Nahid Rianon, M.D., Dr.P.H.The University of Texas Health Science Center at Houston

Osteoporosis Educational Series, Lecture 1of 3:A Public Health Problem of Older Age

Goal and Objectives

GOAL: The goal of this presentation is to demonstrate the public health importance of osteoporosis as a disease of old age and the clinical definition of osteoporosis

LEARNING OBJECTIVES:At the end of this presentation, attendees will be able to– Learn the clinical definition of osteoporosis.– Describe the health impact of osteoporotic fractures from

an individual to health care system level. – Identify the generally recommended DEXA site to diagnose

osteoporosis.

2

Pre QuizQuestion 1 of 5

Approximately how much is spent annually for health care related to osteoporosis and associated fractures in the USA? (pick the one that best fits the answer) a)More than $20 billion per year b)About $7 billion per yearc)About $100 million per year d)Less than 5 billion per year

Pre QuizQuestion 2 of 5

Which of the following is the MOST common site for fracture for age related bone loss or osteoporosis in the elderly population? (pick the one that best fits the answer)

a)Ribsb)Hipc)Vertebraed)Tibia

Pre QuizQuestion 3 of 5

Which one of the following statements best fits the clinical criteria for definition of osteoporosis due to age related bone loss?

a)A T-score of -2.5 for spine or femur neck bone mineral density (BMD)b)A vertebral fracture in a 25 year old man due to a fall from the 4th floor of a buildingc)A family history of hip fracture in the motherd)A normal chest x-ray reporting osteopenic changes in bones

Pre QuizQuestion 4 of 5

Which of the following sites is a generally recommended site for DEXA scan to diagnose osteoporosis?

a)Heelb)Wristc)Hipd)Finger

Pre QuizQuestion 5 of 5

Almost every elderly person recovers to their baseline functional state after a hip fracture.

a)Trueb)False

Osteoporosis & related fractures - important public health problems of old age

~10 million Americans suffers from osteoporosis

~34 million are at risk

More than 2 million fractures in the USA in 2005 were attributable to osteoporosis 547,000 vertebral fractures 297,000 hip fractures 397,000 wrist fractures

Osteoporosis in the Elderly

For Women: Incidence of fractures per year

exceeds that of stroke, myocardial infarction (MI) and breast cancer combined

~1:2 Caucasian women ≥ 50 years experience a fracture in their lifetimes 1 in 3 for vertebral fractures 1 in 6 for hip fracture

For Men: Fracture risk is higher

than that of prostate cancer

21% ≥ 50 years will experience a fracture

Osteoporotic Fractures

Common sites: Vertebral body,

femur neck & wrists

Osteoporotic Fractures: Where and How

Fractures without much force or any trauma: Turning in bed, fall

from a standing height

Osteoporosis and Health Care Events

Health Care Cost

~$22 billion is spent annually for osteoporosis and related fracture in the USA

~$7 billion is spent annually for breast cancer in the USA

Fractures can decrease quality of life: Physical: pain, compressed abdomen, spinal deformity Functional: decreased mobility Psychosocial: depression Rate of recurrent vertebral fracture after the initial one ~5-20%

Osteoporosis and Quality of Life

If one survives a hip fracture —

~50% with hip fractures will never walk without assistance ~25% will require long-term care

Osteoporosis and Quality of Life

Osteoporosis: Measure of Bone Health

Revised definition:Compromised bone strength that increases risk of fracture NIH Consensus Conference 2000

Bone Strength is characterized by Bone density and Other bone qualities, e .g., micro-architecture influenced by bone

remodeling, bone turnover, mineralization and other factors that are more difficult to quantify, such as “damage accumulation”

DEXA scan - Left hip

Usual sites for DEXA is lumbar spine and left hip

DEXA scan - Lumbar spine

Clinical Diagnosis of Osteoporosis

Osteoporosis = A T- score of <-2.5 for BMD Osteopenia = A T- score of -1 to -2.5 for BMD

BMD Decreases with Advanced Age

ASBMR 2011

0

50

100

150

200

250

50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95+

No

. of H

ip f

ract

ure

(in

tho

usa

nd

)

Age group

Estimated number of hip fractures worldwide by age in 2000

Females

Males

Johnell O & Kenis J, 2006; Osteopor Int.

Hip Fracture Worldwide in Year 2000

Approximately how much is spent annually for health care related to osteoporosis and associated fractures in the USA? (pick the one that best fits the answer)

a)More than $20 billion per year b)About $7 billion per yearc)About $100 million per yeard)Less than 5 billion per year

Post QuizQuestion 1 of 5

Post QuizQuestion 2 of 5

Which of the following is the MOST common site for fracture for age related bone loss or osteoporosis in the elderly population? (pick the one that best fits the answer)

a)Ribsb)Hipc)Vertebraed)Tibia

Post QuizQuestion 3 of 5

Which one of the following statements best fits the clinical criteria for definition of osteoporosis due to age related bone loss?

a)A T-score of -2.5 for spine or femur neck bone mineral density (BMD)b)A vertebral fracture in a 25 year old man due to a fall from the 4th floor of a buildingc)A family history of hip fracture in the motherd)A normal chest x-ray reporting osteopenic changes in bones

Post QuizQuestion 4 of 5

Which of the following sites is a generally recommended site for DEXA scan to diagnose osteoporosis?

a)Heelb)Wristc)Hipd)Finger

Post QuizQuestion 5 of 5

Almost every elderly person recovers to their baseline functional state after a hip fracture.

a)Trueb)False

Thank you

Questions?

25

American Cancer Society. Cancer Facts and Figures 1996 Blume S, Curtis J. Medical costs of osteoporosis in the elderly Medicare

population. Osteoporos Int. 2010 Dec 17 Lavelle W & Cheney R, 2006, The Spine Journal: 488-493 and Lindsay R et

al., 2001, JAMA: 285-323. National Osteoporosis Foundation. Physician’s Guide; Belle Mead,

NJ:Exerpta Medica, Inc. 1998 NIH Consensus Conference 2000 Riggs BL, et al. Bone. 1995;17(Suppl):505S State of Health Care Quality 2007, National Committee for Quality

Assurance, Washington D.C., page 27 US Office of the Surgeon General Van Staa T, et al. Bone. 2001;29:517

References

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