Osteoporosis – Suspicion in Older Adult
Osteoporosis is a systemic disease characterized by weakening of the bones, resulting in bone fragility and increased risk of fractures.
A consensus statement defining osteoporosis was reached in 1993: “Osteoporosis is a disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk.”
Osteoporosis is clinically defined by either the presence of a fragility/osteoporotic fracture OR radiographically via bone mineral testing
The presence of a fragility/osteoporotic fracture means the patient has “established osteoporosis.”
While osteoporotic fractures are generally those that would have not occurred in a young, healthy individual, major osteoporotic fractures are typically those at:
- Hip
- Spine
- Wrist (distal radius)
- Shoulder (proximal humerus)
Osteoporotic fractures are exceedingly common
Worldwide, 1 in 3 women and 1 in five men over the age of 50 will have an osteoporotic fracture.
In the United Sates, there are about 12.3 million individuals aged 50+ with osteoporosis (per USPSTF).
Osteoporotic fractures have a tremendous burden on morbidity and mortality
Vertebral fractures: can cause pain, spinal deformity, loss of height, increased risk of future fracture
Hip fractures – 36% one-year mortality rate
Pearl: In one year follow up of previously community dwelling patients who had a hip fracture:
- 80% required gait aid
- 15% lived in long term care
- 10% were bed ridden
Fractures are due to weakened bones AND precipitating events
Therefore, it is important to address BOTH osteoporosis and the fall risk in order to reduce fracture risk
We have many potent therapies to reduce the risk of fractures but patients tend to be under-recognized and under-treated
60-80% of patients who met screening guidelines did not get bone mineral density or who had a fracture (!) did not drug therapy.