Osteoporosis: Preventable silent killer
Rose-Marie Boylan*
Health Economics & Outcomes, Independent Researcher, Canada
Submission: November 02, 2021;Published: November 24, 2021
*Corresponding author: Rose-Marie Boylan, Health Economics & Outcomes, Independent Researcher, Canada
How to cite this article: Rose-Marie B. Osteoporosis: Preventable silent killer. JOJ Orthoped Ortho Surg. 2021; 3(2): 555606.DOI: 10.19080/JOJOOS.2021.03.555606
Facts & Figures Burden of Illness
a. 54 million Americans– have low bone density or osteoporosis [1].
b. 1.5 up to 2 million Canadians are diagnosed with osteoporosis [2].
c.1 in 3 women will suffer from osteoporosis & 1 in 5 men will get osteoporosis [2].
d. 20% of women will die within the first year following a hip fracture & up to 37-40% of men will die in the first year following a hip fracture. (http://www.osteoporosis.ca/osteoporosis-and-you/osteoporosis-facts-and-statistics/)
e. Hip fractures from osteoporosis take up more hospital bed days than stroke, diabetes, or heart attack [2].
f. In the United States there are 2 million broken bones due to osteoporosis a year. This equals 5,500 bone breaks per day. Only 2 in 10 of these patients will get a follow-up test or treatment [1].
g. Every 3 seconds worldwide someone breaks a bone due to osteoporosis (International Osteoporosis Foundation).
A Silent Killer, a Silent Disease
“Most excess deaths occur in the first 6 months after a hip fracture [3-5] Like a robber who creeps into our home at night silently stealing from us, osteoporosis does just that. Only this thief robs us of the basic framework that upholds our entire physical structure; our bones. Osteoporosis demineralizes our skeletal structure & the framework that holds us up and protects our internal organs. This is the fundamental structure which allows us to walk, move, perform life’s daily activities & even feel grounded on the earth against gravity & other accelerations. In a pandemic where social distancing is controlled & patients are alienated: Osteoporosis can be a death sentence for persons living alone in a pandemic. The cost of public health measures is a humanistic, social & ethical cost as it reduces women or men with hip fractures access to family or social support, nutrition & protection. About one in two women & up to one in four men over the age of 50 will break a bone due to osteoporosis [2]. In the United States alone this represents an estimated two million broken bones every year [1].
What is Osteoporosis?
27% of patients enter a nursing home for the 1st time after a hip fracture [5].
Osteoporosis thins out our bones making them weak & reduce their strength. Osteoporosis means “porous bone”. It is a disease where the quality and the actual density of the bones become reduced. “Os” means bone, “porosis” means “poris”; whilst creating holes in our bones and weakening them. The most common sites where we will break a bone with a minor injury will be the wrist, spine, shoulder or hip according to specialists who treat the disease. A man aged 50 or older is more likely to break a bone due to osteoporosis than he is of getting prostate cancer [1]. When we look at an experimental bone biopsy according to Dr. Paul Sidani who led previously the Clinic of Menopause, Osteoporosis & Prevention of Fractures at the Santa Cabrini Hospital in Montreal, Canada, he states “these bones look almost like Swiss cheese when viewing the vertebrae bones because they have become so porous with holes”. Dr. Sidani who has been practicing for several decades, recently stated that some patients even with something as innocuous as a sneeze, may fracture their ribs due to fragility. This is what we call a fragility fracture not caused by a traumatic accident.
Normal Bones vs. Weak Bones
One year after a hip fracture, 40% of patients are unable to walk independently, 80% are restricted in other daily activities such as driving & even grocery shopping [5].
If you take a normal vertebrae or bone and apply pressure to it, it will resist. If you take a bone with a low bone density that is weak or at risk and porous with holes; it will collapse, smash and fracture. When someone loses their height, this is an indication that a vertebrae has smashed. When someone fractures a wrist and has risk factors for osteoporosis it is time to consult a specialist for a bone density test. In these instances, the bone density has become weak & the person is at risk of a fragility fracture. This is osteoporosis. This is what happens to us after the age of 50. After the age of 40, all fractures should be considered suspicious, especially in women.
Myth # 1: Osteoporosis is a women’s health issue
A man aged 50 or older is more likely to break a bone due to osteoporosis than he is of getting prostate cancer. A woman’s risk of breaking a hip due to osteoporosis is equal to her risk of breast, ovarian and uterine cancer combined [1] Women and men alike begin to lose bone in their mid-30s. Women as they approach menopause, lose bone at a greater rate, about 2-3 per cent per year [2]. Despite being more frequently diagnosed in females, osteoporosis occurs in men too. Osteoporosis is both under diagnosed & underreported in males [6-7]. 2/3 of vertebral fractures remain undiagnosed [5].
