Osteoporosis Educational Series, Lecture 1of 3:
A Public Health Problem of Older Age
Nahid Rianon, M.D., Dr.P.H.
The University of Texas Health Science Center at Houston
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 Quiz
Question 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 year
c) About $100 million per year
d) Less than 5 billion per year
Pre Quiz
Question 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) Ribs
b) Hip
c) Vertebrae
d) Tibia
Pre Quiz
Question 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
building
c) A family history of hip fracture in the mother
d) A normal chest x-ray reporting osteopenic changes in bones
Pre Quiz
Question 4 of 5
Which of the following sites is a generally recommended site for
DEXA scan to diagnose osteoporosis?
a) Heel
b) Wrist
c) Hip
d) Finger
Pre Quiz
Question 5 of 5
Almost every elderly person recovers to their baseline functional
state after a hip fracture.
a) True
b) False
Osteoporosis in the Elderly

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
Osteoporotic Fractures
For Women:
 Incidence of fractures per year
exceeds that of stroke,
myocardial infarction (MI) and
breast cancer combined
For Men:
 Fracture risk is higher
than that of prostate
cancer


~1:2 Caucasian women ≥ 50
years experience a fracture in
their lifetimes


1 in 3 for vertebral fractures
1 in 6 for hip fracture
21% ≥ 50 years will
experience a fracture
Osteoporotic Fractures: Where and How

Common sites:


Vertebral body,
femur neck &
wrists
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
Osteoporosis and Quality of Life
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: 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”
Clinical Diagnosis of Osteoporosis
Usual sites for DEXA is lumbar spine and left hip
DEXA scan - Left hip
DEXA scan - Lumbar spine
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
Hip Fracture Worldwide in Year 2000
Estimated number of hip fractures worldwide by age in 2000
No. of Hip fracture (in thousand)
250
200
Females
150
100
Males
50
0
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90-94
95+
Age group
Johnell O & Kenis J, 2006; Osteopor Int.
Post Quiz
Question 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 year
c) About $100 million per year
d) Less than 5 billion per year
Post Quiz
Question 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) Ribs
b) Hip
c) Vertebrae
d) Tibia
Post Quiz
Question 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 building
c) A family history of hip fracture in the mother
d) A normal chest x-ray reporting osteopenic changes in bones
Post Quiz
Question 4 of 5
Which of the following sites is a generally recommended site for
DEXA scan to diagnose osteoporosis?
a) Heel
b) Wrist
c) Hip
d) Finger
Post Quiz
Question 5 of 5
Almost every elderly person recovers to their baseline functional state
after a hip fracture.
a) True
b) False
Thank you
Questions?
References









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
25
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