Osteoporosis: Challenges, Advances and Recommendations

Osteoporosis is estimated to affect 200 million women worldwide. Approximately one in two women and 1 in 5 men over age 50 will break a bone because of osteoporosis. From 2005 to 2025, annual fractures and costs are projected to rise by almost 50%.Physicians face several challenges in treating patients with osteoporosis. It has been shown that 50–70% of the patients discontinue their osteoporosis medications within the first year of initiation. Screening and more widespread treatment of osteoporosis could prevent many osteoporotic fractures. Most fractures occurred in women with osteopenia. A limitation of DXA scans is that they are based on two-dimensional projection images whereas osteoarthritis and bone volume are known to affect bone mineral density. Moreover, it also does not fully detect changes in bone architecture. FRAX with bone mineral density may not be accurate and reliable assessment tool in the following at-risk groups: Type 2 diabetes, high-dose glucocorticoid therapy, post-transplant-induced osteoporosis, obesity and sarcopenia. New drugs are a welcome addition to the armamentarium to treat osteoporosis. Challenges remain to be considered including need for early detection and screening, how to communicate better with patients to improving adherence, better fracture risk detection tools and reducing the risk of falls.