At-risk patients are often not screened to establish fracture probability and not educated about fracture prevention. Despite these advances, a disturbing gap persists in patient care. Since that time, significant improvements have been made in diagnostic technologies and treatments for osteoporosis. The Bone Health and Osteoporosis Foundation (BHOF) - formerly the National Osteoporosis Foundation - first published the Clinician's Guide in 1999 to provide accurate information on osteoporosis prevention and treatment. Osteoporosis detection, diagnosis, and treatment should be routine practice in all adult healthcare settings. Primary care providers and medical specialists are critical gatekeepers who can identify fractures and initiate proven osteoporosis interventions. In appropriate patients, treatment with effective antifracture medication prevents fractures and improves outcomes. Untreated osteoporosis can lead to a vicious cycle of recurrent fracture(s), often resulting in disability and premature death. Clinical or subclinical vertebral fractures, the most common type of osteoporotic fractures, are associated with a 5-fold increased risk for additional vertebral fractures and a 2- to 3-fold increased risk for fractures at other sites. What a patient perceives as an unfortunate accident may be seen as a sentinel event indicative of bone fragility and increased future fracture risk even when the result of considerable trauma. Any new fracture in an adult aged 50 years or older signifies imminent elevated risk for subsequent fractures, particularly in the year following the initial fracture. These fractures place an enormous medical and personal burden on individuals who suffer from them and take a significant economic toll. It is a subclinical condition until complicated by fracture(s). Osteoporosis is the most common metabolic bone disease in the USA and the world.
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