Challenges of bone repair - Bone Repair Biomaterials - page 3

fractures occur in men (Campion and Maricic, 2003). In addition, studies
have shown that the fracture-related morbidity rate is higher in men than
in women (olszynski et al ., 2004). As in the case of arthritis and other
musculoskeletal diseases, osteoporosis is a functional abnormality and an
important clinical syndrome leading to many problems with respect to quality
of life (Yilmaz et al ., 2008).
Hip and vertebral fractures are the most common fractures among individuals
suffering osteoporosis. In osteoporotic women, low BMD particularly at the
femoral neck, increases the risk of hip fractures two- to-threefold (Cummings
et al ., 1985).
Hip fractures constitute a major and growing health care problem in
the Western world and an emerging problem in the developing countries
(Cummings et al ., 1985; WHo, 1994). It has been estimated that the
worldwide annual number of hip fractures in 1990 was 1.66 million (Cooper
et al ., 1992b). If current demographic and incidence trends continue, the
worldwide annual number of hip fractures will increase to 6.26 million by
year 2050 (Cooper et al ., 1992b; Melton, 1993). They are associated with
considerable disability, loss of independence and diminished quality of life,
but more importantly with a 20% reduction in expected survival (Cummings
et al ., 1990; Kannus et al ., 1996; Melton, 1993; richmond et al ., 2003).
Additionally, hip fractures constitute a significant economic burden for
modern medical care, both directly during fracture treatment and indirectly
particularly during the first year after the fracture (Lauritzen, 1996; Sernbo
and Johnell, 1993). Thus, as measured by their frequency, influence on
quality of life and economic cost, hip fractures are a public health problem
of crisis proportions.
vertebral fractures and deformities affect approximately 20% of
postmenopausal women and are the hallmark of osteoporosis (O'Neill et al .,
1996; Fechtenbaum et al ., 2005). Postmenopausal women with previous or
incident vertebral fractures are at higher risk of both vertebral and non-vertebral
fractures than women without previous vertebral fractures, independent of
bone density (Klotzbuecher et al ., 2000; Kotowicz et al ., 1994; Burger et
al ., 1994). In contrast to other major osteoporotic fractures, the majority of
vertebral deformities do not come to clinical attention (Kanis and McCloskey,
1992; Cooper et al ., 1992a; Cooper and Melton, 1992).
vertebral fractures may cause local pain for three years or more, although
they may be presented asymptomatically (ross, 1997). Clinical vertebral
fractures are associated with increased back pain, kyphosis, height loss,
impaired functional capacity in daily life, sleep problems, mood changes
and reduced general health, with recent fractures having the greatest impact
and causing greater health care utilization, including increased numbers of
physician visits (Armstrong et al ., 1992; Cooper and Melton, 1992; ettinger
et al ., 1992; leidig et al ., 1990; Huang et al ., 1996). Social isolation and

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