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Facts and statistics about osteoporosis and its impact

Osteoporosis - General
Osteoporosis in Men
Hip Fracture
Vertebral Fracture
Risk Factors
Treatment
Exercise
Nutrition

Europe
North America
Latin America
Asia
Australia

References

Osteoporosis - General

  • Osteoporosis affects an estimated 75 million people in Europe, USA and Japan [1].
  • 1/3 women over 50 will experience osteoporotic fractures, as will 1/5 men [2-4].
  • 30-50% of women and 15-30% of men will suffer a fracture related to osteoporosis in their lifetime [5].
  • 85% of wrist fractures occur in women [6].
  • Nearly 75% of hip, spine and distal forearm fractures occur among patients 65 years old or over [7].
  • A 10% loss of bone mass in the vertebrae can double the risk of vertebral fractures, and similarly, a 10% loss of bone mass in the hip can result in a 2.5 times greater risk of hip fracture [8].
  • By 2050, the worldwide incidence of hip fracture in men is projected to increase by 310% and 240% in women [9].
  • The combined lifetime risk for hip, forearm and vertebral fractures coming to clinical attention is around 40%, equivalent to the risk for cardiovascular disease [10].
  • In white women, the lifetime risk of hip fracture is 1 in 6, compared with a 1 in 9 risk of a diagnosis of breast cancer [11].
  • A prior fracture is associated with an 86% increased risk of any fracture [12].
  • In women over 45 years of age, osteoporosis accounts for more days spent in hospital than may other diseases, including diabetes, myocardial infarction and breast cancer [13].
  • An IOF survey, conducted in 11 countries, showed denial of personal risk by postmenopausal women, lack of dialogue about osteoporosis with their doctor, and restricted access to diagnosis and treatment before the first fracture result in underdiagnosis and undertreatment of the disease [14].

Osteoporosis in Men

  • About 20-25% of hip fractures occur in men. The overall mortality is about 20% in the first 12 months after hip fracture and is higher in men than women [15,16].
  • It is estimated that the lifetime risk of experiencing an osteoporotic fracture in men over the age of 50 is 30% [3], similar to the lifetime risk of developing prostate cancer [17].
  • Vertebral fractures may cause equal morbidity in men and women. Hip fractures in men cause significant morbidity and loss of normal functioning [18].
  • Although the overall prevalence of fragility fractures is higher in women, men generally have higher rates of fracture related mortality [16,19].
  • As in women, the mortality rate in men after hip fracture increases with age and is highest in the year after a fracture [20,21]. Over the first 6 months, the mortality rate in men approximately doubled that in similarly aged women [20].
  • Forearm fracture is an early and sensitive marker of male skeletal fragility. In aging men, wrist fractures carry a higher absolute risk for hip fracture than spinal fractures in comparison to women [22].
  • In Sweden, osteoporotic fractures in men account for more hospital bed days than those due to prostate cancer [23].
  • 30% of hip fractures and 20% of vertebral fractures occur in men [24].

Hip Fracture

  • Nearly 75% of all hip fractures occur in women [25] and about 25% of hip fractures in people over 50 occurs in men [26].
  • Hip fractures are invariably associated with chronic pain, reduced mobility, disability, and an increasing degree of dependence [27]. After sustaining a hip fracture 10-20% of formerly community dwelling patients require long term nursing care [28-30], with the rate of nursing home admission rising with age [29,31].
  • A 50 year old woman has a 2.8% risk of death related to hip fracture during her remaining lifetime, equivalent to her risk of death from breast cancer and 4 times higher than that from endometrial cancer [32].
  • Approximately 1.6 million hip fractures occur worldwide each year, by 2050 this number could reach between 4.5 million [9] and 6.3 million [26].
  • Hip fractures cause the most morbidity with reported mortality rates up to 20-24% in the first year after a hip fracture [33,34], and greater risk of dying may persist for at least 5 years afterwards [35]. Loss of function and independence among survivors is profound, with 40% unable to walk independently, 60% requiring assistance a year later [36]. Because of these losses, 33% are totally dependent or in a nursing home in the year following a hip fracture [34,37,38].
  • The highest risk of hip fractures are seen in Norway, Sweden, Iceland, Denmark and the USA [39].
  • Hip fractures account for a larger proportion of all fracture expenditures in men than women (73% vs. 61%). Overall, 23% of hip fracture expenditure occurs in men [16].

