BURDEN OF OSTEOPOROSIS AND FRACTURES

Osteoporosis may affect the entire skeleton but, with the exception of tooth loss and ill-fitting dentures related to bone loss in the oral cavity,20 fractures constitute the only important adverse health consequence of this disorder. However, the medical and social consequences of these age-related fractures make osteoporosis a significant public health problem. Table 6-1 indicates some of the dimensions of this problem.

Morbidity

The fractures linked to osteoporosis occur at many skeletal sites because bone loss is widespread, but proximal femur (hip) fractures, distal forearm (wrist or Colles') fractures, and vertebral (spine) fractures are the most important types. Each year in the United States there may be up to a quarter of a million each of hip fractures and wrist fractures and perhaps twice that number of vertebral fractures.27 More precise figures are difficult to obtain—hip fracture victims are generally hospitalized, but hospital discharge data also count readmissions for additional care. Most other fractures, including the majority of wrist and spine fractures, are treated on an outpatient basis, but outpatient data are not routinely collected. This lack of accurate data on fracture occurrence nationally is an impediment to the design and implementation of an effective control program. Some steps to improve this situation were outlined in a 1985 National Research Council/Institute of Medicine report entitled Injury in America;

TABLE 6-1 Impact of Fractures in the United States

Consequence

Hip Fracture

Wrist Fracture

Spine Fracture

Excess mortality

12%

None

None

Morbidity

 

 

 

Lifetime risk

 

 

 

Males

5%

2%

?

Females

15%

15%

35%

Cases per year (approximate)

250,000

240,000

500,000

Disability

+++a

+

++

Cost (1984) All fracture sites combined = $18 billion

a Indicates relative impact.



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