Osteoporosis epidemiology 2013: implications for diagnosis, risk assessment, and treatment

To summarize the recently published studies that provide insights into the changing epidemiology of osteoporosis and fractures.

The main themes reviewed are fracture outcomes; trends in fractures rates; fracture risk assessment and monitoring; atypical femoral fractures; male osteoporosis; falls and physical activity; and sarcopenia, obesity, and metabolic syndrome.

Osteoporotic fractures were found to have long-term consequences on excess mortality (10 years) and economic costs (5 years). The large burden of nonhip nonvertebral fractures has been underestimated. Divergent (but mostly declining) trends in fracture rates were confirmed in several cohorts from around the world. This has significant implications for healthcare planners and clinicians responsible for the care of individuals with osteoporosis, and also impacts on the calibration of fracture prediction tools. Although fracture prediction tools differ in their complexity, performance characteristics are similar when applied to the general population. Large, high-quality comparative studies with different case mixes are needed. Fracture probability does not appear to be responsive enough to support goal-directed treatment at this time. A consensus on the diagnosis of osteoporosis in men has emerged, based upon the same absolute bone density cutoff for both men and women. Finally, a plethora of new data highlight the importance of falls, physical activity, and body composition as contributors to skeletal health.