Hospital Resources - Osteoporosis

Osteoporosis is characterized by low bone mass and deterioration of bone tissue. This can lead to increased bone fragility and risk of fracture, particularly hip, spine and wrists.(1) The current focus is on prevention of fragility fractures and their negative consequences

Why is it important?

Fragility fractures and the consequences of the disease are responsible for excess mortality, morbidity, chronic pain, admission to institutions, human and economic burden.(2) Human costs include reduced quality of life, loss of mobility and decreased independence; annual cost of treatment in 2010 was $2.3 billion to the health care system in patient costs rising to $3.9 billion if individuals were living in LTC as a result of the disease. Each hip fracture costs the system $21,285 in the 1st year after hospitalization and $44,156 if the patient is institutionalized.

  • At least 1 in 3 women and 1 in 5 men will suffer from an osteoporotic fracture during their lifetime. 28 % of women and 37% of men who suffer a hip fracture die within 1 year
  • Osteoporotic hip fractures are in hospital longer than patients who have heart attacks, stroke or are diabetic (1)
  • Hundreds of thousands of Canadians needlessly sufffer a fracture each year because their osteoporosis goes undiagnosed and untreated Without Bone Mineral Density (BMD) testing, 80% of patients with a history of fractures are not given osteoporosis therapies (1)
  • One in three hip fracture patients re-fracture at one year and over 1 in 2 will suffer another fracture within 5 years.  28% of women and 37% of men who suffer a hip fracture will die within the following year (1)

Common Causes

  • Aging female (over 50 yr.), early menopause
  • Family history (parental hip fracture)
  • Certain medications (i.e. >3 months use of glucocorticoid drugs, hormone treatment for cancer)
  • Medical conditions which inhibit nutrient absorption or contribute to bone loss (i.e. rheumatoid arthritis, chronic  malnutrition or malabsorption disease, chronic liver disease, uncontrolled hyperthyroidism),
  • Previous fractures of the spine
  • Recurrent falls (2 or more within the past 12 months)
  • Smoking
  • High alcohol intake (3 or more drinks per day)
  • Low body weight (≤ 60kg or major weight loss: ≥ 10% of weight at age 25 yr.) (2)

Key Considerations

A key factor is to use an integrated approach and base treatment decisions on the absolute risk of fracture. Early detection of bone loss is critical in the prevention of bone fractures. Management of osteoporosis should be guided by an assessment of the patient’s absolute risk (high, moderate or low) of osteoporosis-related fractures. Fragility fracture increases the risk of further fractures and should be considered in the assessment. Lifestyle modification and pharmacological therapy should be individualized to enhance adherence to the treatment plan.(2)

References

1.   Osteoporosis Canada (2014). Retrieved March 20, 2014 from: 
      http://www.osteoporosis.ca

2.   Papaioannou, A., Cheung, A. et al. (2010). 2010 clinical practice guidelines for the diagnosis and management
      of osteoporosis in Canada: summary. Canadian Medical Association Journal.  Retrieved March 2014 from:
      http://www.cmaj.ca/content/182/17/1864.full.pdf