title: Major osteoporotic fragility fractures: Risk factor updates and societal impact.
abstract: Osteoporosis is a silent disease without any evidence of disease until a fracture occurs. Approximately 200 million people in the world are affected by osteoporosis and 8.9 million fractures occur each year worldwide. Fractures of the hip are a major public health burden, by means of both social cost and health condition of the elderly because these fractures are one of the main causes of morbidity, impairment, decreased quality of life and mortality in women and men. The aim of this review is to analyze the most important factors related to the enormous impact of osteoporotic fractures on population. Among the most common risk factors, low body mass index; history of fragility fracture, environmental risk, early menopause, smoking, lack of vitamin D, endocrine disorders (for example insulin-dependent diabetes mellitus), use of glucocorticoids, excessive alcohol intake, immobility and others represented the main clinical risk factors associated with augmented risk of fragility fracture. The increasing trend of osteoporosis is accompanied by an underutilization of the available preventive strategies and only a small number of patients at high fracture risk are recognized and successively referred for therapy. This report provides analytic evidences to assess the best practices in osteoporosis management and indications for the adoption of a correct healthcare strategy to significantly reduce the osteoporosis burden. Early diagnosis is the key to resize the impact of osteoporosis on healthcare system. In this context, attention must be focused on the identification of high fracture risk among osteoporotic patients. It is necessary to increase national awareness campaigns across countries in order to reduce the osteoporotic fractures incidence.
authors.affiliation: Paola Pisani, Maria Daniela Renna, Francesco Conversano, Ernesto Casciaro, Marco Di Paola, Sergio Casciaro, National Council of Research, Institute of Clinical Physiology, 73100 Lecce, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Pisani
authors.affiliation: Paola Pisani, Maria Daniela Renna, Francesco Conversano, Ernesto Casciaro, Marco Di Paola, Sergio Casciaro, National Council of Research, Institute of Clinical Physiology, 73100 Lecce, Italy.
authors.forename: Maria Daniela
authors.initials: MD
authors.lastname: Renna
authors.affiliation: Paola Pisani, Maria Daniela Renna, Francesco Conversano, Ernesto Casciaro, Marco Di Paola, Sergio Casciaro, National Council of Research, Institute of Clinical Physiology, 73100 Lecce, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Conversano
authors.affiliation: Paola Pisani, Maria Daniela Renna, Francesco Conversano, Ernesto Casciaro, Marco Di Paola, Sergio Casciaro, National Council of Research, Institute of Clinical Physiology, 73100 Lecce, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Casciaro
authors.affiliation: Paola Pisani, Maria Daniela Renna, Francesco Conversano, Ernesto Casciaro, Marco Di Paola, Sergio Casciaro, National Council of Research, Institute of Clinical Physiology, 73100 Lecce, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Di Paola
authors.affiliation: Paola Pisani, Maria Daniela Renna, Francesco Conversano, Ernesto Casciaro, Marco Di Paola, Sergio Casciaro, National Council of Research, Institute of Clinical Physiology, 73100 Lecce, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Quarta
authors.affiliation: Paola Pisani, Maria Daniela Renna, Francesco Conversano, Ernesto Casciaro, Marco Di Paola, Sergio Casciaro, National Council of Research, Institute of Clinical Physiology, 73100 Lecce, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Muratore
authors.affiliation: Paola Pisani, Maria Daniela Renna, Francesco Conversano, Ernesto Casciaro, Marco Di Paola, Sergio Casciaro, National Council of Research, Institute of Clinical Physiology, 73100 Lecce, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Casciaro
keywords: Fracture prevention; Fracture risk; Fragility fracture; Hip fracture; Osteoporosis