A study published online today in Current Medical Research and Opinion shows that 86.4% of women with a fracture history had low bone mineral density and over half (51.9%) had osteoporosis, confirming that prior fracture is a strong predictor of osteoporosis.
Lead investigator Dr Eamonn Brankin of Church Street Practice, Coatbridge, Lanarkshire, Scotland, commented: “These results are very interesting and if people adopt a proactive case-finding strategy, as we did, to help identify those who are at high risk of osteoporosis, it will help them treat them appropriately.
By building the patients’ bone density, they will not be so susceptible to fractures from falls in the future. At the same time, this approach will help PCOs meet the targets of the National Service Framework for Older People required by April 2005.”
In this study, over 1,000 women, who had sustained a fracture or who had two or more risk factors of osteoporosis and had not been screened for osteoporosis previously, were invited for a DEXA scan to determine their bone mineral density (BMD). These women were selected based on analysis of questionnaires sent to all women (4,045) over 64 years of age in Coatbridge, Lanarkshire.1
The results showed that among those who had sustained a prior fracture (591), 51.9% were osteoporotic, 34.5% were osteopenic and 13.5% had normal bone mineral density. In addition, 80% of those who had not had, or were unaware that they had suffered, a prior fracture were osteopenic or osteoporotic.1 Treatment was prescribed for 670 of the patients, 90% with bisphosphonates plus calcium/vitamin D, and 6.4% with calcium/vitamin D, according to local guidelines.
It was also found that older women were more likely to have osteoporosis: overall, 46.8% of patients aged 65-74 had osteoporosis, and 63% had the condition over the age 74. In those without a prior history of fracture, 43% of 65-74 year olds and 47.2% of those over 74 years old had osteoporosis.1
Patients who sustain an osteoporotic related fracture are the highest risk group for sustaining further osteoporotic fractures, often within one year of the fracture.
The disease costs the NHS an estimated £1.7 billion per year or £5 million per day for hip fractures alone. These costs are likely to mount in future years because we are living longer, and osteoporosis is largely an age-related disease.
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Interviews available with
· Dr Eamonn Brankin, lead investigator
Notes to editors
· The lifetime risk of suffering any fracture at age 50 years is around 1 in 2 women and 1 in 5 men.
· Each hip fracture costs the NHS £20,000-£25,000 in the first year including hospital and community care costs.
· Osteoporosis is a devastating condition and often there are no signs or symptoms until a break occurs.
Although the condition itself is not life-threatening, the after-effects of fractures can be. Previous research has shown that one year after hip fracture: 20% of patients died (in Lanarkshire this is up to 30%6), 40% were unable to walk unaided, 60% had difficulty with at least one essential activity of daily living and 80% were restricted in other activities such as driving and grocery shopping8.Treating osteoporosis makes sense for both patients and the NHS. After a vertebral fracture, a patient will on average make 14 more visits to her GP in a given year.
· More than 20% of orthopaedic day beds are taken up by patients who have suffered hip fractures.2
· 50% of previously self-caring individuals will be dependent post-hip fracture.6
· The Primary Care Audit in Coatbridge was carried out in June 2003 by NHS Lanarkshire. All women over the age of 64 living at home were sent questionnaires regarding osteoporosis. Responses were received from 2,386 women (59%).1
· This work was supported by unrestricted educational grants from Strakan and Merck Sharp & Dohme Limited (MSD) and sponsorship from Merck Sharp & Dohme Limited, Aventis and Eli Lilly.
Further information is available from Nicky Chapple on 020 8948 8388 or 07973 288819 (mobile) or Calvin Brown on 01698 245006 or 07711 497611 (mobile).
References
1. Eamonn Brankin, Caroline Mitchell and Robin Munro on behalf of Lanarkshire Osteoporosis Service. Closing the osteoporosis management gap in primary care: a secondary prevention of fracture programme. Curr Med Res Opin. 2005 21(4): 475-482; doi10.1185/030079905X38150. Published online 11 March 2005: url: http://www.catchword.com/ini=libra_cmro/rpsv/cw/libra/03007995/previews/2933
2. Scottish Intercollegiate Guidelines (SIGN) Management of Osteoporosis Guideline No.71; Section 1, Introduction.
3. The Care of Fragility Fracture Patients, The British Orthopaedic Association, September 2003 Torgensen DJ, et al. The economics of fracture prevention. Barlow DHed. The effective management of osteoporosis. London. Aesculapius Medical Press 2001;111-21.
4. Van Staa TP, Dennison EM, et al. Epidemiology of fractures in England and Wales. BONE 2001; 29:517-22
5. Falls and fracture redesign report. NHS Lanarkshire, March 2004.
6. National Institute of Health. Osteoporosis prevention, diagnosis, and therapy. JAMA 2001; 285(6):785-95
7. Cooper C. The crippling consequences of vertebral fractures. Am J Med 1997; 103 (2A): 304-435.
8. Dolan P, Torgensen DJ. The cost of treating osteoporotic fractures in the United Kingdom female population. Osteoporosis Int. 1998;8:611-6
