A new epidemic
What is osteoporosis?
Osteoporosis is technically defined as a progressive, systemic skeletal disorder that occurs in later life. From a practical perspective, osteoporosis makes bones fragile and susceptible to fracture when an older person suffers a fall. Osteoporosis can affect both sexes, but women are at greater risk, particularly after the menopause when oestrogen levels decline.
How common is osteoporosis?
The prevalence of osteoporosis increases sharply with age: from approximately 2% at 50 years, to more than 25% at 80 years. Currently, around 20 million people in the UK are aged 50 years or over; 11 million of whom are women. By 2020 this will have increased to 25 million, comprising approximately 13.5 million women.
Why does osteoporosis matter?
Postmenopausal women have a 50% chance of suffering an osteoporosis-related fracture in the remainder of their lifetime. Fracture begets fracture; once a fragility fracture has occurred, the risk of future fractures at least doubles. Crucially, half of hip fracture sufferers have broken another bone before breaking their hip. This “Fracture Cascade” has been highlighted by healthcare professional organisations, patient societies and policymakers as the key opportunity to improve outcomes. By consistently responding to the first fracture to prevent the second a substantial number of hip fractures could be prevented.
Click on image to enlarge
The diagram above illustrates how, without intervention, patients may progress from a wrist fracture during their 50s to a hip fracture during their 80s. Half of all future hip fracture sufferers have already experienced or, in the future, will experience a “Herald Fracture”. This could be at the wrist, humerus, spine or another skeletal site. Put simply, half of hip fracture patients give the NHS advance notice that one day they will be coming to their local orthopaedic unit for surgery. This progression is not inevitable because intervention and treatment after the first fracture can reduce the risk of further events by half. With more than 300,000 fragility fractures occurring in the UK every year – a figure which is set to rise – it is clear that osteoporosis really does matter.
“Hip fracture is all too often the final destination of a 30-year journey fuelled by decreasing bone strength and increasing falls risk”.
Broken bones, shattered lives
Self-evidently, all fragility fractures cause sufferers pain and distress. However, the impact of hip fracture can be particularly devastating:
- Only half of patients who survive a hip fracture will walk unaided again and in many cases they will never regain their former degree of mobility
- 12 months after a hip fracture, 60% of patients require assistance with activities, such as feeding, dressing or toileting – basic aspects of daily life that are fundamental to retaining dignity and independence. 80% need help with activities such as shopping or driving
- 10–20% of these patients are forced to live in care homes in the year following a hip fracture
Vertebral fractures also have a profound impact on morbidity and quality of life by causing back pain, loss of height and curvature of the spine (kyphosis), which may cause problems with breathing, eating and digestion. Non-vertebral fractures such as wrist fractures can also make even the most basic activities, such as getting dressed or going to the toilet unaided, virtually impossible. If Disability Adjusted Life Years (DALYs) are used to calculate the disability burden of different diseases, osteoporosis has a greater impact than most types of cancer, with the exception of lung cancer.
Fractures can be fatal
Hip fractures are the most common cause of accident-related deaths in older people and are also associated with increased mortality. Vertebral fractures are also associated with increased mortality, with an estimated 4.4-fold increase. As the population ages and the number of people affected by osteoporosis rises, the number of deaths related to fractures is expected to increase significantly.
1,150 people die every month in the UK as a result of hip fracture
The Breaking Point Report provided a snapshot of the current situation for women with osteoporosis in the UK.
Breaking Point described the practical steps that must be taken by healthcare professionals, policy makers and commissioners, as well as the public to prevent avoidable suffering and cost of osteoporotic fractures.
Osteoporosis is a long-term condition. Its onset is asymptomatic and its duration thereafter lifelong; and as a result of mass survival into old age it is becoming much commoner. As a long-term condition it is treatable, but usually left untreated. Its exacerbations – in the form of fragility fractures – are a major and rapidly increasing cause of acute morbidity.
BOA-BGS Blue Book: The care of patients with fragility fracture. September 2007