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More than 28 million women in the United States are affected by osteoporosis or have low bone mass. Four out of five people with osteoporosis are women; for women over age 50 years this results in a 40 percent lifetime risk for fractures. A high percentage of these women will become temporarily or permanently disabled, particularly after hip fracture, and up to 20 percent will die within a year of a hip fracture.
Women may not appreciate the true risk of this disease and therefore may fail to take appropriate preventive or treatment actions. A 1995 Gallup survey, supported by the American Heart Association and the American Medical Women’s Association, asked 505 American women ages 45 to 75 nationwide about their views on the leading causes of death among women. Women identified breast cancer as the leading cause of death, suggesting that it accounted for 40 percent of female mortality; heart disease came second, accounting for 19 percent. Actual mortality statistics show a clear discrepancy between real and perceived health threats. Cardiovascular diseases are the leading causes of death among women (accounting for 45 percent of mortality) and breast cancer ranks eighth out of nine categories, accounting for only 4 percent of deaths. A woman’s lifetime risk of hip fracture is equal to her combined risk of developing breast, uterine, and ovarian cancer.
Prevalence and Health Risk
Osteoporosis is defined as a universal, gradual reduction in bone mass to a point where the skeleton is compromised, resulting in fractures from minimal trauma. The 1993 Consensus Development Conference sponsored by the National Osteoporosis Foundation (NOF), the European Foundation for Osteoporosis and Bone Disease, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases further defined osteoporosis as a “systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with consequent increase in bone fragility and susceptibility to fracture.” In 1994, the World Health Organization (WHO) used clinical criteria to establish diagnostic categories for osteoporosis that focus on preventing fragility fractures. Using bone mineral density (BMD) testing, the WHO defined “normal” as BMD or bone mineral content (BMC) within 1.0 standard deviation (SD) of the young adult mean, WHO defines osteopenia as BMD or BMC mea, surement 1.0 to 2.5 SD below the gender-matched young adult mean. Osteopenia is often referred to as the first stage of osteoporosis and carries a two-fold increase risk of fracture. Osteoporosis is defined as BMD or BMC measurement 2.5 SD or more below the gender-matched, young adult mean, because most fragility fractures occur below this bone density. Osteoporosis is advanced osteopenia to the point where a reduction of total bone (protein and minerals) occurs and carries a four-to five-fold increased risk of fracture.
In 1996, the NOF estimated that approximately 29 million people aged 50 and over in the United States had osteoporosis or were at risk of developing this disease; this number is expected to rise to over 41 million by the year 2015. Even among young women, 16 percent were found by the third National Health and Nutrition Examination Survey (NHANES II) to have a BMD below normal (T score < -1). Osteoporosis is often considered the “silent disease” because its progression is insidious and most individuals are unaware of the disease until a bone fracture occurs. About 1.2 million osteoporosis-related fractures are reported each year in the United States. One in every two women and one of every eight men will .suffer an osteoporosis-related fracture at some time during their lives.
[ Read: Osteoporosis – Causes, Symptoms And Treatment ]
About 40 percent of women will have at least One vertebral fracture by the time they are 80 years of age. Vertebral compression fractures are often the first osteoporosis-related fracture to occur. Vertebral fractures can be painless and go undetected until a noticeable loss of height results ( < 1 inch). The consequences of these fractures are severe for many individuals. Multiple thoracic fractures may result in restrictive lung disease (manifested by exertional dyspnea, decreased exercise tolerance, and altered spirometry findings), and lumbar fractures may lead to a reduced abdominal cavity, limiting stomach capacity and leading to early satiety and impaired gastric emptying. Limited bladder capacity may also occur, causing or exacerbating problems already common among elderly and postmenopausal women (e.g., urinary incontinence, nocturia, and other bladder dysfunction). Abdominal distortion may also contribute to dyspareunia and sexual dysfunction in osteoporotic women. Postural disfigurement and height changes can further result in reduced mobility (including bending and reaching) and chronic pain.
The annual hip fracture incidence alone is estimated to range from 147,000 to 250,000, with approximately 80 percent resulting from minor trauma. Sufferers of hip fractures have a 5 to 20 percent greater risk of dying within the first year of their injury compared to others in the same age group; an additional 13 percent mortality is expected within the next year. Fifty percent of people with hip fracture will be unable to walk without assistance during their remaining lifetime. Fifty percent of women and men 60 years or older hospitalized for hip fractures will be discharged to a nursing home and about 25 percent will still reside in the nursing home 1 year later. Both hip and vertebral fractures can also cause psychological symptoms including depression, anxiety, fear, and anger, which can impede recovery and profoundly reduce quality of life?
The estimated economic burden of osteoporosis ranges from $6 to $18 billion and by the year 2040, projected treatment costs will reach $240 billion. The escalating economic cost of osteoporosis appears due to the aging population and increasing life span.
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