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Personal and Societal Burden of Osteoporotic Fractures

  • The burden of osteoporosis
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Clinical Reviews in Bone and Mineral Metabolism Aims and scope Submit manuscript

Abstract

Osteoporosis is a common condition which mainly affects older individuals and is more common in women than in men. Rates vary significantly across the world with higher rates in Northern Europe, North America, and Australasia. There are also differences by country and sometimes on a more local level. This review describes the variation and explores how secular trends in fracture rates have changes over recent years and may alter in the future. Although overall rates tend to be increasing, due largely to an ageing population, age-specific rates appear to be declining in some areas. This has considerable importance for the socioeconomic burden of the disease in years to come. Osteoporotic fractures are associated with significant morbidity and in some cases mortality. Consequently, they often require hospital treatment and may lead to long-term institutional care. This leads not only to effects on the individual’s quality of life but also to major health care and social costs.

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References

  1. van Staa TP, Dennison EM, Leufkens HG, Cooper C. Epidemiology of fractures in England and Wales. Bone. 2001;29:517–22.

    Article  PubMed  Google Scholar 

  2. Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA. 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). Arch Osteoporos. 2013;8:136.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994;843:1–129.

  4. Kanis JA, Oden A, Johnell O, Jonsson B, de Laet C, Dawson A. The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int. 2001;12:417–27.

    Article  CAS  PubMed  Google Scholar 

  5. Cooper C, Harvey N, Javaid K, Hanson M, Dennison E. Growth and bone development. Nestle Nutr Workshop Ser Pediatr Program. 2008;61:53–68.

    Article  PubMed  Google Scholar 

  6. Melton LJ III, Chrischilles EA, Cooper C, Lane AW, Riggs BL. Perspective. How many women have osteoporosis? J Bone Miner Res. 1992;7:1005–10.

    Article  PubMed  Google Scholar 

  7. Fracture patterns revisited. Lancet. 1990;336:1290–1291.

  8. The prevention of falls in later life. A report of the Kellogg International Work Group on the Prevention of Falls by the Elderly. Danish Med Bull. 1987;34(Suppl 4):1–24.

  9. Slemenda C, Hui SL, Longcope C, Johnston CC. Sex steroids and bone mass. A study of changes about the time of menopause. J Clin Invest. 1987;80:1261–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Khosla S, Riggs BL. Pathophysiology of age-related bone loss and osteoporosis. Endocrinol Metab Clin N Am. 2005;34:1015–30.

    Article  CAS  Google Scholar 

  11. Kanis JA, Oden A, McCloskey EV, Johansson H, Wahl DA, Cooper C. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int. 2012;23:2239–56.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17:1726–33.

    Article  CAS  PubMed  Google Scholar 

  13. Ross PD, Davis JW, Epstein RS, Wasnich RD. Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med. 1991;114:919–23.

    Article  CAS  PubMed  Google Scholar 

  14. Strom O, Borgstrom F, Kanis JA, Compston J, Cooper C, McCloskey EV, Jonsson B. Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2011;6:59–155.

    Article  CAS  PubMed  Google Scholar 

  15. Johnell O, Gullberg B, Allander E, Kanis JA. The apparent incidence of hip fracture in Europe: a study of national register sources. MEDOS Study Group. Osteoporos Int. 1992;2:298–302.

    Article  CAS  PubMed  Google Scholar 

  16. Lunt M, Felsenberg D, Adams J, Benevolenskaya L, Cannata J, Dequeker J, Dodenhof C, Falch JA, Johnell O, Khaw KT, Masaryk P, Pols H, Poor G, Reid D, Scheidt-Nave C, Weber K, Silman AJ, Reeve J. Population-based geographic variations in DXA bone density in Europe: the EVOS Study. European Vertebral Osteoporosis. Osteoporos Int. 1997;7:175–89.

    Article  CAS  PubMed  Google Scholar 

  17. Kanis JA, Johnell O, de Laet C, Jonsson B, Oden A, Ogelsby AK. International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res. 2002;17:1237–44.

