Osteoporosis: screening, evaluation, and monitoring.

Michael W. Schaefer, MD, and Geetha Gopalakrishnan, MD  osteoporosis is the most common skeletal disorder. It is characterized by a decrease in bone mineral density resulting in fractures. According to the National Osteoporosis Foundation (NOF), 10 million Americans are affected by osteoporosis and an additional 34 million are at risk for osteoporosis. Although osteoporosis is more common among women, men account for approximately 20% of all cases. It is estimated that 50% of women and 25% of men over the age of 50 years will have an osteoporosis related fracture in their lifetime. Osteoporotic fractures typically involve the spine, hip and forearm and result from minimal or no trauma. The morbidity, mortality, and cost associated with these fractures are significant. Mortality rates as high as 25% are reported one year after a hip fracture. If patients survive, 25% will require longterm nursing home care and only 40% will achieve their pre-fracture level of independence. The estimated cost of these fractures to our health care system is more than $17 billion per year and this cost is anticipated to triple by 2040. Therefore, prevention of osteoporosis, particularly fractures, is a public health priority.1