Osteoporosis: A Neglected but Treatable Disease
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Overview of the Problem
When one thinks about common causes of morbidity and mortality in elderly, osteoporosis is probably not one of the first conditions to come to mind. Even though most physicians are aware of osteoporosis, it is generally considered a less important health matter. Because elderly patients often have several medical problems, these other diseases often attract the attention of the health care provider; as a result, osteoporosis frequently is not adequately addressed. Yet, osteoporosis is a serious, debilitating ailment with morbidity, mortality, and economic costs similar to many other chronic medical problems. The purpose of this article is to demonstrate the similarities between osteoporosis and other chronic diseases with regard to its personal and economic impact, and to highlight the measures to diagnose and treat this neglected but important disease.
Osteoporosis is a very common problem. According to World Health Organization criteria, it is estimated that 13-18% of women over the age of 50 have osteoporosis, and 40% will sustain an osteoporotic fracture (spine, hip, or wrist) in their remaining lifetime. The National Osteoporosis Risk Assessment, a longitudinal study in which more than 200,000 women in the United States over the age of 50 not known to have osteoporosis had a bone mineral density test performed, found that 40% of women had osteopenia, or low bone mass (T-Score between –1 and –2.5), while over 7% had osteoporosis (T-Score < -2.5).1 Women over age 80 have a 93% chance of being osteopenic or osteoporotic (Figure).
Both spine and hip fractures are associated with increased morbidity and mortality.2 The personal impact with regard to the disability that can result from fractures can be compared to the impact that a stroke or MI can have on an elderly person. Hip fractures are devastating for both genders, with about 34% excess mortality in the first year after a fracture for men, and 20-24% for women.3 In Sweden, the death rate for hip fracture per 100,000 elderly women has now exceeded the death rate from stroke.4,5 Many physicians and most patients do not appreciate that a woman at age 50 is as likely to die of a hip fracture in her remaining lifetime (2.8%) as she is from breast cancer (2.8%).6
Those who survive a hip fracture are often unable to return to independent living, and 40% never return to pre-fracture function.7 A recent study to assess the excess mortality and institutionalization of community-dwelling people over age 60 found that after 2 years, 39.2% of the female hip fracture patients vs 19.7% of female controls were dead or institutionalized, compared with 52.1% of male hip fracture patients vs 12.4% of male controls.8 Nursing home residents who sustain a fracture are more than 15 times more likely to be hospitalized in the month following their fracture compared to those without a fracture, and their rate remains increased compared to controls for at least 12 months.9
Lippuner et al10 reported that women with fractures utilized more hospital days (568,000) compared to chronic obstructive pulmonary disease (353,000), stroke (352,000), or myocardial infarction (131,000). In the United States, the cost of fractures secondary to osteoporosis was $13.8 billion in 1995. This compares to asthma’s annual cost of $7.5 billion and congestive heart failure’s $20.3 billion. Hip fractures are expected to increase dramatically in the next several decades as “baby boomers” hit retirement age; therefore, inpatient costs for the year 2050 are projected to be greater than $130 billion.11
Despite these staggering statistics, osteoporosis awareness in all age groups remains low.
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