Osteoporosis: a social problem in the elderly population
Abstract
RESEARCH OBJECTIVE: The aim of this review is to present a broader scope on osteoporosis – both as a medical problem and as a major social burden.
THE RESEARCH PROBLEM AND METHODS: Osteoporosis is a systemic skeletal disease, characterized by low bone mass, leading to increased bone fragility and fractures. It does not only lead to major medical expenses, lower health-related quality-of-life but also strains the population with significant social burden. As modern science is intensively exploring the problem of osteoporosis, new research articles expanding our knowledge on this disease come out weekly. This growing body of research calls for an up-to-date review of the existing state of knowledge on osteoporosis.
THE PROCESS OF ARGUMENTATION: This manuscript presents and overview on osteoporosis and associated problems such as fractures in the following order (1) Etiology and pathogenesis of osteoporosis, (2) Osteoporosis risk factors, (3) Epidemiology of osteoporosis, (4) Aging of the Polish population, (5) Clinical consequences of osteoporosis, (6) Criteria of the World Health Organization (WHO) for Caucasian women after menopause, (7) Morbidity and mortality associated with osteoporotic fractures, (8) Risk factors related to the collapse of the condition of osteoporotic patients, (9) Bone fragility and falls, (10) Recognizing osteoporosis, (11) Prevention and treatment of osteoporosis, (12) Cost of treating fractures, (13) Fracture liaison service, (14) Senior care, (15) Purpose of modern geriatrics, (16) Social inequalities and osteoporosis.
RESEARCH RESULTS: The two major determinants of risk in the development of osteoporosis are peak bone mass and rate of bone loss. These two determinants are influenced by a number of genetic (non-modifiable) and environmental (partly modifiable, and modifiable) factors. Osteoporosis is becoming increasingly prevalent with the aging of the world population. Worldwide, more than 200 million people are suffering from osteoporosis, and 1 in 2 women and 1 in 4 men over 50 will have an osteoporosis-related fracture in their lifetime. About 5% of falls result in fractures, half of which are proximal femur fractures. Out of all falls leading to fractures, 10‑25% result in injury or requirement of specialized medical care. Falls are one of the main causes of disability and the fifth most common cause of death in people over 75 years of age.
CONCLUSIONS, INNOVATIONS AND RECOMMENDATIONS: This review provides a concise overview om osteoporosis as a linked medical and social problem. It also identified a number of knowledge gaps necessary to fill in order to progress our knowledge on osteoporosis diagnosis, prevention and treatment. Understanding patients’ preferences and needs will allow to align them with appropriate service models which are likely to optimize patient outcomes.
References
Adachi, J.D., Ioannidis, G., Olszynski, W.P., Brown, J.P., Hanley, D.A., Sebaldt, R.J., Petrie, A., Tenenhouse, A., Stephenson, G.F., Papaioannou, A., Guyatt, G.H., & Goldsmith, C.H. (2002). The impact of incident vertebral and non-vertebral fractures on health related quality of life in postmenopausal women. BMC Musculoskelet Disorders, 3(1), 11.
Akesson, K., Marsh, D., Mitchell, P.J., McLellan, A.R., Stenmark, J., Pierroz, D.D., Kyer, C., Cooper, C., & IOF Fracture Working Group. (2013). Capture the Fracture: a Best Practice Framework and global campaign to break the fragility fracture cycle. Osteoporosis International, 24(8), 2135‑2152.
Alderman, C.P. & Hill, C.L. (1994). Abnormal bone mineral metabolism after longterm anticonvulsant treatment. Annals of Pharmacotherapy, 28(1), 47‑48.
Anderson, F.H. (2017). Osteoporosis in men. International Journal of Clinical Practice, 52(3), 176‑180.
Benzeval, M., Judge, K., & Smaje, C. (1995). Beyond class, race, and ethnicity: deprivation and health in Britain. Health Service Research, 30(1 Pt 2),163‑177.
Brennan, S.L., Pasco, J.A., Urquhart, D.M., Oldenburg, B., Hanna, F., & Wluka, A.E. (2009). The association between socioeconomic status and osteoporotic fracture in population-based adults: A systematic review. Osteoporosis International, 20(9), 148‑1497.
Brennan, S.L., Pasco, J.A., Urquhart, D.M., Oldenburg, B., Wang, Y., & Wluka, A.E. (2011). Association between socioeconomic status and bone mineral density in adults: A systematic review. Osteoporosis International, 22(2), 517‑527.
Center, J.R. (2017). Fracture Burden: What Two and a Half Decades of Dubbo Osteoporosis Epidemiology Study Data Reveal About Clinical Outcomes of Osteoporosis. Current Osteoporosis Reports, 15(2), 88‑95.
Charles, H. (1997). Approach to the Elderly Patient with Osteopenia or Osteoporosis. Textbook of Internal Medicine, ed. N. William. Philadelphia: Lippincott Raven Publishers.
