Peak bone mineral mass is determined from early childhood by both heritable and environmental factors. Recent developments in the molecular epidemiology of osteoporosis have shown the interest, but also the limitations, of specific molecular markers, such as the vitamin D receptor gene polymorphisms Bsm 1 and Fok 1, to explain bone mineral density differences across the population. Importantly, however, interactions between VDR gene polymorphisms and environmental factors, particularly dietary calcium, have provided new insights into the complex determination of bone mineral mass. Impacts of a frailty pandemic in an aging world. Elffors L Department of Geriatric Medicine, Karolinska Institute, Huddinge, Sweden.
Osteoporosis is a major risk factor for fractures in the elderly.
The risk of dying from hip fracture equals breast cancer mortality. Whereas vertebral fractures mainly seem to be caused by osteoporosis alone, hip fractures are heavily affected by an age-dependent contributory risk factor, frailty. Results of attempts to prevent falls are discouragingly poor. Nevertheless, identification of risk possessors, particularly demented elderly living in institutions, is substantial for directing preventive and treatment programs, mainly acting on general health and on osteoporosis. Frailty of populations increases with longevity.