Due to the increasing osteoporosis prevalence with age, the worldwide aging of the population and the changing lifestyle habits, the prevalence of osteoporosis has risen significantly and will continue to in the future [1]Reginster, J.Y. and N. Burlet, Osteoporosis: a still increasing prevalence. Bone, 2006. 38(2 Suppl 1): p. S4-9.

. As a result, there will also be an increase in both the prevalence and incidence of related fragility fractures. In 1990 it was projected that by 2050, the worldwide incidence of hip fracture in men would increase by 310% and 240% in women [2]Gullberg, B., O. Johnell, and J.A. Kanis, World-wide projections for hip fracture. Osteoporos Int, 1997. 7(5): p. 407-13.

. In 2010, there were an estimated 158 million individuals at high fracture risk, by 2040 it was estimated that this figure will double because of demographic shifts [3]Oden, A., et al., Burden of high fracture probability worldwide: secular increases 2010-2040. Osteoporos Int, 2015. 26(9): p. 2243-8

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In fact, it is estimated that worldwide, 1 in 3 women and 1 in 5 men, over age 50, will experience osteoporosis fractures in their remaining lifetimes [4]Kanis, J.A., et al., Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int, 2000. 11(8): p. 669-74.

[5]Melton, L.J., 3rd, et al., Bone density and fracture risk in men. J Bone Miner Res, 1998. 13(12): p. 1915-23.

[6]Melton, L.J., 3rd, et al., Perspective. How many women have osteoporosis? J Bone Miner Res, 1992. 7(9): p. 1005-10.

[7]Curtis, E.M., et al., Epidemiology of fractures in the United Kingdom 1988-2012: Variation with age, sex, geography, ethnicity and socioeconomic status. Bone, 2016. 87: p. 19-26.

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For the year 2000, there were an estimated 9 million new osteoporosis fractures, of which 1.6 million were at the hip, 1.7 million were at the forearm and 1.4 million were clinical vertebral fractures. Europe and the Americas accounted for 51% of all these fractures, while most of the remainder occurred in the Western Pacific region and Southeast Asia [8]Johnell, O. and J.A. Kanis, An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int, 2006. 17(12): p. 1726-33.

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In 2006, it was estimated that worldwide, osteoporosis caused more than 8.9 million fractures annually, resulting in an osteoporosis fracture every 3 seconds [8]Johnell, O. and J.A. Kanis, An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int, 2006. 17(12): p. 1726-33.

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Unfortunately, evidence suggests that many women who sustain a fragility fracture are not appropriately diagnosed and treated for probable osteoporosis [9]Freedman, K.B., et al., Treatment of osteoporosis: are physicians missing an opportunity? J Bone Joint Surg Am, 2000. 82-A(8): p. 1063-70.

[10]Siris, E.S., et al., Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA, 2001. 286(22): p. 2815-22

[11]International Osteoporosis Foundation: Broken bones, broken lives: a roadmap to solve the fragility fracture crisis in Europe. 2018;

See link[12]Shah, A., et al., Geographic variation in secondary fracture prevention after a hip fracture during 1999-2013: a UK study. Osteoporos Int, 2017. 28(1): p. 169-178.

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Adapted from Sambrook & Cooper, Lancet, 2006 [13]Sambrook, P. and C. Cooper, Osteoporosis. Lancet, 2006. 367(9527): p. 2010-8.

• For more epidemiological data, see our Fact & Statistics on Epidemiology of osteoporosis and fractures 
• For more regional epidemiological data, see our Facts & Statistics for Europe, North America, Latin America, Middle East & Africa, Asia and Oceania

In 2000, it was estimated that 1.6 million fragility fractures occurred at the hip globally [8]Johnell, O. and J.A. Kanis, An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int, 2006. 17(12): p. 1726-33.

. By 2010, the worldwide incidence of hip fractures was estimated to have risen to 2.7 million patients per year [14]. Nearly 75% of all hip fractures occur in women [15]Jordan, K.M. and C. Cooper, Epidemiology of osteoporosis. Best Pract Res Clin Rheumatol, 2002. 16(5): p. 795-806.

. Men account for 25% of hip fractures occurring in the over 50 population [16]Cooper, C., G. Campion, and L.J. Melton, 3rd, Hip fractures in the elderly: a world-wide projection. Osteoporos Int, 1992. 2(6): p. 285-9.

. The peak number of hip fractures occurred at 75-79 years of age for both sexes; for all other fractures, the peak number occurred at 50-59 years and decreased with age [8]Johnell, O. and J.A. Kanis, An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int, 2006. 17(12): p. 1726-33.

. Over 55% of patients with hip fracture have evidence of a prior vertebral fracture [17]Gonnelli, S., et al., The assessment of vertebral fractures in elderly women with recent hip fractures: the BREAK Study. Osteoporos Int, 2013. 24(4): p. 1151-9.