Clark, E.M., Ness, A., & Tobias, J.H. (2005). Social position affects bone mass in childhood through opposing actions on height and weight. Journal of Bone and Mineral Research, 20(12), 2082‑2089.
Cooper, C., Atkinson, E.J., Jacobsen, S.J., O’Fallon, W.M., & Melton, L.J. (1993). Population-based study of survival after osteoporotic fractures. American Journal of Epidemiology, 137(9), 1001‑1005.
Court-Brown, C.M., Aitken, S.A., Ralston, S.H., & McQueen, M.M. (2011). The relationship of fall-related fractures to social deprivation. Osteoprosis International,
(4), 1211‑1218.
Daniel, T. (1996). Metabolic Bone Disease: Textbook of Primary Care Medicine, ed. N. John. St. Louis: CV Mosby Publisher.
Farahmand, B.Y., Persson, P-G., Michaelsson, K., Baron, J.A., Parker, M.G. & Ljunghall, S. (2000). Socioeconomic status, marital status and hip fracture risk: A population-based case-control study. Osteoporosis International, 11(9), 803‑808.
Feber, J., Cochat, P., & Braillon, P. (2000). Bone mineral density in children after renal transplantation. Pediatric Nephrology, 14(7), 654‑657.
Forsén, L., Sogaard, A.J., Meyer, H.E., Edna, T., & Kopjar, B. (1990). Survival after hip fracture: short- and long-term excess mortality according to age and gender. Osteoporosis International, 10(1), 73‑78.
Gallagher, J. (1999). Osteoporosis. Conn’s Current Therapy, ed. E. Robert. Philadelphia: WB Saunders Co.
Genant, H.K., Cooper, C., Poor, G., Reid, I., Ehrlich, G., Kanis, J., (…), & Khaltaev, N. (1999). Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis. Osteoporosis International, 10(4), 259‑264.
Grinspoon, S., Herzog, D., & Klibanski, A. (1997). Mechanisms and treatment options for bone loss in anorexia nervosa. Psychopharmacology Bulletin, 33(3), 399‑404.
Groffen, D.A., Bosma, H., van den Akker, M., Kempen, G.I., & van Eijk, J.T. (2008). Material deprivation and health-related dysfunction in older Dutch people: findings from the SMILE study. European Journal of Public Health, 18(3), 258‑263.
Gullberg, B., Johnell, O., & Kanis, J.A. (1997). World-wide projections for hip fracture. Osteoporosis International, 7(5), 407‑413.
Hernlund, E., Svedbom, A., Ivergård, M., Compston, J., Cooper, C., Stenmark, J., McCloskey, E.V., Jönsson, B., & Kanis, J.A. (2013). Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Archives of Osteoporosis, 8(1‑2), 136.
Hokby, A., Reimers, A., & Laflamme, L. (2003). Hip fractures among older people: do marital status and type of residence matter? Public Health, 117(3), 196‑201.
Hopper, J.L., & Seeman, E. (1994). The bone density of female twins discordant for tobacco use. New England Journal of Medicine, 330(6), 387‑392.
Iqbal, M.M. (2000). Osteoporosis: Epidemiology, Diagnosis, and Treatment. South Medical Journal, 1, 93.
Johnell, O., Borgstrom, F., Jonsson, B., & Kanis, J. (2007). Latitude, socioeconomic prosperity, mobile phones and hip fracture risk. Osteoporosis International, 18(3), 333‑337.
Johnell, O. & Kanis, J. (2005). Epidemiology of osteoporotic fractures. Osteoporosis International, 16(S02), S3-S7.
Johnell, O., Kanis, J.A., Odén, A., Sernbo, I. Redlund-Johnell, I., Petterson, C., De Laet, C., & Jönsson, B. (2004). Mortality after osteoporotic fractures. Osteoporosis
International, 15(1), 38‑42.
Jones, S., Johansen, A., Brennan, J., Butler, J., & Lyons, R.A. (2004). The effect of socioeconomic deprivation on fracture incidence in the United Kingdom. Osteoporosis International, 15(7), 520‑524.
Kanis, J.A., Delmas, P., Burckhardt, P., Cooper, C., & Torgerson, D. Guidelines for diagnosis and management of osteoporosis. (1997). The European Foundation for Osteoporosis and Bone Disease. Osteoporosis International, 7(4), 390‑406.
Kanis, J.A., McCloskey, E.V., Johansson, H., Strom, O., Borgstrom, F., & Oden, A.
(2009). How to decide who to treat. Best Practice Research and Clinical Rheumatology, 23(6), 711‑726.
Kanis, J.A. (2002). Diagnosis of osteoporosis and assessment of fracture risk. Lancet, 359(9321), 1929‑1936.
Keene, G.S., Parker, M.J., & Pryor, G.A. (1993). Mortality and morbidity after hip fractures. British Medical Journal, 307(6914), 1248‑1250.
Kerr, C., Bottomley, C., Shingler, S., Giangregorio, L., de Freitas, H.M., Patel, C., Randall, S., & Gold, D.T. (2017). The importance of physical function to people with osteoporosis. Osteoporosis International, 28(5), 1597‑1607.
