The Burden of Osteoporosis, Poor Bone Health, and Fragility Fractures – Dr Steven R. Goldstein

Bone Health is more than just Osteoporosis

In my office almost all women are cognizant of breast health, have a great fear of breast cancer, and for the most part are attuned to the importance of competent periodic breast imaging… the key to earliest detection.

The goal is not to have a better bone density score on a Dexa test at age 82, the goal is to not break a hip at age 82

Bone health IS more than just osteoporosis. My hope is to get these same patients to be just as concerned about their bone health as they are concerned about their breast health, so I compiled some statistics which I hope will help you to understand how important bone health, osteoporosis and fragility fractures are to you as you pursue HEALTHY aging!

Why pay attention to bone health, osteoporosis and fragility fractures?

First, worldwide, osteoporosis causes more than 8.9 million fractures annually, resulting in an osteoporotic fracture every three seconds.[i]

Second, it is estimated that osteoporosis effects 200 million women worldwide. One-tenth of women aged 60, one-fifth of women aged 70, two-fifths of women aged 80 and, actually two-thirds of women aged 90 carry this diagnosis.[ii]

Third, worldwide, one in three women after the age 50 will experience an osteoporotic fracture.[iii]

Fourth, at menopause, the removal of estrogen has much greater effects in women than men of similar age. The female-to-male ratio of osteoporotic fractures is approximately 1.6, such that 80% of forearm fractures, 75% of humerus fractures, 70% of hip fractures, and 58% of spine fractures occur in women.[iv]

Fifth, A prior fracture is associated with an 86% increased risk of any subsequent fracture.[v]

Sixth, Fragility fractures are a leading cause of chronic disease morbidity. For instance, in Europe, fragility fractures are the fourth leading cause, after ischemic heart disease, dementia, and lung cancer; however, they surpass chronic obstructive pulmonary disease and ischemic stroke.[vi]

Seventh, After sustaining a hip fracture, 10-20% of formerly community-dwelling patients require long-term nursing care.[vii]

Overall, hip fractures cause the most morbidity, and reported mortality rates are up to 20-24% in the first year after a hip fracture.[viii]

Loss of function and independence among survivors is profound, with 40% unable to walk independently, and 60% require assistance a year later.[ix]

Is monitoring bone health just as important as the early detection of breast cancer?

In localized breast cancer where there is no sign that the cancer has spread outside the breast, the 5-year survival in the US is 99%!

(American Cancer Society. Survival Rates for Breast Cancer. Available at: https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-survival-rates.html )

Even regional breast cancer, defined as spread outside the breast to nearby structures or lymph nodes, has an 86% five-year survival.

(American Cancer Society. Survival Rates for Breast Cancer. Available at: https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-survival-rates.html )

In developed countries where women have access to periodic competent breast screening by imaging techniques, for many the diagnosis of localized breast cancer and the psychological ramifications may actually exceed the physical manifestations.

You only have to contrast the statistics above vis a vis breast cancer versus the statistics cited about the incidence, morbidity and even mortality associated with osteoporosis and fragility fractures (ESPECIALLY of the hip) to see the importance of bone health and osteoporosis

Promoting Bone Health

There are several things you can do to improve your bone health.

Be sure you are getting enough calcium in your diet and that you supplement with Vitamin D. Here is an article from Dr. Goldstein with more information on calcium and vitamin D. Click HERE

Be sure to exercise. Walking is a good exercise, especially when you practice “mindful walking”, which includes being aware of your steps and that the surface is safe. Be aware of black ice and use non-skid rugs in the bathroom. Ensure that your eyesight is good and there is sufficient illumination. It is also essential to maintain muscle strength which can be done, depending on your condition and advice from your doctor, by using light weights. You want to avoid sarcopenia which is “muscle wasting,” and atrophy of your muscles.

Balance exercises are also recommended. For more information on this, check out this article from the American Heart Association.

As usual if you have any questions, schedule a consultation with Dr Goldstein.

Footnotes:

[i] Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis Int. 2006;17:1726–1733.

[ii] Kanis, JA, Odén A, McCloskey EV, et al. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporosis Int. 2012;23:2239–2256.

[iii] Adult Official Positions of the ISCD as updated in 2019. www.iscd.org. Last accessed July 2021

[iv] Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis Int. 2006;17:1726–1733.

[v] Kanis JA, Johansson H, Harvey NC, et al. A brief history of FRAX. Arch Osteoporos. 2018;13(1):118

[vi] Kanis JA, Johansson H, Strom O, et al. The National Osteoporosis Guideline Group. Case finding for the management of osteoporosis with FRAX^® – assessment and intervention thresholds for the UK. Osteoporos Int. 2008;19:1395–1408.

[vii] Bone HG, Wagman RG, Brandi ML, et al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol. 2017;5:513–523.

[viii] Goodpaster BH, Park SW, Harris TB, et al. The loss of skeletal muscle strength, mass, and quality in older adults: The health, aging and body composition study. J Gerontol A Biol Sci Med Sci. 2006;61:1059–1064.

[ix] Anker SD, Morley JE, von Haehling S, et al. Welcome to the ICD-10 code for sarcopenia. J Cachexia Sarcopenia Muscle. 2026;7(5):512–514.