IOF LogoIOF World Congress on Osteoporosis 2004, May 14-18, 2004, Rio de Janeiro, Brazil
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How should societies best alleviate the burden of osteoporotic hip fractures?
Research presented at the 2004 IOF World Congress on Osteoporosis aims to help governments set preventive treatment standards and advises greater assistance for families in the aftermath of hip fractures.

May 17, 2004

Heavy family burden, mortality from hip fracture

For survivors of hip fracture and their families, the costs do not end with surgical treatment and physical therapy sessions. Fully two years after hip fracture, according to French researchers, four in ten patients living at home needed significant daily assistance from their family members (conference abstract OC7).

"It has been reported that around 20 percent of people who previously lived independently have to be institutionalized after a hip fracture," said Dr. Marie-Christine De Vernejoul, of INSERM Unit 349 in Paris, France. "We suspected that there could also be a high intangible cost for people who are living with their families but are no longer independent after a hip fracture."

De Vernejoul and her colleagues followed up on 1512 patients in Picardie, France, who had fractured their hip two years earlier. Of 599 people living in "individual accommodations," i.e., not in nursing homes, 38 percent needed help with daily living (e.g., washing or dressing). For about half of this group, this dependency extended to eating, and using the toilet.

While some of the help was provided by paid workers, the majority fell to family members, usually wives and daughters. "In order to avoid institutionalization of patients after a hip fracture, help should be given to the families," suggested De Vernejoul.

Hip fracture risk is higher in prosperous countries

Confirming results from other, less comprehensive studies, researchers have found that hip fracture incidence is closely tied to economic standards.

Who should receive treatment for osteoporosis, and what sort of treatment should be offered? This is a question that vexes policy makers and private payers in different countries. The World Health Organization, with the support of IOF«s Committee of Scientific Advisors, is in the process of producing guidelines to help these decision-makers establish 'cut-offs'-thresholds above which interventions will be recommended-but this process is complicated by large disparities in economic prosperity between countries, as well as variations in health care priorities.

The WHO first needed an overview of how economic prosperity and osteoporosis risk were related. Incidence of hip fracture was selected as the simplest way to assess bone fragility between countries of very different economic standards. Gross domestic product (GDP) per person was selected as the index of economic prosperity.

A multinational research team led by Dr. Olof Johnell of Malmo University Hospital in Sweden, vice-chairman of the IOF Committee of Scientific Advisors, examined data from 30 countries throughout the world. Per person GDP ranged from US,700 to ,600, and for each ,000 increase in GDP per person, the probability that a person would suffer a hip fracture over a 10-year period increased by 1.3 percent.

Longer life expectancy is one obvious reason that hip fracture risks would increase in wealthier countries. Scientists can only speculate on the others, such as reduced physical activity or environmental factors that could range from diets to toxins.

"This is no more than speculation at this point because we have done little research on these questions," said Johnell.

The next stage of this WHO research program will generate recommendations for how decision-makers in different countries should determine cut-offs for osteoporosis treatment, and what those treatments might be.

For more information about the IOF World Congress on Osteoporosis, and to read the abstracts of presentations please visit:


The International Osteoporosis Foundation (IOF) is a worldwide organization dedicated to the fight against osteoporosis. It brings together scientists, physicians, patient societies and corporate partners. Working with its 165 member societies in more than 85 locations, and other healthcare-related organizations around the world, IOF encourages awareness and prevention, early detection and improved treatment of osteoporosis.

Osteoporosis, in which the bones become porous and break easily, is one of the world's most common and debilitating diseases. The result: pain, loss of movement, inability to perform daily chores, and in many cases, death. One out of three women over 50 will experience osteoporotic fractures, as will one out of eight men(1). Unfortunately, screening for people at risk is far from being a standard practice. Osteoporosis can, to a certain extent, be prevented, it can be easily diagnosed and effective treatments are available.

1 Melton U, Chrischilles EA, Cooper C et al. How many women have osteoporosis? Journal of Bone Mineral Research, 1992; 7:1005-10

For more information on the IOF World Congress on Osteoporosis, including access to all the abstracts and press releases, please refer to:

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For further information, please contact
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International Osteoporosis Foundation:

Tel. +41 22 994 0100
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