All sanity depends on this: that is should be a delight to feel heat strike the skin, a delight to stand upright, knowing the bones are moving easily under the flesh - Doris Lessing
World Osteoporosis Day (WOD) - 20th October 2002
Initiated in 1996 by the UK National Osteoporosis Society, WOD has been sponsored and promoted by the International Osteoporosis Foundation since 1997. In 1998 and 1999, the World Health Organisation played a significant role as a co-sponsor, thereby lending an even greater international weight to this annual event. The Bone and Joint Decade was an important co-sponsor of World Osteoporosis Day in 2000.
The WOD 2002 message is "Invest in your bones: Prevent the first fracture". Why does IOF emphasise prevention of the first fracture? The risk of a “cascade” effect resulting in future fractures is high ( for example, one out of five women suffering a first vertebral fracture will fracture again within one year). Also, high hospital and treatment costs make it more cost effective for government health care services and insurance companies to prevent the first fracture than to treat fractures. See the outline "Invest in your bones: Prevent the first fracture" (PDF, 213 KB), which briefly lists the consequences of osteoporotic fractures and how to take action for prevention.
The Facts about Osteoporosis and its Impact
WHAT IS OSTEOPOROSIS
Disease of the bones, characterised by a decrease in bone mass and density. The resulting weakness in the skeleton increases the risk of broken bones, particularly to spine, wrist, hip, pelvis and upper arm.
Also causes debilitating pain, loss of height and humpback. Death secondary to hip fracture is common due to pneumonia, other infections and cardiac insufficiency and outweighs death caused by many types of cancers.
Often referred to as a "silent epidemic" because it progresses without any outward sign, sometimes for decades, until sufferer experiences bone fracture.
Diagnosis often occurs after bones have broken. Early diagnosis possible using non-invasive bone density scans, which requires special equipment but is not frequently used in many countries for a variety of reasons, notably lack of health insurance or government reimbursement. Ordinary x-rays do not accurately measure bone density.
FREQUENCY AND IMPACT – WORLDWIDE
- Worldwide, lifetime risk for osteoporotic fractures
in women at least 30% and probably closer to 40%. In
men risk is 13%.
- Worldwide, number of hip fractures could rise from
1.7 million in 1990 to 6.3 million by 2050. Most
dramatic increase expected to be in Asia during the
next decades.
- Osteoporosis is second only to cardiovascular disease
as a leading health care problem, according to WHO.
- Osteoporosis afflicts an estimated one-third of women
aged 60 to 70, and two-thirds of women aged 80 or
older; approximately 200 million women worldwide
suffer from osteoporosis.
- Incidence of osteoporotic fractures likely to double
during next half-century.
- In seven major countries -France, Germany, Italy, the
United States, the United Kingdom, Spain and Japan
– less than half of women with osteoporosis are
diagnosed.
- Osteoporosis-related disability confines patients to
more immobile days in bed than any of the following:
chronic obstructive pulmonary disease, stroke,
myocardial infarction or breast cancer.
- In the USA the total number of people aged 50 and older estimated to be at risk for osteoporosis and low bone mass was 44 million in 2002 (14 million men and 30 million women).
Hip fractures
- In Europe and the United States together, in the more
than 650,000 patients per year with hip fractures,
mortality is increased by 10-20% and more than
one-third are rendered functionally dependent; 19% of
patients enter long-term care. The most dramatic
increase in osteoporosis is expected to be in Asia.
For example in Singapore, compared to the 1960's, hip
fractures in women have gone up 5 times in women and
1.5 times in men. The Ministry of Health has reported
that there were about 1600 hip fractures in the year
2000.
- Disease and death associated with hip fracture rise
sharply with age.
- In the Western world more people die each year
following a hip fracture than from gastric or
pancreatic cancer.
- Life-time risk for women dying from hip fracture
complications equals risk of dying from breast
cancer.
- In Europe and the United States together, lifetime risk of hip fracture in women is larger that sum of lifetime risks of having breast, endometrial and ovarian cancer. Lifetime risk of hip fracture in men is greater than that of prostatic cancer.
