Guideline Clearinghouse, PubMed, and the Cochrane database. The National Osteoporosis Foundation can be found at and the Clinician’s Guide to Prevention and Treatment of Osteoporosis can be found at


Osteoporosis is the most common human bone disease that is often recognized only after a patient experiences a fracture. Characterized by low bone mass and increased bone porosity, osteoporosis leads to reduced bone strength and an increased risk of bone fracture. Although the disease can affect any bone, most typical fracture sites include the hip, spine, wrist, and ribs. Osteoporosis is prevalent in the United States and considered a major public health threat, particularly as our population ages. U.S. Census data estimated that in 2002, more than 10 million women and men aged 50 and older had osteoporosis, and this number is projected to rise by 30% in 2020.1 Approximately 44 million Americans have osteoporosis and osteopenia (low bone mass) and by 2020, more than 61 million are expected to be affected by these disorders. Osteoporosis most commonly occurs in Caucasian and Asian postmenopausal women, and 50% will experience an osteoporosis-related fracture during their lifetime. Table 33-1 describes other risk factors for developing osteoporosis and fractures. Osteoporotic fractures result in significant financial and individual costs. The United States spends approximately $18 billion annually treating fractures secondary to osteoporosis.2 Adults who incur one fracture are 50% to 100% likely to sustain another. Moreover, the one year posthip fracture mortality rate for patients 50 years and older is approximately 24%.

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Table 33-1. Risk Factors for Developing Osteoporosis and Fractures

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