N K Arden

The intrauterine programming of osteoporosis

Osteoporosis is a skeletal disorder characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in the risk of fracture. These fractures typically occur at the hip, spine, and distal forearm; the annual cost attributable to them in England and Wales is £1.7 billion, with over 90% of this figure ascribed to hip fracture [1]. Figure 1 shows the history of advances in the field of osteoporosis over the previous three millennia. The recognition that fractures might be a consequence of bone fragility was initiated in the writings of Hippocrates; palaeopathological studies of bone specimens removed from burial sites dating as early at the 8th century AD confirm that osteoporotic vertebral collapse has occurred among elderly individuals throughout the ages. Our recent enhanced understanding of the disorder, however, stems from the work of orthopedic surgeons such as Sir Astley Cooper in 1825, who documented the descriptive characteristics of age-related fractures, and the observations of histopathologists in France and Germany at around the same time, who first coined the time “osteoporosis” to denote the rarification of trabecular architecture observed in the central part of vertebral bodies from patients who were elderly, when compared with those who had died at younger ages. The modern era of osteoporosis research originated in the research of Dr. Albright in the United States, who first documented osteoporotic vertebral deformity as a consequence of estrogen deficiency in postmenopausal women.