150 years ago, for the first time, Sir Ashley Cooper suggests that the femoral neck fractures are probably due to an age reduction of bone mass and bone quality. The term “osteoporosis” is introduced to the medical science in the 19th century in France and Germany, as a histological description of an aged bone, underlining the obvious porousness of the bone tissue (from Greek: оsteon – bone + poros - pore). Later on the term is used to distinguish this bone status from the osteomalation of rachitis, and it denotes the reduced quantity of bone mass in condition of normal bone mineralization.

Following the definition of the World Health Organisation, osteoporosis is the most common system disease of the skeleton, characterised with low bone mass and deteriorations in the micro-architectonics of the bone tissue, leading to increased fragility of the bones, and higher risk for fractures.

The bone mass quantity of an aged person is determined by the algebraic total of the peak bone mass quantity and the amount of the bone mass loss following with the menopause or with ageing. In this connection, the 2 major pathogenic determinants of osteoporosis are:

• Accumulation of relatively low peak bone mass (PBM) in the childhood and adolescence. In this case, even the minimum bone loss with ageing will lead to low bone mass and high osteoporosis risk. It is found, that the PBM determines in 50-70%, (for the trabecular and the cortical bones respectively) the bone mass at a mature age, and so it is a first rank prognostic criterion in the etiopathogenesis of osteoporosis.
• Significant bone loss (in terms of quantity, speed and duration) in the menopause and/or at a later age.

Osteoporosis may be developed by individuals of all age groups, but women are affected 3 times more frequently than men. On the background of the lower peak bone mass, accumulated in the second decade of life, after the menopause and with ageing women lose 35–50% of their trabecular bone mass and 25–30% of their cortical bone. The bone loss for men comes later, and it is connected with a loss of 15–45% in the trabecular bones 5–15% in the cortical bones.

For the greater part of the people affected the bone loss proceeds gradually and in the beginning it goes with no symptoms; that’s why osteoporosis is called “the silent thief”. At a later stage the disease is attended by sharp or chronic pains and spine deformations.

The major and most often the first clinical appearances of osteoporosis are fractures occurring as a result of a loss of significant quantity of bone mass and the related with it reduced mechanical strength of the skeleton. It is considered that 50% of women and 25% of men over the age of 60 will undergo at least one fracture for the rest of their life.

The basic localizations of the osteoporosis fractures of the age between 60 and 70 are in the wrist, while the fractures of the hip (mostly the femoral neck) and the vertebrae are the most frequent in the patients over 70.

Predilection sites of osteoporosis fractures

The basic localizations of the osteoporosis fractures of the age between 60 and 70 are in the wrist, while the fractures of the hip (mostly the femoral neck) and the vertebrae are the most frequent with the patients over 70. (Osteoporosis Prevention, Diagnosis and Therapy. NIH Consens. Statement, 2000; Sainz-J et al. 1999).

It’s important that more than 50% of the osteoporosis fractures happen as a result of a minor or a moderate trauma (the so called “low-energy trauma”). Most of the fractures (76%) happen after a fall in home environment and are defined as “fractures within the four walls“.

The most common and serious complications are those of the femoral neck fractures. 5-20% of the people who undergo a hard hip fracture die after a complication within the first year.

The death risk after a hip fracture for a 50-year old woman is almost equal to the risk after a breast cancer, and it is higher than the risk after endometrial cancer:

• Hip fracture: 2.8%
• Breast cancer: 2.8%
• Endometrial cancer: 0.7%

As a whole, a hip fracture reduces the life expectancy with 12-20%. About 11% of the patients who survive become completely handicapped. Only 1/3 of the patients restore their functional abilities. In the other cases a reduced quality of life to a different extent is recorded, due to a functional loss, immobility, pain, social isolation and psychological problems.

For a period of 20 years – from the 70ties to the beginning of the 90ties of the 20th century, the number of limb fractures has increased with 14% (22% in women and 1% in men). A prognosis has been made that while in 1990 1.7 million osteoporosis fractures were registered in the world, in 2050 they will reach 6.3 million, and 4.5 million of them will be femoral neck fractures. It is considered that only in the European Community over the next 50 years the hip fractures will be increased more than twice  - from 414 000 to 972 000.