Risk factors for osteoporotic fracture include (but are not limited to) increasing age, female sex, postmenopause for women, hypogonadism or premature ovarian failure, low body weight, history of parental hip fracture, ethnic background (white persons are at higher risk than black persons), previous clinical or morphometric vertebral fracture, previous fracture due to minimal trauma (that is, previous osteoporotic fracture), rheumatoid arthritis, current smoking, alcohol intake (3 or more drinks daily), low bone mineral density (BMD), vitamin D deficiency, low calcium intake, hyperkyphosis, falling, and immobilization ( 5). The economic impact of osteoporosis on the health care system is estimated to be $25.3 billion per year by 2025 ( 3). Approximately 50% of Americans older than 50 years are at risk for osteoporotic fracture ( 4). Osteoporosis is found in an estimated 200 million people worldwide ( 2), and an estimated 54 million men and women in the United States have osteoporosis or low bone density ( 3). Although osteoporosis can be present in any bone, the hip, spine, and wrist are most likely to be affected. Osteoporosis is a systemic skeletal disease characterized by decreasing bone mass and microarchitectural deterioration of bone tissue that leads to an increased risk for bone fragility and fracture ( 1).
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