Osteoporosis, the data

Osteoporosis is a chronic, debilitating disease that makes bones porous and brittle.1 It causes decreases in bone density and quality, weakening of the skeleton, and an increased risk of fractures, particularly of the vertebral bodies, wrist, femur, pelvis, and limbs. osteoporosis can progress asymptomatically to the point of bone fracture.3 Bone is living tissue with a hard, firm, outer surface (cortical bone) and an internal ”˜spongy' (trabecular bone). Up to the age of 30, the body continues to build bone mass, after which it begins to replace old bone with new one (resorption and reconstitution). Over time, resorption outpaces reconstitution resulting in a loss of bone density and eventually osteoporosis.4 Postmenopausal women are at an increased risk of osteoporosis because estrogen, which decreases with menopause, plays a important protective role on the bone. Osteoporosis and related fractures are a major cause of morbidity and mortality. Osteoporosis: incidence and diffusion Osteoporosis, often referred to as the ”˜silent epidemic', is an ever-increasing global problem due to the aging of the population. The World Health Organization (WHO) recently identified osteoporosis as a major health problem alongside other noncommunicable diseases.6 Although treatments for osteoporosis have been available for more than 10 years, this disease still causes a high number of fractures.7 In 2000, osteoporotic fractures were estimated to have reached 9 million, of which 1.7 million in the forearm, 1.6 million in the femur and 1.4 million represented by fractures of the vertebrae (symptomatic) . MILLIONS OF PEOPLE IN THE WORLD SUFFER FROM OSTEOPOROSIS World

• Over 75 million people in Europe, Japan and the United States are affected by osteoporosis9.
• Most of them have a 15% chance of suffering fractures in the wrist, femur and vertebral bodies, very close to that of being affected by coronary artery disease.

Europe

• In Europe, recent estimates have estimated that around 3.8 million people have suffered fractures attributable to osteoporosis, of which 0.89 million were hip fractures.
• In Europam, one in three women and one in five men over the age of 50 have experienced an osteoporotic fracture in their lifetime.

United States

• In the United States, an estimated 10 million people are affected by osteoporosis.13
• Approximately 34 million Americans are thought to have low bone mass and are therefore at high risk of developing osteoporosis.

Australia

• About 600,000 Australians (3% of the population) have been affected by osteoporosis, of whom 85% are women and 15% are men.
• The incidence of osteoporotic bills is expected to increase, from 1 every 8.1 minutes in 2001 to 1 every 3.7 minutes in 2021.

Compared with hip fractures, non-femoral or vertebral body fractures have resulted in increases in outpatient performance, including:

• Medical visits
• Emergency room and hospital visits
• Physical therapy
• Radiological diagnosis
• Medicines
• Use of ambulance
• Orthopedic supports

Cost of Osteoporosis: A Growing Burden The economic burden of osteoporosis is comparable to that of major chronic diseases. In women over the age of 45, osteoporosis causes more hospital admissions than other diseases, including diabetes, heart attack and breast cancer. Despite the increased awareness of osteoporosis, the number of osteoporotic fractures is expected to increase, in line with the aging of the European population, going from an economic cost of € 31.7 billion in 2000 to around € ‚¬ 76.7 billion in 2050.20 The total costs attributable to osteoporosis in Australia are A$7.4 billion annually, of which A$1.9 billion is attributable to direct costs. A history of fragility fracture is an important risk factor for further fractures. The risk of subsequent fractures increases more than two-fold in people who have suffered previous fractures of the femur or vertebral bodies. The need for new osteoporotic therapies, including those that can demonstrate efficacy on the whole skeletal system and not only on the femur and vertebral bodies, is really high. Fracture of the femur, while not the most common osteoporotic fracture, is devastating and can lead to death.23 Fractures of the femur can also be very costly, as patients require lengthy hospital stays and at least one third of them will lose its own independence. In Europe, healthcare costs incurred in the first year after a hip fracture have been estimated at € 14.7 billion and this number rises to € 25 billion when all osteoporotic fractures are taken into account. In Europe, 29% of vertebral fractures go undiagnosed.25 97% of lumbar vertebral fractures and 74% of thoracic fractures result in days of limited activity.26 The economic burden of vertebral fractures is due to the cost of outpatient care, nursing care and loss of working days. Are you at risk of osteoporosis? Among the risk factors that increase the likelihood of fractures and the onset of osteoporosis are:

• Being a woman
• Low bone mass
• Family members who have suffered from osteoporosis, especially first degree relatives
• Thinness and/or petite build
• Old age
• Estrogen deficiency due to menopause, especially if it is early or surgically induced
• Inadequate calcium intake
• High caffeine consumption
• Vitamin D deficiency
• Use of certain medications (corticosteroids, chemotherapy, anticonvulsants, and others)
• Sedentary habits
• Smoking (active or passive)
• Excessive alcohol consumption (three or more drinks per day)

Diagnosis Many people are diagnosed with osteoporosis only after a painful bone fracture, despite the fact that today we have specific tests to measure bone mineral density (BMD) in various parts of the body. Treatment Combined with an appropriate diet and weight control, drugs can slow bone resorption and reduce the risk of fractures. Although several treatments are available, the most commonly used therapies are bisphosphonates. New therapies currently in advanced development are exploring different approaches to treating osteoporosis.