Young People Get Osteoporosis Too 

Osteoporosis is responsible for more than 1.5 million fractures annually, including 300,000 hip fractures, 700,000 vertebral fractures, 250,000 wrist fractures and 300,000 fractures of other sites. The cost of those fractures to the US health care system is more than 13.8 billion dollars per year, greater than the costs for either congestive heart failure or asthma. Over the next thirty years, as the average age of the American population continues to increase costs related to low bone mass could more than double unless comprehensive preventive treatment programs are initiated. 


Osteoporosis related fractures occur about four times as often in women than men. Of the individuals who fracture a hip, one-half will be permanently disabled, and almost twenty percent will require long-term nursing care. Some twenty percent of hip fracture victims die within one year, usually from complications such as pneumonia or blood clots in the lung related to either the fracture or surgery. Hip fracture is responsible for about 65,000 deaths per year in the United States. Hence, osteoporosis represents a major public health problem. 


According to a recent US wide survey, results make it apparent that men and women are not well informed of the most common danger of osteoporosis. American women severely underestimate the chances of experiencing a spinal fracture resulting from osteoporosis. Nearly one half of all women (forty-six percent) say they know only a little or nothing at all about osteoporosis. A full 92 percent of women are unaware that the most common osteoporosis-related fractures are compression fractures of the spine. Spinal fractures (compressed vertebrae) are the most common osteoporosis-related fractures, with more than 700,000 such fractures occurring in the United States each year. Loss of height and stooped posture are irreversible changes that result from compression fractures. 

Hip fractures are a major cause of loss of independence in older women and men. Many are discharged into nursing homes instead of back to their previous living situation. The one-year mortality following a hip fracture is 12 to 24%. However, many of the patients who break their hip were frail and would be expected to have a high mortality rate anyway. It is estimated that 14% of deaths following a hip or pelvic fracture in previously ambulatory women were caused or hastened by the fracture.

Overall about half of hip fractures are intertrochanteric and the others are femoral neck fractures. In older women the proportion of trochanteric fractures increases. Trochanteric fractures, but not femoral neck fractures, are related to bone density. Femoral neck fractures, on the other hand, may be more related to mechanical factors.

The vast majority of hip fractures occur after a fall. About 5% appear to be "spontaneous" fractures, in which the patient feels a fracture and then falls.  

Vertebral fractures
About 60% of women with compression fractures do not realize they have had a fracture!

Vertebral compression fractures vary in degree from mild wedges to complete compression. The symptoms also vary, but the degree of compression is not necessarily related to the amount of pain. It is possible that some of the fractures occurred gradually and therefore did not cause acute pain. Michael Nevitt, et al took spine xrays in 7223 older women and repeated the xrays 3.7 years later. During that time 371 women had a new vertebral fracture. Women were asked carefully about pain and disability symptoms. Increased back pain was experienced in 22% of women who did not have a new fracture and 38% of women who did have a new fracture.

These findings are similar to those in clinical trials, in which new vertebral fractures are found by xrays but only a minority of patients were aware of the occurance of the fracture. I think this has several implications for the management of osteoporosis. Since vertebral fractures strongly predict future fractures, and since many of them are "silent", it makes sense to recommend spine xrays as part of the evaluation of patients at risk for osteoporosis.

When women and men do suffer painful compression fractures, the pain usually lasts from one to two months, is localized to the back with accompanying muscle spasms, then gradually subsides. Patients with continuing severe pain should be evaluated for other pathologic etiologies of the fracture, especially malignancy or myeloma. Persistent pain can also be caused by continuing fracture, muscle spasms, spinal stenosis, or degenerative joint disease.

To correctly interpret a spine xray, it is important to know the definition of a vertebral fracture, which is not quite as straightforward as it first appears, especially for research. For practical clinical purposes, a vertebra can be considered fractured if the anterior height is 80% or less of the posterior height. A new fracture requires loss of at least 20% of anterior or posterior height.

Wrist fractures