American Association of Orthopaedic Surgeons (AAOS)
October 15, 2019
Osteoporosis is often called a silent disease that is largely preventable, yet it affects approximately 54 million Americans. Despite the modifiable lifestyle choices people can take to prevent osteoporosis-related fractures, they continue to rise, resulting in a fracture every three seconds. Orthopaedic surgeons are the front line of recognizing patients with osteoporosis and those at high risk of osteoporosis-related fractures. In a new literature review published in the October issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), the authors compiled data to help orthopaedic surgeons identify, manage and prevent osteoporosis.
The article notes that an estimated nine million people worldwide experience an osteoporosis-related fracture annually, with nearly half of these cases occurring in the United States and Europe, according to the International Osteoporosis Foundation. The most common fractures are in the hip, spine and wrist. Additionally, as incidence rates increase, so do osteoporosis mortality rates and health care expenses.
“Osteoporosis is a condition of the bone as a result of a decrease in bone mass and deterioration of its structure,” said lead researcher and orthopaedic surgeon Elizabeth G. Matzkin, MD, FAAOS with Brigham and Women’s Hospital in Boston. “Because patients likely don’t know they have osteoporosis until they experience a fracture, our team wants to bring awareness to our colleagues and patients as the incidence continues to rise and many cases go undetected by health care providers.”
According to the International Osteoporosis Foundation:
· One in three women and one in five men older than 50 years will experience an osteoporosis-related fracture.
· Sixty-one percent of osteoporotic fractures occur in women. It has been shown that women older than 45 years spend more days in the hospital due to osteoporosis compared with breast cancer, diabetes, or a heart attack.
· Approximately 25% of osteoporotic hip fractures occur in men, and the one-year mortality rate in men is 20% higher compared with women.
· Compared with rates of osteoporotic fracture in 1990, by 2050, the incidence of osteoporotic hip fractures will increase 240% in women and 310% in men.ii
“It is imperative that bone health is addressed since bone is living tissue and, therefore, can remodel and respond to stress,” said Dr. Matzkin. “For example, I inform my younger patients that they can only build their ‘bone bank’ or peak bone mass until around age 25. After that, their bone density slowly depletes over time, especially in women following menopause, so it’s important to start strong and do what you can to maintain optimal bone density. Patients need to know the risk factors they can control and those they can’t in order to preserve bone mass.”
Modifiable factors include smoking (cigarettes), low body weight or body mass index (BMI), limited exercise, heavy alcohol intake, estrogen deficiency, and dietary factors such as low calcium and vitamin D intake. Nonmodifiable risk factors include female sex, Caucasian race, increasing age, and genetic/familial history. Additionally, thyroid problems, diabetes, radiation for cancer, beginning a menstrual cycle later in life or early menopause are also associated with increased risk for osteoporosis.
While orthopaedic surgeons need to be armed with this information for their patients, the JAAOS review article also serves as a resource for patients themselves to advocate on behalf of their health. It helps to educate them on pertinent facts about osteoporosis so they can have an open dialogue with their health care teams on risk factors, prevention, diagnosis and management of the disease.
Dr. Matzkin encourages patients to work with their health care teams to receive an accurate risk assessment based on medical history and lifestyle. The U.S. Preventative Services Task Force recommends a bone mineral density (BMD) test for all women aged 65 years and older and postmenopausal women younger than 65 years with increased risk determined by a clinical assessment.
In order to prevent osteoporotic fragility fractures before they occur or to limit recurring fractures, there are a variety of treatments available including prescription medications, vitamin D and calcium supplementation and lifestyle modifications such as increased physical activity (weight-bearing and muscle strengthening exercise) and smoking cessation.
“Osteoporosis is big deal and it’s time to shift our level of awareness both as orthopaedic surgeons and as patients to address bone health as a lifelong commitment,” added Dr. Matzkin.