Globally there are an estimated 35 million women and 14 million men with osteoporosis or low bone mass, and in the US if you are over 50 years of age, you have a 1 in 4 chance of suffering from an osteoporotic fracture. Osteoporosis and the resultant fractures represent a huge public health burden, with a currently estimated annual cost of £2.1 billion in the UK alone. The incidence of this disabling disease is on the increase, and this is complicated by the fact that osteoporosis is known as a 'silent disease' – by the time a patient has their first osteoporotic fracture, the damage to their bones has already been done. Articles from Nature Reviews Endocrinology and Nature Reviews Rheumatology, collected together here, cover the interesting developments within this field relating to the clinical assessment of patients with osteoporosis, approaches for the prevention and management of this disease, as well as the impact of osteoporosis on health and economics worldwide. These articles and the accompanying library of the most relevant recent publications from Nature Publishing Group describe our current understanding of this field.


REVIEWS

Hypovitaminosis D in developing countries—prevalence, risk factors and outcomes

Asma Arabi, Rola El Rassi & Ghada El-Hajj Fuleihan

doi:10.1038/nrendo.2010.146

Nature Reviews Endocrinology 6, 550-561 (2010)

Clinical manifestations of hypovitaminosis D, a highly prevalent disorder worldwide, include musculoskeletal disorders as well as nonclassical manifestations, such as increased risk of respiratory infections, diabetes mellitus and possibly cardiovascular diseases. This Review discusses the prevalence of hypovitaminosis D across the lifecycle, and risk factors and health outcomes associated with it in developing countries.

Genetic epidemiology of age-related osteoporosis and its clinical applications

Ching-Lung Cheung, Su-Mei Xiao & Annie W. C. Kung

doi:10.1038/nrrheum.2010.106

Nature Reviews Rheumatology 6, 507-517 (2010)

Technological innovations have contributed greatly to advancing our knowledge of the genetic basis of osteoporosis. This article reviews the current understanding of osteoporosis genetics with a focus on developments since 2007. The potential clinical implications of this information and future directions for research are also discussed.

Physical therapy approaches to reduce fall and fracture risk among older adults

Saija Karinkanta, Maarit Piirtola, Harri Sievänen, Kirsti Uusi-Rasi & Pekka Kannus

doi:10.1038/nrendo.2010.70

Nature Reviews Endocrinology 6, 396-407 (2010)

Falls and fall-related injuries, such as fractures, are often the cause of pain, functional impairments, reduced quality of life and excess health-care costs and mortality among older adults. This Review focuses on evidence-based physical therapy approaches for the prevention of falls and fractures, including exercise, vibration training and improvement of safety at home and during periods of mobility, and highlights the benefits of multifaceted intervention strategies.

Management of glucocorticoid-induced osteoporosis

Juliet Compston

doi:10.1038/nrrheum.2009.259

Nature Reviews Rheumatology 6, 82-88 (2010)

The clinical importance of glucocorticoid-induced osteoporosis has gained increasing recognition over recent years, but its management generally remains suboptimal. The currently recommended pharmacologic therapies and the development of clinical guidelines for the management of patients with this condition are discussed in this article.

Osteoporosis: impact on health and economics

Nicholas Harvey, Elaine Dennison & Cyrus Cooper

doi:10.1038/nrrheum.2009.260

Nature Reviews Rheumatology 6, 99-105 (2010)

Osteoporosis is a highly prevalent disease that leads to bone fragility and subsequent fracture, most commonly at the hip, spine and wrist. This article reviews the epidemiology of this potentially devastating disease, highlighting the incidence and prevalence of osteoporotic fractures, the resulting morbidity and mortality and the associated costs both to the individual and to society as a whole.

Fracture prevention in men

Piet Geusens, Philip Sambrook & Willem Lems

doi:10.1038/nrrheum.2009.148

Nature Reviews Rheumatology 5, 497-504 (2009)

The risk of experiencing a fracture is lower in men than in women beyond the age of 50 years, but the burden of fractures is, nevertheless, substantial in men. This difference in fracture incidence is likely to be accounted for by differences in bone-related and fall-related factors, which are outlined, along with other data relating to the epidemiology, pathophysiology and treatment options for osteoporosis in men, in this Review.