    Article  PubMed  Google Scholar 

  18. Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA. Regional variation in the incidence of hip fracture. US white women aged 65 years and older. JAMA. 1990;264:500–2.

    Article  CAS  PubMed  Google Scholar 

  19. Looker AC, Orwoll ES, Johnston CC Jr, Lindsay RL, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP. Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res. 1997;12:1761–8.

    Article  CAS  PubMed  Google Scholar 

  20. Cooper C, Campion G, Melton LJ III. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992;2:285–9.

    Article  CAS  PubMed  Google Scholar 

  21. Melton LJ III, O’Fallon WM, Riggs BL. Secular trends in the incidence of hip fractures. Calcif Tissue Int. 1987;41:57–64.

    Article  PubMed  Google Scholar 

  22. Chevalley T, Guilley E, Herrmann FR, Hoffmeyer P, Rapin CH, Rizzoli R. Incidence of hip fracture over a 10-year period (1991–2000): reversal of a secular trend. Bone. 2007;40:1284–9.

    Article  CAS  PubMed  Google Scholar 

  23. Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Jarvinen M. Nationwide decline in incidence of hip fracture. J Bone Miner Res. 2006;21:1836–8.

    Article  PubMed  Google Scholar 

  24. Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, Melton LJ, Cummings SR, Kanis JA. Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int. 2011;22:1277–88.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Samelson EJ, Zhang Y, Kiel DP, Hannan MT, Felson DT. Effect of birth cohort on risk of hip fracture: age-specific incidence rates in the Framingham Study. Am J Public Health. 2002;92:858–62.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Prieto-Alhambra D, Premaor MO, Fina Aviles F, Hermosilla E, Martinez-Laguna D, Carbonell-Abella C, Nogues X, Compston JE, Diez-Perez A. The association between fracture and obesity is site-dependent: a population-based study in postmenopausal women. J Bone Miner Res. 2012;27:294–300.

    Article  PubMed  Google Scholar 

  27. Johansson H, Clark P, Carlos F, Oden A, McCloskey EV, Kanis JA. Increasing age- and sex-specific rates of hip fracture in Mexico: a survey of the Mexican Institute of Social Security. Osteoporos Int. 2011;22:2359–64.

    Article  CAS  PubMed  Google Scholar 

  28. Cooper C, Atkinson EJ, Jacobsen SJ, O’Fallon WM, Melton LJ III. Population-based study of survival after osteoporotic fractures. Am J Epidemiol. 1993;137:1001–5.

    CAS  PubMed  Google Scholar 

  29. Office of Technology Assessment CotUS. Hip fracture outcomes in people aged fifty and over: mortality, service use, expenditures, and long-term functional impairment. In: Washington, DC; 1993.

  30. Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009;301:513–21.

    Article  CAS  PubMed  Google Scholar 

  31. Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby AK. The components of excess mortality after hip fracture. Bone. 2003;32:468–73.

    Article  CAS  PubMed  Google Scholar 

  32. Sernbo I, Johnell O. Consequences of a hip fracture: a prospective study over 1 year. Osteoporos Int. 1993;3:148–53.

    Article  CAS  PubMed  Google Scholar 

  33. Cameron ID, Chen JS, March LM, Simpson JM, Cumming RG, Seibel MJ, Sambrook PN. Hip fracture causes excess mortality owing to cardiovascular and infectious disease in institutionalized older people: a prospective 5-year study. J Bone Miner Res. 2010;25:866–72.

    PubMed  Google Scholar 

  34. Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jonsson B. Mortality after osteoporotic fractures. Osteoporos Int. 2004;15:38–42.

    Article  CAS  PubMed  Google Scholar 

  35. Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA. 2009;302:1573–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. Nikitovic M, Wodchis WP, Krahn MD, Cadarette SM. Direct health-care costs attributed to hip fractures among seniors: a matched cohort study. Osteoporos Int. 2013;24:659–69.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Kanis JA, Johnell O, Oden A, Borgstrom F, Zethraeus N, De Laet C, Jonsson B. The risk and burden of vertebral fractures in Sweden. Osteoporos Int. 2004;15:20–6.

