Osteoporosis: Pathophysiology and Clinical Aspects
Osteoporosis has become a major health issue over the last years due to the steadily increasing life expectancy. Beyond the age of 50 years more than 50 percent of women and 13 percent of men will sustain an osteoporosis-related fracture (1). In line with
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Peter Mikosch
7.1
Osteoporosis, a Worldwide Disease with High Economic Burden
Osteoporosis has become a major health issue over the last years due to the steadily increasing life expectancy. Beyond the age of 50 years more than 50 percent of women and 13 percent of men will sustain an osteoporosis-related fracture (1). In line with the demographic development, fractures of the humerus, wrist, or hip will occur noticeably more often during the next four decades (2). The number of patients with hip fractures will increase to 170 % of present-day numbers, and in the age group over 80 years to 250 % (2). In the United States over 10 million have been diagnosed with osteoporosis (1) causing direct medical costs of 17 billion dollars (3, 4). In Germany 7.8 million (6.5 million women) were affected by osteoporosis in 2003 (5). At least one clinical fracture was present in 4.3 % of these patients leading to direct costs of 5.4 billion Euro, although only 21.7 % of the patients were treated with anti-osteoporotic drugs as shown in a recent study from Germany (5). Considering only osteoporosis-attributable hip fractures, 108,341 occurred in Germany in 2002 resulting in costs of almost 3 billion Euro, which will more than double according to estimations in 2050 (6). These already tremendous costs of health care linked to osteoporosis are further alarming, as a care gap with under-diagnosis and under-treatment of the entity has been stressed in several studies (7–13). Improvements in diagnostic strategies, the diagnostic work up in the context of interdisciplinary settings, are warranted in order to optimize the management and care of patients with osteoporosis. The basis of such an aim has to be set up with a better and broader understanding of the pathophysiology, clinical presentation, interactions with other disorders, and the currently available therapeutic possibilities. Univ.-Doz. Dr. Peter Mikosch Ludwig Boltzmann Institute of Osteology, at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, 1140 Vienna, Austria [email protected] Pietschmann et al., Principles of Osteoimmunology, Molecular Mechanisms and Clinical Applications; DOI 10.1007/978–3–7091–0520–7, © SpringerWienNewYork 2012
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7 Osteoporosis: Pathophysiology and Clinical Aspects
Before discussing the pathophysiological mechanisms on the cellular and intracellular level, a short description of the clinical presentation of patients with osteoporosis and the development of bone mass during lifetime will be presented in order to show the connection between clinical appearance of osteoporosis and its underlying cellular mechanisms.
7.2
Balance of Bone Remodeling During Lifetime and the Development of Bone Fragility
Bones and the skeleton resemble a static organ giving shape to the human body and protection to certain organs such as the brain, heart and lungs. It is also a niche for mesenchymal and hematopoetic progenitors with the bone marrow being the place of blood production.
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