Approaches to the targeting of treatment for osteoporosis

John A. Kanis, Eugene V. McCloskey, Helena Johansson & Anders Oden

doi:10.1038/nrrheum.2009.139

Nature Reviews Rheumatology 5, 425-431 (2009)

New clinical guidelines incorporate the concept of absolute fracture risk, an important advance in the field of rheumatology. This Review article discusses the background, history and recent advances in the use of absolute fracture risk assessment in the management of patients with osteoporosis.

Estrogens as regulators of bone health in men

Liesbeth Vandenput & Claes Ohlsson

doi:10.1038/nrendo.2009.112

Nature Reviews Endocrinology 5, 437-443 (2009)

The role of sex steroids in the regulation of bone metabolism has been extensively studied in women; however, less is known about their skeletal effects in men.
On the basis of associations between serum estradiol levels, bone metabolism and fracture risk in adult men and skeletal symptoms in young men with estrogen resistance or aromatase deficiency, the authors suggest a crucial role for estradiol in regulating skeletal growth and health in men.

Hierarchical microimaging of bone structure and function

Ralph Müller

doi:10.1038/nrrheum.2009.107

Nature Reviews Rheumatology 5, 373-381 (2009)

The use of high-resolution imaging techniques will lead to a better understanding of the relative contribution of the different hierarchical levels to bone competence. Such information could help improve predictions of fracture risk, clarify the pathophysiology of skeletal diseases, and define the response to therapy. This Review focuses on three-dimensional approaches to hierarchical biomechanical imaging in the study of microstructural and ultrastructural bone failure.

YEAR IN REVIEW

Osteoporosis in 2010: Building bones and (safely) preventing breaks

Elaine Dennison & Cyrus Cooper

doi:10.1038/nrrheum.2010.227

Nature Reviews Rheumatology 7, 80-82 (2011)

NEWS & VIEWS

Comorbidities: Glucocorticoids and osteoporosis: predicting fracture risk

Stanley B. Cohen

doi:10.1038/nrrheum.2010.194

Nature Reviews Rheumatology 6, 681-682 (2010)

Thyroid gland: Variation in 'normal' thyroid function—effect on bone health?

Mark S. Cooper

doi:10.1038/nrendo.2010.132

Nature Reviews Endocrinology 6, 599-600 (2010)

Bone: Is screening for secondary causes of osteoporosis worthwhile?

J. Chris Gallagher & Adarsh J. Sai

doi:10.1038/nrendo.2010.86

Nature Reviews Endocrinology 6, 360-362 (2010)

Bone: Using FRAX® wisely: lessons from Switzerland and beyond

E. Michael Lewiecki

doi:10.1038/nrendo.2009.270

Nature Reviews Endocrinology 6, 126-128 (2010)

Bone: Bone density screening leads to reduced fracture risk

Nelson B. Watts

doi:10.1038/nrendo.2009.246

Nature Reviews Endocrinology 6, 17-18 (2010)

Bone: Causes of low bone mass in breast cancer—time for action?

Robert E. Coleman & Jennifer S. Walsh

doi:10.1038/nrendo.2009.244

Nature Reviews Endocrinology 6, 10-12 (2010)

Metabolic bone diseases: Translational research—preventing fractures with denosumab

Peter R. Ebeling

doi:10.1038/nrrheum.2009.234

Nature Reviews Rheumatology 5, 660-661 (2009)

Bone: Use of bisphosphonates in children—proceed with caution

Joan C. Marini

doi:10.1038/nrendo.2009.58

Nature Reviews Endocrinology 5, 241-243 (2009)

CASE STUDIES

Treatment of postmenopausal osteoporosis in a patient with celiac disease

JoAnn V. Pinkerton, Alan C. Dalkin, Sheila E. Crowe, Barbara B. Wilson & Edward B. Stelow

doi:10.1038/nrendo.2009.272

Nature Reviews Endocrinology 6, 167-171 (2010)

This Case Study describes a patient diagnosed as having celiac disease as a result of examinations for secondary causes of bone loss. As osteoporosis in patients with celiac disease might result from a reduction of nutrient absorption in the small bowel, leading to calcium and/or vitamin D deficiency, the investigators highlight the need to evaluate secondary causes of osteoporosis in patients with persistent decline in BMD, particularly in postmenopausal women after treatment with hormone replacement therapy.

