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The Osteoporosis Paradox: The Neglected Disease

A symposium in conjunction with the 2nd International Meeting on Social and Economic Aspects of Osteoporosis and Bone Disease, Liège, Belgium, 7 December 2000

J.Y. Reginster, MD, PhD, Professor of Epidemiology and Public Health; Director, WHO Collaborating Center, University of Liège, Liège, Belgium

We live in a world of paradoxes, and many of them, for the moment at least, remain unresolved. The paradox we address today is doubly frustrating because we do have the means to resolve it successfully.

Osteoporosis, by virtually any definition, is a devastating and costly disease for the millions of people who suffer from it, and in terms of the tremendous financial burden it imposes upon national healthcare systems in many countries. This is not a rare disease. Osteoporosis is highly prevalent – afflicting an estimated one-third of women aged 60 to 70, and two-thirds of women aged 80 or older.

The major physical consequence of osteoporosis is fracture of the hip, spine and wrist caused by thinning and weakening of the bones following the menopause. While this may be considered a "natural" progression in elderly women and in many men, we now have conclusive evidence that the progression can be halted and, indeed, reversed with pharmaceutical therapies available today.

The most important and well known risk factors for osteoporosis include advancing age, female gender and the menopause, and we know that the existence of an osteoporotic fracture substantially increases the risk of a subsequent fracture. This is a disabling and potentially dangerous spiral. The lifetime risk of fracture for a white woman is about 16% for the hip and more than 30% for the spine. Hip fracture is the most serious type of osteoporotic fracture, and women who suffer a hip fracture are 2 to 5 times more likely to die from consequences of the fracture than women without hip fracture. Not only do hip fractures result in increased risk of mortality, but for those who do survive, there is often a loss of physical and social function as well.

The economic costs of this disease are very high and will continue to rise as the population ages. The rate of hip fractures alone is projected to increase nearly 50% in Europe over the next several decades. In a paper published in The Lancet this year, we demonstrated that if we do not initiate preventive treatment, and if the rate of increased hip fractures is not reduced, we will have a seven-fold increase in hip fractures in Belgium by the year 2050.

And yet, despite the seriousness of osteoporosis, the ability to diagnosis it and the availability of effective therapies, paradoxically we are not doing all we can to combat this global public health problem. The reasons for this are many and varied, but primarily it stems from misconceptions about the aging process, as well as the nature of disease itself. Many of the elderly believe that osteoporosis is a normal process of aging, and that there is little they can do about it.

Compounding this misconception on the part of women, as well as government health authorities, is that osteoporosis does not appear to be an "urgent" disease, such as cancer or heart disease or even arthritis. Osteoporosis may take years to develop, and the symptoms are less apparent. National healthcare budgets are generally influenced by short-term considerations.

It is time for all concerned to focus our efforts and our resources on this most neglected disease. We have the means to detect and treat osteoporosis, to solve this paradox. If we do not do so, the physical, social and financial consequences of neglect will only increase as the world ages.

Also see slide presentation from the introduction and conclusion (PDF files, 84 and 70 KB)

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