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Hube, O. Johnell, L. Lidgren, K. Miles, L. Panarella, H. Simpson, W. A. Wallace From the Bone and Joint Decade and the International Osteoporosis Foundation K. E. Dreinhöfer, MD, Deputy Head Department of Orthopaedics, Rehabilitationskrankenhaus, Ulm University, Oberer Eselsberg 45, 89081 Ulm, Germany. J.-M. Féron, MD, Professor, Chef de Service Service de Chirurgie Orthopedique et Traumatologique, Hopital Tenon, 4 rue de la Chine, 75970 Paris, France. A. Herrera, MD, PhD, Professor, Chief Service of Orthopaedic Surgery and Trauma, University Hospital “Miguel Servet”, P° Isabel la Católica 1-3, 5009 Zaragoza, Spain. R. Hube, MD, PhD, Professor Department of Orthopaedic Surgery, Martin-Luther-University, Magdeberge Strasse 22, 06122 Halle, Germany. O. Johnell, MD, PhD, Professor Department of Orthopaedics, Malmö General Hospital, 20520 Malmö, Sweden. L. Lidgren, MD, PhD, Professor, Head of the Department Department of Orthopaedics, Lund University, 22185 Lund, Sweden. K. Miles, BSc, Chief Executive New Zealand Orthopaedic Association, 43 Kent Terrace, Wellington, New Zealand. L. Panarella, MD Department of Orthopaedic Surgery, University of Rome, “Tor Vergata”, 130, Via Chiala, 00139 Rome, Italy. H. Simpson, FRCS, Professor of Orthopaedics and Trauma University of Edinburgh, The Royal Infirmary of Edinburgh at Little France, Old Dalkeith Road, Edinburgh EH16 4SU, UK. W. A. Wallace, FRCS, FRCS ED (Orth), Professor of Orthopaedics and Trauma University Hospital, Queen’s Medical Centre, Nottingham NG7 2UH, UK. Correspondence should be sent to Dr K. E. Dreinhöfer. ©2004 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.86B7.15328 $2.00 J Bone Joint Surg [Br] 2004;86-B:958-61. Osteoporosis is a “progressive skeletal disease characterized by low bone mass and microarchitectural deterioration, with a consequent increase in bone fragility and susceptibility to fracture”.1 The clinical relevance of osteoporosis is the resulting fractures that occur in the weakened bone – the so-called fragility fractures. Although managing the initial fractures, orthopaedic surgeons are missing a major opportunity to prevent future fractures by not providing appropriate care themselves and by instigating appropriate protocols of care to be provided by their colleagues. Clinical trials have demonstrated that medical treatment given to patients with fragility fractures can reduce the risk of future such injuries by up to 50%.2-4 In a 1998 editorial, ‘Fracture care is not enough’, Tosi and Lane5 in the American volume of the Journal of Bone and Joint Surgery stated “We must thrive to prevent fractures rather than treating them once they occur”. In a recent review in the British volume it was stated that “with such a large and diverse list of risk factors to recall when reviewing a patient with a simple insufficiency fracture in a busy clinic, it is easy to dismiss the underlying cause and simply ‘treat the fracture’.”6 The reasons for such neglect are related to the availability of time and resources. There has also been a lack of simple algorithms and protocols for treating the disease. Recent articles suggest that orthopaedic surgeons are still neglecting to identify, evaluate and treat patients with osteoporosis who are admitted with low-energy fractures.7-17 Why we have to change this now? Fractures related to osteoporosis are common. Every second woman and every third man over the age of 50 will eventually suffer from an osteoporosis-related fracture. The lifetime risk for an osteoporotic fracture of the hip, spine or wrist has been reported to be 40% for Caucasian women in Europe.18-20 The risk for a hip fracture is between 11% and 18% in women, which is equal to the combined risk for breast, uterine, and ovarian cancers.21 Vertebral fractures are between two and three times more prevalent than those in the hip but only onethird are ever diagnosed.22 In the US alone, 1.5 million fractures, including 250 000 of the hip, 250 000 of the distal radius and 700 000 of the vertebrae occur each year secondary to osteoporosis.23 In the UK over 300 000 osteoporotic fractures are sustained each year.24 In Germany 130 000 fractures of the hip were operated on in 1999.25 The European Parliament Osteoporosis Interest Group found that 480 000 fractures of the hip had occurred in the European Union in 1999.26 The number of hip fractures is expected to increase dramatically. The number of individuals over 65 years of age is expected to almost double by the year 2040 and as the population ages, the number of hip fractures is predicted to rise dramatically.25 In 1990, the estimated total number of these injuries in persons over the age of 50 was 1.7 million worldwide.27 Assuming that there are no changes in the ageand sex-specific incidence, the number of such fractures is estimated to reach 6.3 million worldwide by 2050 and in Europe the number will double in 50 years and exceed 970 000.27 This increase can be explained primarily by the aging of the population, and it is based on the assumption that no major changes will occur in the health of elderly people or in the prevention of these fractures. As the cost of treating these patients will also rise, a three- to eightfold increase of the overall expenditure by the year 2030 can be expected.28 The projected total costs are
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