Vertebral Fracture

  • A 50 year old white woman has a 16% lifetime risk of experiencing a vertebral fracture and 5% in white men [3].
  • Vertebral fractures are associated with an increased risk of both further vertebral and nonvertebral fractures [8,19,40-42]. Women who develop a vertebral fracture are at substantial risk for additional fracture within the next year [40].
  • A woman 65 years of age with one vertebral fracture has a one in four chance of another fracture over 5 years, which can be reduced to one in eight by treatment [43].
  • Vertebral fractures can lead to back pain, loss of height, deformity, immobility, increased number of bed days, and even reduced pulmonary function [44-46]. Their impact on quality of life can be profound as a result of loss of self-esteem, distorted body image and depression [47-50]. Vertebral fractures also significantly impact on activities of daily living [51,52].
  • After hospitalization for a vertebral fracture, there is a greatly increased risk of requiring hospitalization for a further fracture in the years following initial hospitalization [53].
  • It is estimated that only one-third of vertebral fractures come to clinical attention [54] and under diagnosis of vertebral fracture is a worldwide problem [55].
  • The incidence of vertebral factures increases with age in both sexes. Most studies indicate that the prevalence of vertebral facture in men is similar to, or even greater than, that seen in women to age 50 or 60 years [56,57].

Risk Factors

  • Although low BMD confers increased risk for fracture, most fractures occur in postmenopausal women at moderate risk [58].
  • Many older women who suffer a hip fracture are not particularly osteoporotic. However, several characteristics increased fracture risk, including advancing age, lack of exercise, reduced visual acuity, falls, prevalent vertebral fracture, and lower total hip BMD [59].
  • Osteoporosis has been shown in twin and family studies to have a large genetic component [60,61]. A parental history of fracture (particularly hip fracture) confers an increased risk of fracture that is independent of BMD [62].
  • Studies have provided evidence that weight in infancy is a determinant of bone mass in adulthood [63-65] .
  • Smoking can lead to lower bone density and higher risk of fracture [66-69].
  • A high intake of alcohol confers a significant risk of future fracture [70]. The risk of vertebral and hip fractures in men increases greatly with heavy alcohol intake, particularly with long term intake [71].
  • Prolonged use of corticosteroids is the most common cause of secondary osteoporosis. It is estimated that 30-50% of patients on long term corticosteroid therapy will experience fractures [72,73].
  • Low body weight and weight loss is associated with greater bone loss and increased risk of fracture [74-77].
  • Some young females, particularly those training for elite athletic competition, exercise too much, eat too little, and consequently experience amenorrhea which makes them at risk for low bone mass and fractures [78].
  • Falls contribute to fractures - 90% of hip fractures result from falls [79]. A third of people over age 65 fall annually, with approximately 10-15% of falls in the elderly resulting in fracture, and almost 60% of those who fell the previous year will fall again [79,80].
  • Inactivity and impaired neuromuscular function are risk factors for falling and hip fractures [81,82].
  • Fractures are more prevalent among people with severe and profound developmental disabilities than in the general population [83].

Treatment

  • There is range of drug treatment available for postmenopausal osteoporosis. Different studies have consistently shown that, depending on the drug and the patient population, treatment reduces the risk of vertebral fracture by between 30-65% and of nonvertebral fractures by between 16-53% [84].
  • Treatment of established osteoporosis is cost-effective irrespective of age [85] and therapies with proven rapid efficacy may offer important value to healthcare payers, providers and patients [86].
  • Identifying and treating patients at risk of fracture, but who have not yet sustained a fracture, will substantially reduce the long term burden of osteoporosis. Reducing the risk of first fracture from 8% to 2% can reduce the 5-year fracture incidence from approximately 34% to 10% [87].
  • Evidence suggests that many women who sustain a fragility fracture are not appropriately diagnosed and treated for probable osteoporosis [88,89].
  • The great majority of individuals at high risk (possibly 80%), who have already had at least one osteoporotic fracture, are neither identified nor treated [90].
  • Poor compliance by patients with drug therapies for osteoporosis over a year leaves them at risk for fractures and higher health care costs [91].

Exercise

  • Childhood and adolescence are particularly valuable times to improve bone mass through exercise [92-96].
  • Higher levels of leisure time, sport activity, and household chores and fewer hours of sitting daily were associated with a significantly reduced relative risk for hip fracture [97,98].
  • Physical activity and fitness reduce risk of osteoporosis and fracture [99-101] and fall-related injuries [102-104].
  • Epidemiologic evidence suggests that physical activity is associated with reductions in hip fracture in women and men [105-107].
  • Strengthening back muscles can reduce the risk of vertebral fractures and kyphosis [108-111].
  • Studies have shown that bone mineral density in postmenopausal women can be maintained or increased with therapeutic exercise [112-114].
  • In the frail elderly, activity to improve balance and confidence may be valuable in fall prevention. Studies have shown that individuals who practice tai chi have a 47% decrease in falls and 25% the hip fracture rate of those who do not [102] and that tai chi can be beneficial for retarding bone loss in weight-bearing bones in early postmenopausal women [115].
  • Intensive exercise training can lead to improvements in strength and function in elderly patients who have had hip replacement surgery due to hip fracture [116].