Giant osteoclasts after long-term bisphosphonate therapy: diagnostic challenges

Nidhi Jain & Robert S. Weinstein

doi:10.1038/nrrheum.2009.87

Nature Reviews Rheumatology 5, 341-346 (2009)

This Case Study describes a postmenopausal woman who sustained a vertebral compression fracture 1 year after discontinuing long-term alendronate therapy for osteoporosis. A bone biopsy specimen revealed numerous giant, multinucleated osteoclasts, in contrast to the current opinion that alendronate therapy reduces the number of osteoclasts. In the context of this case, the authors highlight diseases that might be associated with giant osteoclasts, and discuss how to discriminate between them in order to avoid unnecessary tests and referrals.

RESEARCH HIGHLIGHTS

Bone: Nitroglycerin ointment boosts bone formation and reduces resorption

Emma Leah

doi:10.1038/nrrheum.2011.32

Nature Reviews Rheumatology 7, 196 (2011)

Bone: Could IFN-γ be a new therapeutic target in osteoporosis?

Jenny Buckland

doi:10.1038/nrrheum.2011.21

Nature Reviews Rheumatology 7, 194 (2011)

Metabolic bone diseases: Cathepsin K inhibition halts bone destruction, while remodeling merry-go-round runs merrily on

Emma Leah

doi:10.1038/nrrheum.2011.17

Nature Reviews Rheumatology 7, 191 (2011)

Metabolic Bone diseases: Mapping therapy-induced changes to osteoporotic bone

Sarah Price

doi:10.1038/nrrheum.2011.18

Nature Reviews Rheumatology 7, 194 (2011)

Bone: Zoledronic acid: paracetamol effective against post-dose symptoms

Carol Wilson

doi:10.1038/nrendo.2011.6

Nature Reviews Endocrinology 7, 125 (2011)

Bone: Fracture prediction in osteoporosis

Rosanne Diaz

doi:10.1038/nrendo.2010.221

Nature Reviews Endocrinology 7, 63 (2011)

Biomarkers: Osteopontin to determine response to parathyroid hormone therapy?

Linda Koch

doi:10.1038/nrendo.2010.177

Nature Reviews Endocrinology 6, 653 (2010)

Bone: Zoledronic acid and teriparatide: better together?

Carol Wilson

doi:10.1038/nrendo.2010.185

Nature Reviews Endocrinology 6, 656 (2010)

Osteoporosis: Elucidating the role of the glucocorticoid receptor in glucocorticoid-induced osteoporosis

Nick Warde

doi:10.1038/nrrheum.2010.130

Nature Reviews Rheumatology 6, 497 (2010)

Pharmacotherapy: Increased stroke risk associated with osteoporosis drugs

Rosanne Diaz

doi:10.1038/nrendo.2010.110

Nature Reviews Endocrinology 6, 472 (2010)

Osteoporosis: Zoledronic acid for osteoporosis treatment—a matter of time

Rowan Higgs

doi:10.1038/nrrheum.2010.96

Nature Reviews Rheumatology 6, 382 (2010)

Imaging: Elucidating the relationship between hand bone loss and osteoporosis

Sarah Price

doi:10.1038/nrrheum.2010.12

Nature Reviews Rheumatology 6, 120 (2010)

Bone: Hip fracture: how can outcome be improved?

Carol Wilson

doi:10.1038/nrendo.2009.252

Nature Reviews Endocrinology 6, 57 (2010)

Osteoporosis: Elderly patients with distal radial fractures should be assessed for osteoporosis

Rowan Higgs

doi:10.1038/nrendo.2009.230

Nature Reviews Endocrinology 6, 3 (2010)

Metabolic bone diseases: Teriparatide or alendronate for glucocorticoid-induced osteoporosis therapy?

Negin Nassabeh

doi:10.1038/nrrheum.2009.241

Nature Reviews Rheumatology 6, 1 (2010)

Metabolic bone diseases: Cathepsin K inhibition for osteoporosis

Sarah Price

doi:10.1038/nrrheum.2009.250

Nature Reviews Rheumatology 6, 5 (2010)

Bone: Hyponatremia-induced osteoporosis

Linda Koch

doi:10.1038/nrendo.2009.235

Nature Reviews Endocrinology 6, 6 (2010)

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