Osteoporosis

A two-article symposium

Symposium coordinator

Carolyn Crandall, MD
Associate Professor of Medicine
David Geffen School of Medicine at
University of California
Los Angeles

VOL 114 / NO 3 / SEPTEMBER 2003 / POSTGRADUATE MEDICINE

INTRODUCTION TO THE SYMPOSIUM. By Carolyn Crandall, MD
HIP FRACTURE PREVENTION: Drug therapies and lifestyle modifications that can reduce risk. By Justus J. Fiechtner, MD, MPH
LABORATORY WORKUP FOR OSTEOPOROSIS: Which tests are most cost-effective? By Carolyn Crandall, MD

Osteoporosis is not just a problem in women. In the United States, 44 million people aged 50 years or older, including an estimated 14 million men, have either low bone mass or osteoporosis. Overall, low bone density affects one in two adults.

In addition to being common, osteoporosis is a major cause of disability and pain. For example, one third of patients with hip fracture are discharged to a nursing home within the year after fracture, and only one third of such patients regain their prefracture level of function. Substantial disability also occurs after fracture of the vertebra, humerus, distal forearm, ankle, and foot. Such fractures are associated with difficulty in bending, lifting, reaching, walking, and climbing and descending stairs. Fracture also causes difficulty in dressing, cooking, shopping, and performing heavy housework.

The marked impact of vertebral fractures on bending and walking persists for years. Spinal deformity also causes decreased pulmonary function. In addition, vertebral fractures have been shown to have adverse emotional effects on women. Health-related quality of life is lower with each subsequent fracture.

Osteoporosis has also been linked to increased risk of death. Although it is widely recognized that 20% of patients die within the year after hip fracture, it is underappreciated that the mortality rate increases after vertebral fractures, even among healthy older women. Rates of mortality and hospitalization increase in proportion to the number of vertebral deformities. Even clinically occult vertebral fractures increase the risk of mortality. Long-term studies in men and women with vertebral deformities confirm the increased risk of mortality, especially for cardiovascular, pulmonary, and cancer-related deaths. Despite this evidence, osteoporosis continues to be underevaluated and undertreated.

Many pharmacologic therapies that decrease the risk of fracture are available, including bisphosphonates, estrogen therapy, calcitonin-salmon, and raloxifene. Most recently, parathyroid hormone was approved for treatment of osteoporosis. Therapy not only reduces fracture risk but also the number of days of bed disability and limited activity due to back pain.

In the first article of this symposium, Dr Justus J. Fiechtner discusses the scope of the problem of osteoporotic hip fracture and reviews current nonpharmacologic and pharmacologic interventions for prevention and treatment. In the second article, I explore the controversy over laboratory evaluation of newly diagnosed osteoporosis and examine the available data regarding effective screening tests for secondary causes. Dr Fiechtner and I hope that this symposium will help you manage osteoporosis with the reassurance that underlying (possibly silent) medical conditions are not left undetected and that you are offering the most effective pharmacologic therapies for prevention and treatment.

RETURN TO SEPTEMBER 2003 TABLE OF CONTENTS

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