Myth # 2: Osteoporosis is not a costly disease
The annual cost of osteoporosis & fractures was estimated at $22 billion dollars in the United States in 2008. [8] In Canada, it was estimated at $2.3 billion dollars in 2010
People in Canada & the United States are living much longer than ever. The World Health Organization (WHO) data from 2010 predicts the average life expectancy of males to be 75.9 years and that of females to be 81.2 years of age. For 2008, the annual cost of osteoporosis & fractures was estimated at $22 billion dollars in the United States [8]. These figures on the burden of illness in the United States correlate with other figures based on different methodologies which were projected from the costs of $16 billion dollars in 2002 which reviewed a U.S. based population sample of the elderly [7]. Other experts in the field then projected the cumulative costs for osteoporosis over the next 2 decades to exceed $474 billion dollars in the United States alone [7-15 and 17-19]. Comparatively in Canada, “the overall yearly costs of osteoporosis were estimated to be $2.3 billion dollars in 2010. These costs only include acute care costs, outpatient care costs, prescription drug costs & indirect costs.” These costs allegedly rise anywhere from $3.9 up to $4.1 billion if a proportion of Canadians were assumed to be living in long-term care facilities because of osteoporosis [7].
With hip fractures from osteoporosis taking up more hospital bed days than stroke, diabetes, or heart attack [2]. It would be important to do a burden of illness study to evaluate the combined bed days for osteoporosis fractures associated with 27% of the elderly being institutionalized following a hip fracture & compare these bed days to the costs of other chronic illnesses to get a true depiction of the societal impact of this silent disease which goes under reported. This way our governments could monitor the economic impact this disease has on our aging population, institutionalization & develop programs for intervention, prevention in adolescents to reduce healthcare expenditures for sustainability for nations & economic productivity. “A study recently 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 [2]. After the first fracture, patients are likely to experience a subsequent fracture because patients are both under diagnosed and under treated despite the availability of effective medicines and pharmaceutical innovation in bringing new medicines to market [20-30]. Sadly, osteoporosis is an avoidable & preventable disease if we increase our care of those at risk. Risk factors include age, sex, vertebral compression fractures, a fragility fracture after the age of 40 [31-37]. Other risk factors include, if & when either parent has had a hip fracture, if a patient has been taking glucocorticoid drugs for more than 3 months, if a patient has a medical condition that inhibits the absorption of nutrients, when patients have a low calcium intake from foods and other medical conditions or medications that contribute to bone loss [1,2].
There is good news: Together we can make a difference
It is important to speak with your physician, because our general practitioners can refer people who are vulnerable to a specialist like a gynecologist, an endocrinologist, a rheumatologist and even orthopedic/orthopaedic surgeons who specialize in the disease. See a dietitian to protect your bones and learn how to eat properly to increase your bioavailability of calcium.
Risk Factors
There are a variety of factors - both those we can control & those which are harder to control; what we call uncontrollable risk factors.
Uncontrollable Risk Factors
Try to monitor these uncontrollable risk factors in yourself & your loved ones by seeing a physician:
a. Being over the age of 50.
b. Being a female, but also being a male poses some risks as we saw earlier.
c. Family history of osteoporosis.
d. Low body weight/being small and thin.
e. Broken bones or height loss.
Controllable Risk Factors
Try to make these lifestyle medicine changes: “Controllable risk factors.”
Taking Appropriate Medication for your condition
After a fracture make sure you seek medical attention to discuss what intervention is best for you including the appropriate use of a medication & ensuring you get the proper diagnostic tests to assess your risks & whether you have had a fragility fracture.
Nutrition
a) Eat more calcium rich foods & foods rich in Vitamin D.
b) Eat more fruits & vegetables.
c) Reduce your over consumption of protein, sodium & caffeine.
d) Live an active life.
e) Stop smoking.
f) Reduce your alcohol consumption.
Osteoporosis has been called a pediatric disease with geriatric consequences [2]. Osteoporosis is a financial devastating emotional burden on our society for both caregivers and those who suffer from the disease. The burden of disability & pain results in loss of autonomy, loss of self-esteem & time off work for patients & caregivers alike. This can also result in unemployment. Unemployment for persons at risk & caregivers further exacerbates the social & financial burden on our society.
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