. It has also been shown that a 10% loss of bone mass in the hip can result in a 2.5 times greater risk of hip fractures [18]Klotzbuecher, C.M., et al., Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res, 2000. 15(4): p. 721-39

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Hip fracture is associated with serious disability and excess mortality. Women who have sustained a hip fracture have a 10-20% higher mortality than would be expected for their age [19]Cummings, S.R. and L.J. Melton, Epidemiology and outcomes of osteoporotic fractures. Lancet, 2002. 359(9319): p. 1761-7.

. After sustaining a hip fracture 10-20% of formerly community dwelling patients require long term nursing care [20]Autier, P., et al., Costs induced by hip fractures: a prospective controlled study in Belgium. Belgian Hip Fracture Study Group. Osteoporos Int, 2000. 11(5): p. 373-80.

[21]Cree, M., et al., Mortality and institutionalization following hip fracture. J Am Geriatr Soc, 2000. 48(3): p. 283-8.

[22]Kiebzak, G.M., et al., Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med, 2002. 162(19): p. 2217-22.

, with the rate of nursing home admission rising with age [21]Cree, M., et al., Mortality and institutionalization following hip fracture. J Am Geriatr Soc, 2000. 48(3): p. 283-8.

[23]Reginster, J.Y., et al., Direct costs of hip fractures in patients over 60 years of age in Belgium. Pharmacoeconomics, 1999. 15(5): p. 507-14.

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Hip fracture rates vary markedly between populations. After age adjustment, hip fracture rates are more common in Scandinavian and North America than these observed in southern European, Asian and Latin American countries [24]Kanis, J.A., et al., A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int, 2012. 23(9): p. 2239-56.

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 Age-standardised annual incidence of hip fractures in women (per 100 000) according to country, colour-coded as high, moderate or low incidence. 

Reproduced from Kanis et al., Osteoporos Int, 2012 [24]Kanis, J.A., et al., A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int, 2012. 23(9): p. 2239-56.

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Vertebral fractures due to osteoporosis are common – with one occurring every 22 seconds worldwide in men and women over age 50 [8]Johnell, O. and J.A. Kanis, An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int, 2006. 17(12): p. 1726-33.

. The incidence of vertebral fractures increases with age in both sexes and is greater in women than men at older ages. Most studies indicate that the prevalence of vertebral facture in men is similar to, or even greater than, that seen in women, up to the ages of 50 or 60 years, but is somewhat greater in women than men thereafter [25]Davies, K.M., et al., Prevalence and severity of vertebral fracture: the Saunders County Bone Quality Study. Osteoporos Int, 1996. 6(2): p. 160-5.

[26]O'Neill, T.W., et al., The prevalence of vertebral deformity in european men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res, 1996. 11(7): p. 1010-8

. It has been shown that a 10% loss of bone mass in the vertebrae can double the risk of vertebral fractures [18]Klotzbuecher, C.M., et al., Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res, 2000. 15(4): p. 721-39

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Vertebral fractures are rarely reported by physicians and remain most of the time remain undiagnosed. It is estimated that only one-third of vertebral fractures come to clinical attention [27]Cooper, C., et al., Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985-1989. J Bone Miner Res, 1992. 7(2): p. 221-7.

and under-diagnosis of vertebral fracture is a worldwide problem. The proportion of vertebral fractures that go unrecognized, during the local assessment of a thoracolumbar lateral radiograph, is as high as 46% in Latin America, 45% in North America, and 29% in Europe/South Africa/Australia [28]Delmas, P.D., et al., Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT study. J Bone Miner Res, 2005. 20(4): p. 557-63.

. Fewer than 10% of vertebral fractures result in hospitalisation, even if they cause pain and substantial loss of quality of life [29]Melton, L.J., 3rd and D.F. Kallmes, Epidemiology of vertebral fractures: implications for vertebral augmentation. Acad Radiol, 2006. 13(5): p. 538-45.

[30]Nevitt, M.C., et al., The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med, 1998. 128(10): p. 793-800.

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In Europe, the prevalence defined by radiological criteria increases with age in both sexes and is almost as high in men as in women: 12% in females (range 6-21%) and 12% in males (range 8-20%) [26]O'Neill, T.W., et al., The prevalence of vertebral deformity in european men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res, 1996. 11(7): p. 1010-8

. This fact could be explained by occupation-associated trauma in men [13]Sambrook, P. and C. Cooper, Osteoporosis. Lancet, 2006. 367(9527): p. 2010-8.

. New fractures are most likely in nearby vertebrae, and they occur more frequently in the mid-thoracic or thoracolumbar regions of the spine [29]Melton, L.J., 3rd and D.F. Kallmes, Epidemiology of vertebral fractures: implications for vertebral augmentation. Acad Radiol, 2006. 13(5): p. 538-45.