Nutrition

  • Studies in children and adolescents have shown that supplementation with calcium, dairy calcium-enriched foods or milk enhances the rate of bone mineral acquisition [117-119]
  • Adequate levels of calcium intake can maximize the positive effect of physical activity on bone health during the growth period of children [120].
  • Calcium supplementation has been shown to have a positive effect on bone mineral density in postmenopausal women [121].
  • Calcium and vitamin D supplementation reduces rates of bone loss and also fracture rates in older male and female adults, and the elderly [122-124]. In institutionalized elderly women, this combined supplementation reduced hip fracture rates [122].
  • Fruit and vegetable intake was positively associated with bone density in a study in men and women. The exact components of fruits and vegetables which may confer a benefit to bone are still to be clarified [125,126].
  • Supplementation with both vitamin D and calcium, compared with calcium alone, reduced body sway in elderly women, suggesting that correction of vitamin D deficiency may improve neuromuscular function and reduce the propensity to fall [127].
  • In a study in elderly men and women, higher dietary protein intake was associated with a lower rate of age-related bone loss [128].
  • Good nutrition is an important part of a successful rehabilitation program in patients who have had an osteoporotic fracture. In frail, elderly, hip fracture patients this is crucially important, as poor nutritional status can slow recovery, and increase susceptibility to further fractures [129-132].
  • Anorexia nervosa can be a cause of amenorrhea (cessation of menstruation). the onset of anorexia nervosa frequently occurs during puberty, the time of life when maximal bone mass accrual occurs, thereby putting adolescent girls with anorexia nervosa at high risk for reduced peak bone mass [133].
  • Lactose intolerance has been shown to be associated with low bone mass and increased risk of fracture due to low milk (calcium) intake [134].
  • Moderate alcohol intake is not thought to be harmful to bone. However, chronic alcohol abuse is detrimental to bone health, with one of the mechanisms being a direct toxic effect on bone forming cells [135].

Europe

  • 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 [136].
  • In 2000 the number of osteoporotic fractures was estimated at 3.79 million of which 0.89 million were hip fractures (179000 hip fractures in men and 711000 in women). The total direct costs were estimated at €31.7 billion (£21 billion) which were expected to increase to €76.7 billion (£51 billion) in 2050 based on the expected changes in the demography of Europe [137].
  • It is estimated that in Europe, 179000 men and 611000 women will suffer a hip fracture each year and that the cost of all osteoporotic fractures in Europe is provisionally €25 billion [138].
  • A study in Switzerland showed that the annual costs of hospitalizations (in terms of duration of stay) for osteoporotic fractures were greater than those for myocardial infarction, stroke and breast cancer, and only slightly lower than for chronic obstructive pulmonary disease. For women, the costs associated with osteoporosis were higher than for all these diseases [139].
  • In Belgium, the annual costs of osteoporotic fracture are estimated at about €150 million [28].
  • In Sweden, hip fractures account for nearly as many hospital days as acute myocardial infarction and for more than prostate and breast cancers combined [140].
  • In Sweden, the probability of sustaining an osteoporotic hip fracture at the age of 50 years is 23% in women and 11% in men. The risk of sustaining a clinical vertebral fracture is 15% in women and 8% in men. For any common osteoporotic fracture, the remaining lifetime risk is 46% in women and 22% in men [4].
  • In Denmark, the estimated prevalence of osteoporosis in persons aged 50 years or more is about 41% among women and 18% among men [141].
  • A UK study has shown that fractures are a common problem in childhood, with about a third of boys and girls sustaining at least one fracture before 17 years of age, mostly at the arm. Fractures were more common among boys than girls, with peak incidences at 14 and 11 years of age, respectively [142].

