17 November 2023

Focus on Osteoporosis

Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both. Bones become weak and may break from a fall or, in serious cases, from sneezing or minor bumps.

Osteoporosis is significantly more common in females than in males. Females also tend to develop the condition earlier and have fractures at younger age due to factors such as typically having smaller bones than males.

Estimates suggest that some 10 million people in the US over the age of 50 have osteoporosis, 8 million of which are female. Another 44 million people suffer from low bone density, placing them at a higher risk of bone fractures. (from Bone Health and Osteoporosis Organization and Medical News Today)

Healthy (A) and osteoporosis-affected (B) bones enlarged about 12 times (from University of Alabama at Birmingham video, What is Osteoporosis, www.youtube.com/watch?v=xbZ8AvnbIvE&t=17s).

Welcome back. Last month, osteoporosis featured in two major news releases. The International Osteoporosis Foundation reported the results of its annual World Osteoporosis Day and Bone Health Survey, and Osteoporosis Canada published an updated comprehensive guideline for skeletal health and fracture prevention. I'll summarize the first and introduce the second.

Poster highlighting results of International Osteoporosis Foundation s 2023 World Osteoporosis Day Survey of more than 7000 women, age 60 and over, in 5 countries--Brazil, Japan, South Korea, Spain and the UK (from www.eurekalert.org/news-releases/1005385).
World Osteoporosis Day Survey
The survey, conducted via Facebook in the lead-up to World Osteoporosis Day, 20 October, was completed by 7139 women, age 60 and over, in 5 countries--Brazil, Japan, South Korea, Spain and the UK.

Key Survey Findings
* On average, 43% of the women had broken a bone following a minor fall or bump after the age of 50. The percentage was highest in Japan (73%), lowest in Brazil (22%).
* An average of 33% had no diagnostic scan and 45% received no treatment for osteoporosis following their fracture. The treatment gap was highest in Spain (58%) and Brazil (52%).
* Of the respondents who had not broken a bone, an average of 31% had never discussed bone health or osteoporosis with their doctors (highest in the UK, 51%). Of those who had discussed bone health with their doctors, an average of 63% had a diagnostic scan (44% in the UK to 72% in Brazil and South Korea) and only 13% had discussed risk factors.
* Wrist fractures were the most common fracture (average 33%) followed by spine fractures (average 20%).
* Spinal fractures due to osteoporosis often remain undiagnosed and unrecognized. Many women who said they had not broken a bone were experiencing back pain (average 49%) or height loss of more than 4 cm/1.5 in (average 18%), with the latter ranging from 7% in Japan to 26% in Spain.

Osteoporosis Canada's 2023 Guideline (from osteoporosis.ca/2023-clinical-practice-guideline/).

Osteoporosis Canada Guideline
Published in the Canadian Medical Association Journal, the latest comprehensive guideline from Osteoporosis Canada aims to help primary care professionals deliver care to postmenopausal females and males age 50 and older.

The guideline has 25 recommendations and 10 good practice statements grouped in sections on exercise, nutrition, fracture risk assessment and treatment initiation, pharmacologic interventions, duration and sequence of therapy and monitoring. For example:

* Balance and functional training at least twice a week to reduce the risk of falls.
* Progressive resistance training at least twice a week, including exercises targeting abdominal and back extensor muscles.
* For people who meet the recommended dietary allowance for calcium with a variety of calcium-rich foods, no supplementation to prevent fractures is needed.
* Follow Health Canada's recommendation on vitamin D for bone health: 600 international units (age 51-70) and 800 international units (age > 70) for males and females.
Fracture Risk Assessment
* A clinical assessment for osteoporosis and fracture that includes identifying risk factors and assessing for signs of undiagnosed vertebral fracture(s). This includes bone mineral density testing in postmenopausal females and males age 50 to 64 with a previous osteoporosis-related fracture or 
2 clinical risk factors, or age  65 with 1 clinical risk factor for fracture, or age  70.

Some Key Points
* Prior fracture is a strong risk predictor of subsequent fracture (especially within 1 to 2 years); however, other risk factors are also important to identify individuals who would benefit from pharmacotherapy.
* Osteoporosis management should be guided by the patient's risk of fracture based on clinical assessment, including risk for falls, and using a validated fracture risk assessment tool.
* Exercise, nutrition, fall prevention and pharmacotherapy are key elements of the management strategy for fracture prevention; these should be individualized.
* Clinicians and patients should collaborate in developing care plans that consider patients' priorities and preferences.

Wrap Up
Before I departed Virginia, my primary care physician suggested I be tested for osteoporosis. Though I don t remember more than being told I'm marginal and should be monitored, I did pay more attention to relevant dietary concerns, particularly calcium. The topic has never come up here in Wisconsin. Guess it's time to be proactive. Maybe you should too. Thanks for stopping by.


World Osteoporosis Day

Osteoporosis Canada Guideline
2023 Clinical Practice Guideline:
Canadian Medical Association Journal:
Article on guideline on EurekAlert! website: www.eurekalert.org/news-releases/1003584

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