Shelby Webb

July 1, 2014
Epidemiology of Osteoporosis
Osteoporosis is considered by many a silent disease. There is no pain or visible
symptoms. One will typically not be in pain or even be able to tell that their bones are
thinning. One will not know they have osteoporosis until they fracture a bone due to
decreased connectivity in the bone tissue, measured as bone mineral density. Fractures of the
wrist, vertebrae, and hip are the most common. A hip fracture has huge implications, such as
large incurred costs both direct and indirect and possible disability and premature death.
Someone who has suffered a hip fracture is at risk of losing their independence altogether,
and that risk increases with each subsequent fracture if osteoporosis is not treated
immediately. Because of this, preventive screening and care are absolutely imperative in the
fight against osteoporosis. However, despite having the ability to affect anyone regardless of
race, age, or gender, osteoporosis is not widely talked about within health education. Because
one in two women over 50 and one in four men over 50 will have a fracture due to
osteoporosis, with hip fractures having a mortality of 15-30%
1
, osteoporosis should be a
larger public health concern in all regions.
There are almost 100 different risk factors for osteoporosis, and there is a high
possibility that there are many more undiscovered links. Osteoporosis does not discriminate
against those it affects; those of any gender, age, and race can experience it. However, there
are particular situations a person might be in that would render them more susceptible to the
disease than others. These are the target populations that should have an emphasis of
preventive screening. One of these groups would include those who do not get enough sun,
whether that is from climate or attire for religious reasons. Another group is those who have

1
Epidemiology of osteoporosis, Laura Masi, pg. 2, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781190/
undergone radiation or chemotherapy as a cancer treatment. These procedures can do
significant damage to the ways the human body processes hormones, making osteoporosis a
strong possibility.
The largest group that should be targeted is teenagers. While teenagers worry about
algebra and acne, their bone mineral density is doing some of the most significant increases
in a persons lifetime. Educating them on the importance of eating healthy and doing
appropriate weight bearing exercise now to prevent osteoporosis will create adults that
maintain that health regimen and are aware of the risk factors. The teen years are also
important for preventing smoking, eating disorders, and mental health disorders, all of which
are risk factors for osteoporosis. Osteoporosis is irrevocably tied to a persons general health,
so taking the time to educate people in their teen years about appropriate healthy lifestyles
will pay off considerably.
There are additional bonuses to pushing this information on teenagers. Because bone
health is 80% due to genetics, many teenagers will go home and ask the adults in their life
about family bone health history. Most middle-age adults have probably not thought about it
themselves. In the best case scenario, this prompts the adult to have a preventive scan and
speak to their general practitioner about their personal risk of osteoporosis.
The results of the risk of osteoporosis can vary greatly depending on the region. Using
the estimation tool of Quality Adjusted Life Years to see how osteoporosis burdens European
Union citizens, the total value of years lost in 2010 was estimated at 60.4 billion. In North
America, Osteoporosis is estimated to be a major public health threat for 44 million U.S. men
and women 50 years and older. In China, the average length of a persons stay in a hospital
due to hip fractures exceeds that of treating breast cancer, ovarian cancer, prostate cancer, or
heart disease.
2


