The number of hip fractures worldwide due to osteoporosis is expected to rise three-fold by the middle of the next century, from 1.7 million in 1990 to 6.3. million by 2050.

At the present time, the majority of hip fractures occur in Europe and North America. Demographic changes over the next 50 years will lead to unprecedented increases in the number of the elderly in Asia, Africa and South America. As a result, up to 75% of all hip fractures will be occurring in the developing countries 50 years from now.

Concerned by these trends, Dr Gro Harlem Brundtland, Director-General of the World Health Organization (WHO), cited cardiovascular diseases as an example. "Twenty-five years ago, the world's leading experts in cardiovascular diseases warned of an impending epidemic of heart disease in developing countries. This warning was largely ignored and we are now seeing a dramatic increase in prevalence of cardiovascular diseases in the developing countries. We must not allow the same thing to happen for osteoporosis. We must act now," cautioned Dr Brundtland.

Osteoporosis is a skeletal disease characterised by low density and general deterioration of bone tissue. Bone fragility induces fractures that represent the major clinical aspect of the disease. There are three major fractures in osteoporosis: of the hip, vertebrae and distal radius.

The higher occurrence of these fractures in women is related to important postmenopausal changes in bone metabolism and to the fact that they live almost one third of their lives after the menopause.

"These fractures should not be considered as an unavoidable price to pay for a longer life", explains Dr Nikolai Khaltaev, in charge of WHO Osteoporosis Programme. "Early detection is the key. By measuring bone mineral density (BMD) it is easy to identify those at risk and to suggest preventive course of action. We know that BMD declines quite sharply with age in women but we also know what should be done by way of prevention".

Until recently, osteoporosis was known as a clinical condition. It was only in 1992 that osteoporosis was upgraded to a progressive systemic disease characterized by low bone mass and deterioration of bone tissue leading to bone fragility and fracture.

There are a number of important risk factors for hip fracture, including low body weight, history of fracture, smoking, high alcohol intake, use of steroids and physical inactivity. Genetic factors are important although specific genes are still to be identified.

Osteoporosis and associated fractures are a major public health concern because of related morbidity and disability, decreased quality of life and mortality. According to the International Osteoporosis Foundation, every 30 seconds someone in the European Union has a fracture as a result of osteoporosis. Annual direct medical costs to treat 2.3 million osteoporosis fractures in Europe and in the United States of America come up to US$ 27,000 million.

Ignorance about osteoporosis is still common among health professionals, patients and the public at large. The aim of an extensive education and communication programme proposed by WHO is to increase the knowledge of bone physiology and osteoporosis, and to raise the awareness about major risk factors, prevention and management of the disease.

WHO's recommendations to the general public include a physically active lifestyle, with some time regularly spent outdoors, balanced diet providing a calcium intake of at least 800-1500 milligram per day in children and adults, as well as avoiding smoking and high alcohol consumption.

For further information, journalists can contact Mr Valery Abramov, Office of Press and Public Relations, WHO, Geneva. Telephone (+41 22) 791 25 43; Fax (+41 22 ) 791 48 58. E-Mail: abramovv@who.int

All WHO Press Releases, Fact Sheets and Features as well as other informationon this subject can be obtained on the Internet on the WHO home page http://www.who.int/