Vertebral fractures
- Once a woman suffers a first vertebral fracture,
there is a five-fold increase in the risk of
developing a new fracture within one year. Therefore,
it is critical to prevent the first fracture.
- Approximately 20-25% of women over the age of 50 have
one or more vertebral fractures.
- Clinical vertebral fractures and hip fractures are
associated with a substantial increase in mortality
among relatively healthy older women.
- In women over 65 years there is a 1% per annum risk of vertebral fracture which doubles every decade. By the time a woman is 80 years of age she has a 40% chance of having one or more vertebral fractures. The risk for men is approximately half that.
FREQUENCY AND IMPACT – EUROPEAN COMMUNITY
- 40% middle-aged women (8 in 20) and 15% middle-aged
men (3 in 20) in Europe will suffer one or more
osteoporotic fractures during their remaining life
time.
- Every 30 seconds someone in the EU has a fracture as
a result of osteoporosis.
- Rate of osteoporosis patients will double in next 50
years, due to increase in ageing population and
lifestyle factors.
- Only one in two osteoporotic spinal fractures gets
diagnosed.
- Bone mineral density measurement is under-utilized in majority of European countries. Reasons include limited availability of densitometers, restrictions in personnel permitted to perform scans, low awareness of usefulness of BMD testing, limited or non-existent reimbursement.
Hip Fractures
- 1 in 3 women and 1 in 9 men over age 80 will have hip
fracture (a break at the head of the femur) as a
result of osteoporosis.
- Hip fractures have an overall mortality rate of 15 to
30 percent, with the majority of deaths occurring in
the first six months after fracture.
- One in four women with osteoporotic hip fracture will
require long-term nursing home care. Half of those
will be unable to walk without assistance.
- Considerable morbidity associated with hip fracture.
Hospital admissions following hip fractures typically
range from 20 to 30 days.
- Annual incidence of hip fractures in the EU estimated
to more than double, from more than 414,000 to
972,000 over next 50 years.
- Hospital beds needed to treat people with hip and
spine fractures will more than double over next 50
years.
- Each year doctors in the EU treat probably more than
one million patients with osteoporotic fractures,
including 400,000 hip fractures, 400,000 wrist
fractures.
- Perhaps 20% patients with osteoporotic hip fractures, 20% patients with osteoporotic spine fractures,die annually; about 150,000 total.
PEOPLE AT RISK
- Postmenopausal women at greatest risk, also women
with premature menopause.
- Genetic factors play an important role. People with a
family history of osteoporosis are at risk.
- People with a slight body build are more susceptible.
- People with eating disorders, such as anorexia, more
susceptible.
- Smokers have a higher lifetime risk of hip fracture
than non-smokers.
- Caucasians and Asians most susceptible; Africans less affected.
COSTS
European Community
- Osteoporosis costs national treasuries over €
4.8 billion annually in hospital healthcare alone, a
33% increase over past three years.
- In Sweden and the UK the total cost (e.g. primary care, outpatient care, institutional care) for caring for someone with hip fracture is 2.5 times greater than the direct hospital costs.
USA
- According to the National Osteoporosis Foundation (U.S.) the current estimated price tag for America in direct medical costs for treating fractures resulting from osteoporosis is $17 billion annually.
TREATMENT
- There is no cure, but treatments can stop further
bone loss and fractures. Treatments include:
bisphosphonates, calcitonin, calcium, fluorides,
hormone replacement therapy (HRT), ipriflavone,
selective oestrogen receptor modulators, steroids
(anabolic), tibolone, vitamin D and vitamin D
metabolites. However evidence for the effectiveness
of these medications in reducing fracture risk varies
considerably.
- Additionally new medications are in development such
as additional bisphosphonates, selective oestrogen
receptor modulators, strontium ranelate and
parathyroid hormone.
- Other care: Rehabilitation to regain mobility and reduce pain. Peer support through patient societies very helpful to restore social contact, confidence and to prevent falls.
