Osteoporosis Prevention across the Lifespan: A Public Health Perspective on Reducing Fragility Fracture Burden

Abstract

Osteoporosis represents a major public health challenge worldwide, affecting approximately 200 million individuals and resulting in over 8.9 million fragility fractures annually. This narrative review examines contemporary preventive medicine strategies for osteoporosis and fragility fracture reduction across the lifespan from a public health perspective. We explore evidence-based primary, secondary, and tertiary prevention interventions including nutritional optimization, physical activity promotion, fall prevention programs, screening strategies, and pharmacological prophylaxis. Emerging evidence demonstrates that peak bone mass optimization during childhood and adolescence, combined with targeted interventions in high-risk populations, can substantially reduce lifetime fracture risk. Population-level strategies including vitamin D fortification, calcium supplementation programs, and community-based exercise interventions have shown promise in reducing osteoporosis prevalence. However, significant gaps persist in screening coverage, treatment initiation, and post-fracture secondary prevention, particularly in low- and middle-income countries. The review highlights the economic burden of fragility fractures, projected to exceed $25 billion annually in the United States, emphasizing the cost-effectiveness of prevention strategies. We discuss implementation challenges including healthcare access disparities, medication adherence barriers, and the need for multidisciplinary care coordination. This review provides orthopedic surgeons and preventive medicine specialists with a comprehensive framework for implementing evidence-based osteoporosis prevention strategies within clinical practice and public healthcare systems.