The osteoporosis revolution marches on

In 1997, when I reported on the progress of the “osteoporosis revolution,” fi ve topics were emphasized: genetics, local factors, bone mass measurements, biochemical markers, and prevention and therapy. During the past 10 years there has been substantial progress in all of these areas, but the revolution is by no means over. This review summarizes our current concepts of epidemiology, pathogenesis, diagnosis, prevention, and treatment with an emphasis on the advances that have been made during the past decade. The osteoporosis revolution is a relatively recent problem in human history, due largely to the great increase in life expectancy and the effects of “civilization,” that is, the movement of humans from outdoors to indoors and from heavy physical activity to sedentary occupations. Although originally the diagnosis of osteoporosis was made after patients had had a fragility fracture, we now can make a diagnosis of osteoporosis before fractures occur when there is a marked reduction of bone mineral density (BMD) or of osteopenia, when there is a moderate reduction in BMD. This has made it possible to start preventive measures and early therapy in high-risk patients before there is any fracture. Nevertheless, most patients are not diagnosed until after their fi rst fragility fracture; and, unfortunately, many are not diagnosed or treated even after that fracture. Although the highest incidence is among postmenopausal women, substantial numbers of older men are affected; and a few younger individuals, particularly those with important secondary causes for bone loss, are also at risk for fragility fractures. Epidemiology