PREVENTION
- Best prevention: Build strong bones, especially
before age of 35. Healthy lifestyle including:
balanced diet rich in calcium and vitamin D, regular
exercise, no smoking, limit alcohol intake, consult
with your doctor if you have a family history of
osteoporosis.
- Identify and treat persons at risk. First step: take
the One
Minute Risk test.
- Hip protectors might reduce number hip fractures of people living in nursing homes by 50%. Nursing home patients constitute 20% of all osteoporosis hip fractures; hip protectors could reduce total hip fracture incidence by 10%.
For further information on Osteoporosis, see........
The International Osteoporosis Foundation (IOF) is an international non-governmental organization whose bylaws were registered in Berne, Switzerland in 1987 as the European Foundation for Osteoporosis (EFFO). In 1998, EFFO joined forces with the International Federation of Societies on Skeletal Diseases (IFSSD), established 1995. IOF's mission is to advance the understanding of osteoporosis and to promote prevention, diagnosis and treatment of the disease worldwide.
- MedlinePlus latest news and links to osteoporosis.
The goal of the Bone and Joint Decade is to improve the health- related quality of life for people with musculoskeletal disorders throughout the world. These disorders are the most notorious and common causes of severe long-term pain and physical disability, affecting hundreds of millions of people across the world. The Decade aims to raise awareness and promote positive actions to combat the suffering and costs to society associated with musculoskeletal disorders such as joint diseases, osteoporosis, spinal disorders, severe trauma to the extremities and crippling diseases and deformities in children.
- National Institutes of Health Osteoporosis and Related Bone Diseases~National Resource Center (NIH ORBD~NRC)
The NIH ORBD~NRC was established in 1994 with a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) of the National Institutes of Health to The National Osteoporosis Foundation. Its mission is to provide patients, health professionals, and the public with an important link to resources and information on metabolic bone diseases, including osteoporosis, Paget's disease of the bone, osteogenesis imperfecta, and hyperparathyroidism. The Center is operated by the National Osteoporosis Foundation, in collaboration with The Paget Foundation and the Osteogenesis Imperfecta Foundation.
In 1986 doctors at the Royal National
Hospital for Rheumatic Disease in Bath were concerned that
people were unaware of the risks of osteoporosis. Medical
practice on diagnosis, treatment and prevention was patchy.
The National Osteoporosis Society (NOS) was launched with the
backing from the Department of Health and the Chief Medical
Officer. Fifteen years later the National Osteoporosis
Society (NOS) is the only national charity dedicated to
improving the diagnosis, prevention and treatment of this
fragile bone disease.
BoneKEy-Osteovision®, the Bone Knowledge Environment, is the result of a cooperation between the International Bone and Mineral Society and Osteovision®. This web-based site employs the highly sophisticated technology of HighWire Press, the leading electronic publisher of scientific journals.
The Doctor's Guide Personal Edition
publishes the latest medical news and information for
patients or those who know patients diagnosed with
osteoporosis. Doctors can join in Internet research on health
and medicine by becoming a member of the Healthcare
Advisory Board. Established in countries worldwide to
benefit and serve its members with the aim of improving
overall medical communications, its purpose is to unite
experience and expertise toward a goal of global improvement
in health care advances.
As a non-profit resource center, Foundation for Osteoporosis Research and Education is dedicated to preventing osteoporosis through research and education including lectures, conferences and newsletters available through their website. Located in Oakland, California USA, the Foundation is a clinical research site, employing "state of the art" epidemiological bone density testing and international clinical research for pharmaceutical companies conducting osteoporosis related drug trials.
Osteoporosis Australia was formed in 1994 in response to community demand for information about Osteoporosis. Consumer and health professional services providing information, advice and education had been established as early as 1989.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases - Osteoporosis: Progress and Promise
The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases, the training of basic and clinical scientists to carry out this research, and the dissemination of information on research progress in these diseases.
With that I let your "mouse" or your "keyboard" do the "talking".
Till next month, "Happy Surfing".
Cyberdoc ( vadivale@yahoo.com )
The links to URL mentioned above are valid at the time of writing (5 October 2002).
Last updated 15 January 2006.
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