2
International Osteoporosis Foundation, http://www.iofbonehealth.org/facts-statistics
All of these statistics point to a disease that is sweeping the entire globe by storm as a
massive threat to health. So why is no one talking about osteoporosis? For starters, as
explained earlier, osteoporosis is a largely silent disease. It can be incredibly difficult to
convince people that they should get checked for a disease when they feel perfectly fine and
healthy. Promoting this health factoid will be one of the most important accomplishments of
modern public health for osteoporosis. Once this has been established as a fact among the
greater community, more will be willing to seek preventive care and get a scan for bone
mineral density.
There are many different public health campaigns that advocate for early screening
and other preventive care. Some of the most notable campaigns include prostate and breast
cancer and many sexually transmitted diseases. Many health care plans offer incentives for
preventive health screenings, and for the most part, doctors on these plans are educated about
routine screening as annual check-ups.
There is also a fiscal incentive for preventive care. In Ireland, a DXA screening to
check bone mineral density runs at about 100. This allows early detection for trouble in
bone growth. If left undetected, problematic bone growth can lead to osteopenia or
osteoporosis, which can result in a fracture. The cost of a fractured hip, including the cost of
rehabilitation, is approximately 31,000. The cost of a preventive screening is absolutely
worth it even in the financial sense.
There are some obstacles that arise when looking at preventive care and treatment in
general. There are many that cannot afford the screenings or whose health plan does not
cover the cost. Those with a lower socio-economic status are more likely to be less educated
as well, which will drastically reduce their understanding of preventive health and the
importance of it. There are many different types of treatments, including diverse levels of
appropriate weight bearing exercise and varying medication. Some of the prescribed
medications can be not covered by a health plan and too expensive There are other obstacles
other than a persons economic status and education level. Many doctors might not be
educated on osteopenia and osteoporosis. This can result in someone having multiple risk
factors for the disease, but still not getting a recommendation for a screening from a health
care professional. Even more so, a DXA screening might be misread or misinterpreted by a
professional. Treatment might be prescribed incorrectly, which will exacerbate the disease
rather than assuage it. Since there are so many risk factors and causes behind osteoporosis, it
is also important to get to the root of the disease and treat the causes. The health benefits of a
prescribed medication and appropriate weight bearing exercise will be completely lost on a
person if the initial factors that causes osteoporosis are not found and eradicated. This method
of treating the symptoms rather than the causes just puts a bandage on a very serious disease.
If the causes are found and treated, then it is very possible that a person will be able to come
off the medication.
These problems are not specifically unique to osteoporosis. The solution for these
problems will not come about easy, as these obstacles stand between many people and their
clean bill of health. This is what public health aims to accomplish. Despite years of work, we
are still many years from a definite resolution.
However, there might be a case that osteoporosis receives far less attention than it
deserves, especially when compared to other diseases with similar morbidity and mortality.
...expenditures related to osteoporosis represent just 7 percent of total health care
costs among women age 45 and older. This is more than double the amount spent for
gynaecological cancers but only a fraction of the cost of cardiovascular disease. However,
osteoporosis accounts for nearly 14 percent of all nursing home days, due to the late age at
which expenses are incurred for osteoporosis relative to other diseases.
3

Other than the direct costs that are incurred to due a hip fracture in treatment and
rehabilitation, there are also a multitude of indirect costs that can be added on. These are

3
The Burden of Bone Disease, http://www.ncbi.nlm.nih.gov/books/NBK45502/
mostly related to the decrease in productivity in a person after they have suffered a fracture
due to disability and premature death. These indirect costs are very difficult to measure, but
one study estimate these costs account for 26% of total fracture costs.
4

Osteoporosis does not only affect a persons physical well being. Multiple fractures of
the vertebrae can create discs that are shorter at one end. This is known as a wedge fracture,
and it results in extreme curvature of the spine, known as a Dowagers Hump. This can have
a negative impact on a persons body image, self esteem, and mood. Individuals who have
suffered fractures may also be immobilized from fear of falling, causing feelings of isolation
and helplessness. These feelings can manifest in anxiety and depression, and also result in
severe psychological consequences.
Osteoporosis is a bridge between many health risks and many health consequences. It
is not difficult to treat, and the screening process is relatively inexpensive and non-invasive.
In keeping up with good bone health, one will also be completing activities that regulate their
overall health. Yet still many are uneducated, unaware, or ignorant of the disease. Therefore,
health promotion for those living with or at risk for osteoporosis should be a huge focus for
public health in all regions.

4
The Burden of Bone Disease, http://www.ncbi.nlm.nih.gov/books/NBK45502/