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Nahid Rianon, M.D., Dr.P.H.The University of Texas Health Science Center at Houston
Osteoporosis Educational Series, Lecture 1of 3:A Public Health Problem of Older Age
Goal and Objectives
GOAL: The goal of this presentation is to demonstrate the public health importance of osteoporosis as a disease of old age and the clinical definition of osteoporosis
LEARNING OBJECTIVES:At the end of this presentation, attendees will be able to– Learn the clinical definition of osteoporosis.– Describe the health impact of osteoporotic fractures from
an individual to health care system level. – Identify the generally recommended DEXA site to diagnose
osteoporosis.
2
Pre QuizQuestion 1 of 5
Approximately how much is spent annually for health care related to osteoporosis and associated fractures in the USA? (pick the one that best fits the answer) a)More than $20 billion per year b)About $7 billion per yearc)About $100 million per year d)Less than 5 billion per year
Pre QuizQuestion 2 of 5
Which of the following is the MOST common site for fracture for age related bone loss or osteoporosis in the elderly population? (pick the one that best fits the answer)
a)Ribsb)Hipc)Vertebraed)Tibia
Pre QuizQuestion 3 of 5
Which one of the following statements best fits the clinical criteria for definition of osteoporosis due to age related bone loss?
a)A T-score of -2.5 for spine or femur neck bone mineral density (BMD)b)A vertebral fracture in a 25 year old man due to a fall from the 4th floor of a buildingc)A family history of hip fracture in the motherd)A normal chest x-ray reporting osteopenic changes in bones
Pre QuizQuestion 4 of 5
Which of the following sites is a generally recommended site for DEXA scan to diagnose osteoporosis?
a)Heelb)Wristc)Hipd)Finger
Pre QuizQuestion 5 of 5
Almost every elderly person recovers to their baseline functional state after a hip fracture.
a)Trueb)False
Osteoporosis & related fractures - important public health problems of old age
~10 million Americans suffers from osteoporosis
~34 million are at risk
More than 2 million fractures in the USA in 2005 were attributable to osteoporosis 547,000 vertebral fractures 297,000 hip fractures 397,000 wrist fractures
Osteoporosis in the Elderly
For Women: Incidence of fractures per year
exceeds that of stroke, myocardial infarction (MI) and breast cancer combined
~1:2 Caucasian women ≥ 50 years experience a fracture in their lifetimes 1 in 3 for vertebral fractures 1 in 6 for hip fracture
For Men: Fracture risk is higher
than that of prostate cancer
21% ≥ 50 years will experience a fracture
Osteoporotic Fractures
Common sites: Vertebral body,
femur neck & wrists
Osteoporotic Fractures: Where and How
Fractures without much force or any trauma: Turning in bed, fall
from a standing height
Osteoporosis and Health Care Events
Health Care Cost
~$22 billion is spent annually for osteoporosis and related fracture in the USA
~$7 billion is spent annually for breast cancer in the USA
Fractures can decrease quality of life: Physical: pain, compressed abdomen, spinal deformity Functional: decreased mobility Psychosocial: depression Rate of recurrent vertebral fracture after the initial one ~5-20%
Osteoporosis and Quality of Life
If one survives a hip fracture —
~50% with hip fractures will never walk without assistance ~25% will require long-term care
Osteoporosis and Quality of Life
Osteoporosis: Measure of Bone Health
Revised definition:Compromised bone strength that increases risk of fracture NIH Consensus Conference 2000
Bone Strength is characterized by Bone density and Other bone qualities, e .g., micro-architecture influenced by bone
remodeling, bone turnover, mineralization and other factors that are more difficult to quantify, such as “damage accumulation”
DEXA scan - Left hip
Usual sites for DEXA is lumbar spine and left hip
DEXA scan - Lumbar spine
Clinical Diagnosis of Osteoporosis
Osteoporosis = A T- score of <-2.5 for BMD Osteopenia = A T- score of -1 to -2.5 for BMD
BMD Decreases with Advanced Age
ASBMR 2011
0
50
100
150
200
250
50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95+
No
. of H
ip f
ract
ure
(in
tho
usa
nd
)
Age group
Estimated number of hip fractures worldwide by age in 2000
Females
Males
Johnell O & Kenis J, 2006; Osteopor Int.
Hip Fracture Worldwide in Year 2000
Approximately how much is spent annually for health care related to osteoporosis and associated fractures in the USA? (pick the one that best fits the answer)
a)More than $20 billion per year b)About $7 billion per yearc)About $100 million per yeard)Less than 5 billion per year
Post QuizQuestion 1 of 5
Post QuizQuestion 2 of 5
Which of the following is the MOST common site for fracture for age related bone loss or osteoporosis in the elderly population? (pick the one that best fits the answer)
a)Ribsb)Hipc)Vertebraed)Tibia
Post QuizQuestion 3 of 5
Which one of the following statements best fits the clinical criteria for definition of osteoporosis due to age related bone loss?
a)A T-score of -2.5 for spine or femur neck bone mineral density (BMD)b)A vertebral fracture in a 25 year old man due to a fall from the 4th floor of a buildingc)A family history of hip fracture in the motherd)A normal chest x-ray reporting osteopenic changes in bones
Post QuizQuestion 4 of 5
Which of the following sites is a generally recommended site for DEXA scan to diagnose osteoporosis?
a)Heelb)Wristc)Hipd)Finger
Post QuizQuestion 5 of 5
Almost every elderly person recovers to their baseline functional state after a hip fracture.
a)Trueb)False
Thank you
Questions?
25
American Cancer Society. Cancer Facts and Figures 1996 Blume S, Curtis J. Medical costs of osteoporosis in the elderly Medicare
population. Osteoporos Int. 2010 Dec 17 Lavelle W & Cheney R, 2006, The Spine Journal: 488-493 and Lindsay R et
al., 2001, JAMA: 285-323. National Osteoporosis Foundation. Physician’s Guide; Belle Mead,
NJ:Exerpta Medica, Inc. 1998 NIH Consensus Conference 2000 Riggs BL, et al. Bone. 1995;17(Suppl):505S State of Health Care Quality 2007, National Committee for Quality
Assurance, Washington D.C., page 27 US Office of the Surgeon General Van Staa T, et al. Bone. 2001;29:517
References
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