Osteoporosis: a view into the next century

Abstract Osteoporosis is a systemic disease in which fractures in later life result from gradual deterioration of bone mass and architecture. It will become an increasingly serious problem world-wide as the population ages and as a result of a secular trend that is not well understood. A review of information on the geographical variation of osteoporosis is followed by a consideration of the possible effects of calcium, smoking and exercise. The problem of osteoporosis will be very difficult to tackle, but the best preventive approach is probably to develop a screening strategy for women well after the menopause — perhaps at 65 years — and to target interventions to those at highest risk.