Kimble, R.B. (1997). Alcohol, cytokines, and estrogen in the control of bone remodeling. Alcohol Clinical and Experimental Research, 21(3), 385‑391.
Klein, R.F. (1997). Alcohol-induced bone disease: impact of ethanol on osteoblast proliferation. Alcohol Clinical and Experimental Research, 21(3), 392‑399.
Kreiger, N., Kelsey, J.L., Holford, T.R., & O’Connor, T. (1982). An epidemiologic study of hip fracture in postmenopausal women. American Journal of Epidemiology, 116(1), 141‑148.
Lane, N.E. (2006). Epidemiology, etiology, and diagnosis of osteoporosis. American Journal of Obstetrics and Gynecology, 194(2), S3-S11.
Leszko, M., Zając-Lamparska, L., & Trempala, J. (2015). Aging in Poland. Gerontologist, 55(5), 707‑715.
Lips, P., Cooper, C., Agnusdei, D., Caulin, F., Egger, P., Johnell, O., (…), & Wiklund, I. (1999). Quality of Life in Patients with Vertebral Fractures: Validation of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Osteoporosis International, 10(2), 150‑160.
Marmot, M. (2001). From Black to Acheson: two decades of concern with inequalities in health. A celebration of the 90th birthday of Professor Jerry Morris. International Journal of Epidemiology, 30(5), 1165‑1171.
Masi, L. (2008). Epidemiology of osteoporosis. Clinical Cases in Mineral and Bone Metabolism, 5(1), 11‑13.
Melton, L.J. (2000). Who has osteoporosis? A conflict between clinical and public health perspectives. Journal of Bone and Mineral Research, 15(12), 2309‑2314.
Miller, P.D. (1999). Management of osteoporosis. Disease Month, 45(2), 21‑54. Miyakoshi, N., Itoi, E., Kobayashi, M., & Kodama, H. (2003). Impact of postural deformities and spinal mobility on quality of life in postmenopausal osteoporosis. Osteoporosis International, 14(12), 1007‑1012.
NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. (2001). Osteoporosis prevention, diagnosis, and therapy. Journal of the American Medical Association, 285(6), 785‑795.
Praet, J.P., Peretz, A., Rozenberg, S., Famaey, J.P., & Bourdoux, P. (1992). Risk of osteoporosis in men with chronic bronchitis. Osteoporosis International, 2(5), 257‑261.
Quah, C., Boulton, C., & Moran, C. (2011). The influence of socioeconomic status on the incidence, outcome and mortality of fractures of the hip. Journal of Bone and Joint Surgery – Series B, 93B(6), 801‑805.
Sampson, H.W. (1997). Alcohol, osteoporosis, and bone regulating hormones. Alcohol Clinical and Experimental Research, 21(3), 400‑403.
Syddall, H.E., Evandrou, M., Dennison, E.M., Cooper, C., & Sayer, A.A. (2012). Social inequalities in osteoporosis and fracture among community-dwelling older men and women: findings from the Hertfordshire Cohort Study. Archives of Osteoporosis, 7, 37‑48.
Tarride, J.E., Hopkins, R.B., Leslie, W.D., Morin, S., Adachi, J.D., Papaioannou, A., Bessette, L., Brown, J.P., & Goeree, R. (2012). The burden of illness of osteoporosis in Canada. Osteoporosis International, 23(11), 2591‑2600.
The National Osteoporosis Foundation. (2017). Retrieved from: https://www.nof.org/. (access: 23.03.2017).
Ting, G., Woo, J., To, C., & Woo, J. (2009). Elder care: is legislation of family responsibility the solution? Asian Journal of Gerontology and Geriatrics, 4(2), 72‑75.
Vanderschueren, D. & Vandenput, L. (2000). Androgens and osteoporosis. Andrologia, 32(3), 125‑130.
Vestergaard, P., Rejnmark, L., & Mosekilde, L. (2006). Socioeconomic aspects of fractures within universal public healthcare: A nationwide case-control study from Denmark. Scandinavian Journal of Public Health, 34(4), 371‑377.
West, J., Hippisley-Cox, J., Coupland, C.A.C., Price, G.M., Groom, L.M., Kendrick, D., & Webber, E. (2004). Do rates of hospital admission for falls and hip fracture in elderly people vary by socio-economic status? Public Health, 118(8), 576‑581.
Wilkinson, R.G. (1997). Socioeconomic determinants of health. Health inequalities: relative or absolute material standards? British Medical Journal, 314(7080), 591‑595.
World Health Organization – WHO Criteria for Diagnosis of Osteoporosis – 4BoneHealth.
Retrieved from: http://www.4bonehealth.org/education/world-health-organization-criteria-diagnosis-osteoporosis/ (access: 24.03.2017).
Zingmond, D.S., Soohoo, N.F., & Silverman, S.L. (2006). The role of socioeconomic status on hip fracture. Osteoporosis International, 17(10), 1562‑1568.
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