Osteoporosis Basics

Costs

Financial

• The overall yearly cost to the Canadian healthcare system of treating osteoporosis and the fractures it causes was over $2.3 billion as of 2010. This cost includes acute care costs, outpatient care, prescription drugs and indirect costs. This cost rises to $3.9 billion if a proportion of Canadians were assumed to be living in long-term care facilities because of osteoporosis. (The burden of illness of osteoporosis in Canada, Tarride et al, Osteoporosis International March 2012)Given the increasing proportion of older people in the population, these costs will likely rise.
• A study reported that only 44% of people discharged from hospital for a hip fracture return home; of the rest, 10% go to another hospital, 27% go to rehabilitation care, and 17% go to long-term care facilities.

Human

The reduced quality of life for those with osteoporosis is enormous. Osteoporosis can result in disfigurement, lowered self-esteem, reduction or loss of mobility, decreased independence and even death.

Some basic human impact statistics about osteoporosis and fractures:

• at least 80% of fractures in people 50+ are related to osteoporosis
• a 50-year-old woman has a 40% chance of developing hip, vertebral or wrist fractures during her lifetime.
• patients are at highest risk for subsequent fracture in the first few months following a vertebral fracture.
• 1 in 5 women who have a new vertebral fracture will fracture again within one year.
• 14% of persons with a wrist fracture suffered a repeat fracture within 3 years.
• Over 1 in 2 hip fracture patients will suffer another fracture within 5 years.

The statistics related to hip fractures are particularly disturbing:

• approx. 30,000 hip fractures annually in Canada osteoporosis causes 70-90% of 30,000 hip fractures annually
• each hip fracture costs the system $21,285 in the 1st year after hospitalization, and $44,156 if the patient is institutionalized
• 28% of women and 37% of men who suffer a hip fracture will die within a year
• hip fractures result in disability in 50% of those who survive
• the lifetime risk of hip fracture is greater (1 in 6) than the 1 in 9 lifetime risk of developing breast cancer.

Assessing risk factors for fracture and testing for bone loss are the keys to preventing fractures

Osteoporosis does not develop overnight. Bone mass can be lost steadily for many years without experiencing any symptoms or signs of the disease until a bone fractures. For this reason, osteoporosis is often called “the silent thief” – literally stealing our bone mass without giving us any indication whatsoever. If osteoporosis is first diagnosed at the time a fracture occurs, it is already fairly advanced. A fragility fracture is the most significant clinical consequence of osteoporosis, and therefore preventing a fracture, or the second fracture if one has already occurred, is of paramount importance.

Who should be assessed for risk of fracture?

• Women and men over 50 to identify those at high risk
• Anyone over 50 who has experienced a fragility fracture

How is the Assessment Done?

Detailed history to identify risk factors for low BMD, future fractures and falls:

• Prior fragility fracture
• Parental hip fracture
• Glucocorticoid use
• Current smoking
• High alcohol intake (3 or more drinks per day)
• Rheumatoid arthritis
• Inquire about falls in past 12 months
• Inquire about gait & balance

Physical examination

• Measure weight
• Screening for vertebral fractures:
• Measure height annually
• Measure rib to pelvis distance
• Measure occiput-to-wall distance
• Spinal x-ray indicated if there is evidence of vertebral fracture
• Assess fall risk by using Get-Up-and-Go Test