North America

  • It is estimated that around 40% of US white women and 13% of US white men aged 50 years will experience at least one clinically apparent fragility fracture in their lifetime. At age 50, a white woman has a 17% chance of sustaining a hip fracture, 15% chance of vertebral fracture and 16% chance for forearm fracture, with comparable figures of 6%, 5% and 2.5%, respectively, for fractures in white males [11].
  • It has been estimated that in the USA, 54% postmenopausal white women are osteopenic and 30% are osteoporotic, and by the age of 80, 27% of women are osteopenic and 70% are osteoporotic [143].
  • Fracture incidence in the USA is usually higher for Whites and lower for other ethnic groups [144,145]. The incidence of hip fractures amonth Hispanic women in California appears to be increasing [146].
  • The National Osteoporosis Foundation in the USA reported that by 2010, about 12 million people over the age of 50 are expected to have osteoporosis and another 40 million to have low bone mass. By 2020, it is expected to increase to 14 million cases of osteoporosis and over 47 million cases of low bone mass [147]. This increase in cases could cause the number of hip fractures to double or triple by 2040 [148].
  • Annual direct medical cost in 1995 totaled $13.8 million (or $17.5 billion adjusted to 2002 dollars) for the treatment of osteoporotic fractures in the USA (hip fractures alone were responsible for 63% of the total) [149]. This exceeds annual expenditures for breast and gynecologic malignancies combined [150].
  • It has been estimated that in a 10 year period, postmenopausal white women in the USA will experience 5.2 million fractures of the hip, spine or distal forearm, which will lead to over $45 billion in direct medical expenditures [151].
  • More than 1.5 million Americans experience osteoporotic fractures each year (700 000 of which are vertebral fractures) with an annual cost of nearly $14 billion to the US healthcare system [37,149].
  • Osteoporosis affects approximately 1.4 million Canadians, mainly postmenopausal women and the elderly [152]. The prevalence of osteoporosis in Canada is about 16% in women age 50 years or older and approximately 6.5% in men [153].

Latin America

  • From 1990 to projections in 2050 the number of hip fractures for women and men aged 50-64 in Latin America will increase by 400%. For age groups older than 65 the increase will be a staggering 700 % [26].
  • Latin Americans will suffer an estimated 655,648 hip fractures in 2050, at an estimated direct cost of $13 billion [154].
  • In Brazil, 10 million people, approximately one person in every 17, has osteoporosis [155].
  • In Chile, in 1985, a large clinical trial of women older than 50 indicated that 46% have osteopenia and 22% have osteoporosis [156].
  • In Mexico, in 1998, one out of every four people has osteopenia or osteoporosis; some 24.5 million people; Mexicans suffer more than 100 hip fractures daily [157].
  • In Venezuela, in 1995 there were 9.6 hip fractures per day. In 2030 it is estimated that there will be 67 hip fractures per day. Of the people that suffer a hip fracture, 17% die in the first 4 months after the fracture. Clinical trials indicated that only the 10% of the population older than 70 years have normal peak bone mass [158].

Asia

  • It is projected that more than about 50% of all osteoporotic hip fractures will occur in Asia by the year 2050 [9,26]
  • Vertebral fractures are as frequent in Asian as in white women [159,160]., whereas hip fractures are less prevalent in Asians [161].
  • China:
    • From 1988 to 1992, the incidence of hip fractures in Beijing increased by 34% in women and 33% in men [162].
    • China: There is a higher incidence of hip fractures in men than women in China [162-164].
  • Hong Kong:
    • In 1996, the acute hospital care cost of hip fracture per year amounted to $17 million US [165].
    • The incidence of hip fracture has increased by 200% in the last 3 decades [166].
    • In Hong Kong Chinese, the prevalence of vertebral fracture was 17% in men [167] and 30% in women [160].
  • India: Expert groups peg the number of osteoporosis patients at approximately 26 million (2003 figures) with the numbers projected to increase to 36 million by 2013 [168].
  • Japan:
    • New hip fractures increased a dramatic 1.7-fold in the 10 years from 1987 to 1997 in Japan [169].
    • The prevalence of osteporosis in the Japanese female population aged 50-79 years has been estimated to be about 35% at the spine and 9.5% at the hip [161].
  • Korea:
    • The occurrence of hip fractures increased about 4-fold over 10 years (1991-2001) [170].
    • The number of hip fractures after 75 years of age was 4.3 per 1000 in women and 2.97 per thousand in men [171].
  • Singapore: Compared to the 1960's, hip fractures in women have gone up 5 times in women and 1.5 times in men [172].

Australia

  • About 11% of men and 27% of women aged 60 years or more are osteoporotic, and 42% of men and 51% of women are osteopenic [173].
  • The lifetime risk of osteoporotic fracture after 50 years of age: 42% in women, 27% in men [174].
  • 2 million Australians are affected by osteoporosis [174].
  • There are 20000 hip fractures per year in Australia (increasing by 40% each decade) [174].
  • Total costs relating to osteoporosis in Australia are $7.4 billion per year of which $1.9 billion are direct costs [174].

References

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