    Article  CAS  PubMed  Google Scholar 

  38. Chrischilles EA, Butler CD, Davis CS, Wallace RB. A model of lifetime osteoporosis impact. Arch Intern Med. 1991;151:2026–32.

    Article  CAS  PubMed  Google Scholar 

  39. Kanis JA, McCloskey EV. Epidemiology of vertebral osteoporosis. Bone. 1992;13(Suppl 2):S1–10.

    PubMed  Google Scholar 

  40. Oleksik A, Lips P, Dawson A, Minshall ME, Shen W, Cooper C, Kanis J. Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res. 2000;15:1384–92.

    Article  CAS  PubMed  Google Scholar 

  41. Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. 2000;15:721–39.

    Article  CAS  PubMed  Google Scholar 

  42. Budhia S, Mikyas Y, Tang M, Badamgarav E. Osteoporotic fractures: a systematic review of U.S. healthcare costs and resource utilization. PharmacoEconomics. 2012;30:147–70.

    Article  PubMed  Google Scholar 

  43. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res. 2007;22:465–75.

    Article  PubMed  Google Scholar 

  44. Bleibler F, Rapp K, Jaensch A, Becker C, Konig HH. Expected lifetime numbers and costs of fractures in postmenopausal women with and without osteoporosis in Germany: a discrete event simulation model. BMC Health Serv Res. 2014;14:284.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Tosteson AN, Burge RT, Marshall DA, Lindsay R. Therapies for treatment of osteoporosis in US women: cost-effectiveness and budget impact considerations. Am J Manag Care. 2008;14:605–15.

    PubMed  Google Scholar 

  46. Parthan A, Kruse M, Yurgin N, Huang J, Viswanathan HN, Taylor D. Cost effectiveness of denosumab versus oral bisphosphonates for postmenopausal osteoporosis in the US. Appl Health Econ Health Policy. 2013;11:485–97.

    Article  PubMed  Google Scholar 

  47. Dimai HP, Redlich K, Peretz M, Borgstrom F, Siebert U, Mahlich J. Economic burden of osteoporotic fractures in Austria. Health Econ Rev. 2012;2:12.

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

This work was supported by the Medical Research Council of Great Britain; Arthritis Research UK; and the International Osteoporosis Foundation. This review was also made possible thanks to a Research Grant from the International Osteoporosis Foundation and SERVIER. MHE was funded by an Arthritis Research UK Clinical PhD Studentship (Grant Number 19583). The work herein was also supported by the NIHR Nutrition BRC, University of Southampton and the NIHR Musculoskeletal BRU, University of Oxford.

Disclosures

Conflict of interest

Professor Cooper has received consultancy fees/honoraria from Servier; Eli Lilly; Merck; Amgen; Alliance; Novartis; Medtronic; GSK; and Roche. CF, MHE, and EMD declare that they have no conflicts of interest.

Animal/Human Studies

This article does not contain any studies with human or animal subjects performed by the author.

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Authors and Affiliations

  1. MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK

    C. Fox, M. H. Edwards, E. M. Dennison & C. Cooper

  2. Victoria University, Wellington, New Zealand

    E. M. Dennison

  3. NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, OX3 5UG, UK

    C. Cooper

  4. NIHR Nutrition Biomedical Research Centre, University Hospital Southampton NHS Trust, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK

    C. Cooper

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  1. C. Fox
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  4. C. Cooper
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Correspondence to M. H. Edwards.

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Fox, C., Edwards, M.H., Dennison, E.M. et al. Personal and Societal Burden of Osteoporotic Fractures. Clinic Rev Bone Miner Metab 13, 53–60 (2015). https://doi.org/10.1007/s12018-015-9181-1

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  • DOI: https://doi.org/10.1007/s12018-015-9181-1

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