Looming increase in fragility fractures demands improved preventative care


Looming increase in fragility fractures demands improved preventative care

Two million fractures per year are attributed to osteoporosis, and with an increasing elderly population, this number is expected to double by 2040. Despite these numbers and the increasing economic burden of these fractures, published studies show that only 20% of patients with osteoporosis are receiving proper treatment and prevention measures.
Fracture Liaison Services and other fracture prevention programs are working to bend the curve on the fragility fracture rate in the elderly population.
“We are trying to apply the models that have been shown to be effective and reduce the numbers of fragility fractures by between 20% and 40%,” Richard M. Dell, MD, an orthopedic surgeon at Kaiser Permanente in Downey, Calif., toldOrthopedics Today.
According to the National Osteoporosis Foundation (NOF), about 52 million Americans have osteoporosis or low bone mass (osteopenia), which places them at increased risk for osteoporosis.
“The problem is that as people get older, their risk for a hip fracture doubles roughly every 5 years,” Dell said.
To reduce the fragility fracture rate, Richard M. Dell, MD, said efforts should focus on instituting evidence-based medicine best practices.

To reduce the fragility fracture rate, Richard M.
Dell, MD, said efforts should focus on instituting
evidence-based medicine best practices.
Image: Paul Woodworth, MD
Data have suggested that approximately one in two women and one in four men aged 50 years or older will break a bone due to osteoporosis. “There are almost two times as many hip fractures as there are new cases of breast cancer diagnosed each year,” Julie A. Switzer, MD, director of geriatric trauma at Regions Hospital in St. Paul, Minn., and assistant professor at the University of Minnesota, told Orthopedics Today.
Burge and colleagues found there were more than 2 million osteoporosis-related fractures costing more than $19 billion in 2005. They projected that by 2025, annual fractures and costs will increase by almost 50%, with the most rapid growth estimated for people aged 65 years to 74 years — an increase of more than 87%.
According to the Administration on Aging, the population of those age 65 years or older was 39.6 million in 2009. By 2030, this figure is estimated to reach 72.1 million.
The consequences of these fragility fractures are significant. “Mortality rates for those who sustain an osteoporotic-related fracture are 81% higher in women and 105% higher in men than [patients with] non-osteoporotic fractures,” saidKenneth A. Egol, MD, professor and vice chairman of the Department of Orthopedic Surgery at the Hospital for Joint Diseases and NYU Medical Center. “Having a fragility fracture significantly increases mortality risk and that usually stays elevated for a period of time — up to 5 years.”
After a hip fracture, the 1-year mortality rate is 25% and this number is closer to 30% in men, according to Switzer. “Across the board, morbidity and mortality following hip fracture is much greater in men than in women,” she said. “In other words, 80% of hip fractures occur in women, and 20% occur in men, but if you are one of the men who sustains a hip fracture, you are probably frailer than other men your age.”
Switzer added that sustaining more than one fracture simultaneously also increases the mortality rate.
Data continue to show that few patients who need osteoporosis treatment receive it. In a prospective observational study, Greenspan and colleagues analyzed self-administered questionnaires from 60,393 postmenopausal women aged 55 years or older and found that 17% of women who reported an incident fracture had started anti-osteoporosis medication.
“Only about 20% of patients who actually have a fragility fracture are identified as having osteoporosis and are then treated,” Dell said.

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