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In “The Progression of Osteo­porosis: An Orthopaedist's Challenge,” photographer Geoff Higgs, MD, depicts the link between the risk for osteoporosis and family history.

AAOS Now

Published 5/1/2009
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Elaine Fiedler

Osteoporosis: A global concern

May is Osteoporosis Awareness and Prevention Month

“Osteoporosis is an international concern,” said Kimberly J. Templeton, MD, chair of the Academy’s U.S. Bone and Joint Decade Committee. The need to “stay one step ahead of osteoporosis” by educating the public on bone health and steps to prevent osteoporosis was reinforced during the 2009 AAOS Annual Meeting by a panel of international surgeons.

In the United States alone, 10 million people have been diagnosed with osteoporosis and at least 32 million people are at risk. Osteoporosis contributes to an estimated 1.5 million bone fractures each year. Among those older than age 65, one in two women and one in five men will sustain osteoporotic fractures. Because osteoporosis is a “silent” disease, with few outward manifestations until a fracture occurs, the public and the medical profession often are not as aware of its presence and impact as they should be.

Studies underscore need for follow-up
Several studies presented at the Annual Meeting underscored the need for follow-up and the importance of the orthopaedic surgeon’s role in ensuring that patients receive treatment for osteoporosis after a fracture. A recent study found that an osteoporosis management program initiated by an orthopaedic surgeon can result in much better care and higher adherence by patients to the pharmacologic treatment.

Wrist fractures, noted Dr. Templeton, are an important indicator of osteoporosis, as shown in an Israeli study conducted by Leonid Kandel, MD. Although the risk of another fracture in women increases three-fold after a distal radius fracture, and the risk of a hip fracture doubles, only 15 percent to 25 percent of women who sustain a distal radius fracture are referred for a bone density test by a family physician after the fracture.

“Patients must understand the connection between the current problem (the fracture) and the possibility that the underlying cause is osteoporosis,” said Dr. Kandel, who also advocated for more community education programs by hospitals on osteoporosis management and treatment.

“If we screen for osteoporosis at the earliest sign of the disease,” agreed T. Ted Funahashi, MD, “we can implement treatment and help to decrease the rate of hip fractures by 45 percent.” Dr. Funahashi was part of a major study at Kaiser Permanente in Southern California on the effectiveness of an osteoporosis management program. (See “Challenging orthopaedists to reduce hip fractures”)

He suggested that increasing the understanding of how osteoporosis relates to hip fractures can help to prevent fractures in those at greatest risk. “With screening and medication, osteoporosis management programs could reduce fractures and the burden of osteoporosis on our aging population,” he said.

The global impact
In Europe, the disability due to osteoporosis is greater than that caused by cancers (with the exception of lung cancer) and is comparable or greater than the disability caused by a variety of chronic noncommunicable diseases, such as rheumatoid arthritis, asthma, and high blood pressure-related heart disease.

An Italian study conducted by Francesco Pegreffi, MD, and associates analyzed the correlation among age, sex, duration of rheumatoid arthritis, vitamin D supplementation, and osteoporotic fractures. They found that female patients with rheumatoid arthritis for more than three years are at increased risk for osteoporosis. In such patients, corticosteroids can trigger bone loss, and the pain and loss of function can lead to inactivity, increasing greater risk. The study also found that vitamin D therapy was not sufficient to prevent further bone loss and fractures.

A “gift” from mothers to daughters
Researchers have long cited a clear link between the risk for osteoporosis and family history as evidenced by generations of mothers with osteoporosis and generations of daughters witnessing the effects of the disease—not realizing their own risk. As a result, the National Osteoporosis Foundation has adopted the theme, “A gift from mothers to daughters” for its 2009 osteoporosis awareness and prevention month efforts.

Orthopaedic surgeons can help break that cycle—not only by treating family members with fragility fractures and advising them about the need for osteoporosis treatment—but also by encouraging family dialogue about the importance of bone health. In addition to public education, orthopaedic surgeons can also help promote the need for fall prevention programs, which may be as or even more effective than medication.

Elaine Fiedler is a freelance writer who frequently covers health and medical news. She can be reached at elainefiedler@comcast.net