usually reserved for patients with very high fracture risk and is the only available drug therapy for osteoporosis that leads to simultaneous inhibition of bone resorption together with an anabolic effect. certain medications like alendronate, etidronate, risedronate, raloxifene, and strontium ranelate can help to prevent osteoporotic fragility fractures in postmenopausal women with osteoporosis. tentative evidence suggests that chinese herbal medicines may have potential benefits on bone mineral density. prognosis hip fractures per 1000 person-years who categoryage 50–64age > 64overall normal5.39.46.6 osteopenia11.419.615.7 osteoporosis22.446.640.6 although people with osteoporosis have increased mortality due to the complications of fracture, the fracture itself is rarely lethal. hip fractures can lead to decreased mobility and additional risks of numerous complications (such as deep venous thrombosis and/or pulmonary embolism, and pneumonia). the six-month mortality rate for those aged 50 and above following hip fracture was found to be around 13.5%, with a substantial proportion (almost 13%) needing total assistance to mobilize after a hip fracture. vertebral fractures, while having a smaller impact on mortality, can lead to severe chronic pain of neurogenic origin, which can be hard to control, as well as deformity. though rare, multiple vertebral fractures can lead to such severe hunchback (kyphosis), the resulting pressure on internal organs can impair one's ability to breathe. apart from risk of death and other complications, osteoporotic fractures are associated with a reduced health-related quality of life. the condition is responsible for millions of fractures annually, mostly involving the lumbar vertebrae, hip, and wrist. fragility fractures of ribs are also common in men. fractures hip fractures are responsible for the most serious consequences of osteoporosis. in the united states, more than 250,000 hip fractures annually are attributable to osteoporosis. a 50-year-old white woman is estimated to have a 17.5% lifetime risk of fracture of the proximal femur. the incidence of hip fractures increases each decade from the sixth through the ninth for both women and men for all populations. the highest incidence is found among men and women ages 80 or older. between 35 and 50% of all women over 50 had at least one vertebral fracture. in the united states, 700,000 vertebral fractures occur annually, but only about a third are recognized. in a series of 9704 women aged 68.8 on average studied for 15 years, 324 had already sustained a vertebral fracture at entry into the study and 18.2% developed a vertebral fracture, but that risk rose to 41.4% in women who had a previous vertebral fracture. in the united states, 250,000 wrist fractures annually are attributable to osteoporosis. wrist fractures are the third most common type of osteoporotic fractures. the lifetime risk of sustaining a colles' fracture is about 16% for white women. by the time women reach age 70, about 20% have had at least one wrist fracture. fragility fractures of the ribs are common in men as young as age 35. these are often overlooked as signs of osteoporosis, as these men are often physically active and develop the fracture in the course of physical activity, such as falling while water skiing or jet skiing. epidemiology age-standardised hip fracture rates in 2012. low (< 150 / 100 000) medium (150–250 / 100 000) high (> 250 / 100 000) it is estimated that 200 million people have osteoporosis. osteoporosis becomes more common with age. about 15% of caucasians in their 50s and 70% of those over 80 are affected. it is more common in women than men. in the developed world, depending on the method of diagnosis, 2% to 8% of males and 9% to 38% of females are affected. rates of disease in the developing world are unclear. postmenopausal women have a higher rate of osteoporosis and fractures than older men. postmenopausal women have decreased estrogen which contributes to their higher rates of osteoporosis. a 60-year-old woman has a 44% risk of fracture while a 60-year-old man has a 25% risk of fracture. there are 8.9 million fractures worldwide per year due to osteoporosis. globally, 1 in 3 women and 1 in 5 men over the age of 50 will have an osteoporotic fracture. data from the united states shows a decrease in osteoporosis within the general population and in white women, from 18% in 1994 to 10% in 2006. white and asian people are at greater risk. people of african descent are at a decreased risk of fractures due to osteoporosis, although they have the highest risk of death following an osteoporotic fracture. it has been shown that latitude affects risk of osteoporotic fracture. areas of higher latitude such as northern europe receive less vitamin d through sunlight compared to regions closer to the equator, and consequently have higher fracture rates in comparison to lower latitudes. for example, swedish men and women have a 13% and 28.5% risk of hip fracture by age 50, respectively, whereas this risk is only 1.9% and 2.4% in chinese men and women. diet may also be a factor that is responsible for this difference, as vitamin d, calcium, magnesium, and folate are all linked to bone mineral density. there is also an association between celiac disease and increased risk of osteoporosis. in studies with premenopausal females and males, there was a correlation between celiac disease and osteoporosis and osteopenia. celiac disease can decrease absorption of nutrients in the small intestine such as calcium, and a gluten-free diet can help people with celiac disease to revert to normal absorption in the gut. about 22 million women and 5.5 million men in the european union had osteoporosis in 2010. in the united states in 2010 about 8 million women and one to 2 million men had osteoporosis. this places a large economic burden on the healthcare system due to costs of treatment, long-term disability, and loss of productivity in the working population. the eu spends 37 billion euros per year in healthcare costs related to osteoporosis, and the us spends an estimated us$19 billion annually for related healthcare costs. history the link between age-related reductions in bone density goes back to the early 1800s. french pathologist jean lobstein coined the term osteoporosis. the american endocrinologist fuller albright linked osteoporosis with the postmenopausal state. anthropologists have studied skeletal remains that showed loss of bone density and associated structural changes that were linked to a chronic malnutrition in the agricultural area in which these individuals lived. "it follows that the skeletal deformation may be attributed to their heavy labor in agriculture as well as to their chronic malnutrition", causing the osteoporosis seen when radiographs of the remains were made.