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Also in Europe, the age-standardized incidence of morphometric fracture is 10.7 and 5.7 per 1000 person-years in women and men, respectively [31]Felsenberg, D., et al., Incidence of vertebral fracture in europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res, 2002. 17(4): p. 716-24.

. These figures increase markedly with age in both women and men.

Wrist fractures are most likely to occur in women over 65 years old. An increase in age-adjusted incidence in white women between 45 and 60 years of age has been observed. Then the trend stabilises or slightly increases. Only 15% of wrist fractures occur in men and this rate does not increase much with age [32]Owen, R.A., et al., Incidence of Colles' fracture in a North American community. Am J Public Health, 1982. 72(6): p. 605-7.

. In Europe, the annual incidence of distal forearm fractures in male and female were estimated 1.7 and 7.3 per 1000 person-years, respectively [33]Ismail, A.A., et al., Incidence of limb fracture across Europe: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int, 2002. 13(7): p. 565-71.

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It is important to notice that distal forearm fractures are an early and sensitive marker of male skeletal fragility. Aging men carry a higher absolute risk for hip fractures than spinal fractures in comparison to women [34]Haentjens, P., et al., Evidence from data searches and life-table analyses for gender-related differences in absolute risk of hip fracture after Colles' or spine fracture: Colles' fracture as an early and sensitive marker of skeletal fragility in white men. J Bone Miner Res, 2004. 19(12): p. 1933-44.

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It has been shown that an initial fracture is a major risk factor for a new fracture. This risk of a subsequent fracture is particularly elevated in the first two years after an initial fracture [35]Kanis, J.A., et al., Characteristics of recurrent fractures. Osteoporos Int, 2018. 29(8): p. 1747-1757.

[36]Johansson, H., et al., Imminent risk of fracture after fracture. Osteoporos Int, 2017. 28(3): p. 775-780

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An increased risk of 86 % for any fracture has been demonstrated in people that have already sustained a fracture [37]Kanis, J.A., et al., A meta-analysis of previous fracture and subsequent fracture risk. Bone, 2004. 35(2): p. 375-82.

. 5-10% of patients experience a recurrent hip fracture, of these, 23% occurred in the year following their first hip fracture, and 70% within the first five years [38]. Patients with a history of vertebral fracture have a 2.3-fold increased risk of future hip fracture and a 1.4-fold increase in risk of distal forearm fracture [39]Melton, L.J., 3rd, et al., Vertebral fractures predict subsequent fractures. Osteoporos Int, 1999. 10(3): p. 214-21.

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Surprisingly, osteoporosis is much more common than other diseases which usually catch public attention, even though the consequences of certain fractures can lead to death. 
The combined lifetime risk for hip, forearm and vertebral fractures coming to clinical attention is around 40%, equivalent to the risk for cardiovascular disease [40]Kanis, J.A., Diagnosis of osteoporosis and assessment of fracture risk. Lancet, 2002. 359(9321): p. 1929-36.

. A 1 in 9 risk of developing breast cancer has been observed in white women, which is lower than the 1 in 6 lifetime risk of hip fracture in this population [19]Cummings, S.R. and L.J. Melton, Epidemiology and outcomes of osteoporotic fractures. Lancet, 2002. 359(9319): p. 1761-7.

. Additionally, it is estimated that the residual lifetime risk of experiencing an osteoporotic fracture in men over the age of 50 is up to 27%, higher than the lifetime risk of developing prostate cancer of 11.3% [41]Cooley, H. and G. Jones, A population-based study of fracture incidence in southern Tasmania: lifetime fracture risk and evidence for geographic variations within the same country. Osteoporos Int, 2001. 12(2): p. 124-30.

[42]Merrill, R.M., D.L. Weed, and E.J. Feuer, The lifetime risk of developing prostate cancer in white and black men. Cancer Epidemiol Biomarkers Prev, 1997. 6(10): p. 763-8.

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Fragility fractures are the fourth leading cause of chronic disease morbidity in Europe, after ischemic heart disease, dementia and lung cancer, however before chronic obstructive pulmonary disease and ischemic stroke [43]Hernlund, E., et al., Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos, 2013. 8: p. 136.

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In women over 45 years of age, osteoporosis accounts for more days in hospital than may other diseases, including diabetes, myocardial infarction and breast cancer [26]O'Neill, T.W., et al., The prevalence of vertebral deformity in european men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res, 1996. 11(7): p. 1010-8

. In Sweden, osteoporotic fractures in men account for more hospital bed days than those due to prostate cancer [44]Kanis, J.A., et al., Epidemiology of osteoporosis and fracture in men. Calcif Tissue Int, 2004. 75(2): p. 90-9.

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