Reducing osteoporosis: prevention during childhood and adolescence.

Osteoporosis will become a large-scale global health issue as the world's population continues to age. In their article, Delmas and Fraser present a compelling argument describing the potential health crisis the world will face if osteoporosis is not made a high priority by the world health community. They estimate that the worldwide lifetime risk for osteoporotic fractures is as high as 40% in women and 13% in men and describe several health-related consequences of this disease, especially in terms of increases in human pain and suffering and the continual increase in global health care costs (1). Osteoporosis greatly affects the health of ageing women and is recognized as a major area of focus in women's health. In comparison to men, women are at higher risk from osteoporosis and have a lifetime risk of an osteoporotic fracture as high as one in three (2). Osteoporotic fractures, commonly of the hip and spine, often result in secondary complications, such as functional impairment, increased hospital stays that may result in further health problems, increased medical costs, and increased dependence on others for living assistance (2). The loss of bone strength and the potential for the onset of osteoporosis do not reflect normal ageing (1). These fractures can be prevented and bone loss reduced by the introduction and continuation of certain behaviours throughout life. While commonly associated with older women, the origins of osteoporosis are linked to strong bones being built during childhood and adolescence and being maintained throughout adult life. While the clinical manifestations of osteoporosis usually appear later in life, there is an opportunity for prevention during childhood and adolescence. Delmas and Fraser call for a decrease in the extent of osteoporosis through prevention, early and accurate diagnosis, and increased research and availability of information (1). Currently, there is no medical intervention to reverse completely the effects of osteoporosis and the most powerful tool to reduce the incidence of osteoporosis is prevention through health education (2). In the USA, 28 million people are estimated as being at risk of developing osteoporosis and one in three women over the age of 50 will suffer an osteoporotic fracture in her lifetime (3). In addition to a decreased quality of life for individuals affected by osteoporosis, the United States faces increasing health care costs due to the extent of the problem. Estimated by the actual cost of health care and lost productivity, the United States spent US$ 13.8 billion in 1996 on osteoporosis and its related health problems (2). The costs in human pain and in health care will only increase as the number of older people in the United States doubles by the year 2030 (2). As women continue to outnumber men in older age groups, osteoporosis is a growing women's public health issue (3). The millions of women affected by osteoporosis and the increasing health care costs to treat the disease and its complications accurately depict the extent and severity of this health issue. However, left out of this picture is the decrease in the quality of life of women affected by osteoporosis. Osteoporotic fractures, such as hip fractures, may render an individual unable to walk independently following the fracture (2). The negative health consequences following osteoporotic fractures often result in a decrease of individual independence, compromising not only the physical health but the general quality of life of women affected by this disease. Osteoporosis is a disease that may be prevented throughout life, but it is particularly important to begin primary prevention during childhood and adolescence (2). Current evidence indicates that young women can increase their peak bone mass, promote long-term bone health and reduce the risk of disease later in life by following effective dietary, exercise and lifestyle practices (2). …