Author: Simon Kipersztok, M.D., University of Florida

Brief Introductory Case and Learning Objectives

A 55 year old healthy postmenopausal woman has a 78 year old mother who recently fractured her femoral neck after falling. The mother's physician indicates that the fracture was caused by osteoporosis. Is the woman at risk for similar fractures? How can she determine how severe that risk is? If the risk is severe, what can she do to minimize it? What advise can the woman give to her 30 year old daughter such that she will have a substantially lower risk of having an injury similar to her grandmother's later in life?

In this module, you will have the opportunity to learn about postmenopausal osteoporosis, its diagnosis and the currently available treatments. After completing the module, you will also have acquired sufficient knowledge about bone densitometry in order to apply it in your practice when evaluating patients at risk of osteoporosis.

Definition

Osteoporosis is a chronic, progressive condition associated with micro architectural deterioration of bone tissue that results in low bone mass. As the condition progresses there is an increase in bone fragility that consequently increases the susceptibility to fractures [1].

Epidemiology

Osteoporosis is considered to be a major public health hazard because of two main reasons. The first reason is that osteoporotic fractures, most commonly observed in the vertebrae, the femur and the radius, can cause substantial morbidity and mortality. In situations where femoral fractures occur patients are likely to require assistance for their activities of daily living or require institutionalization in a chronic care facility after they leave the hospital. Moreover, up to 20% of such patients can die as a result of post-operative complications.

The second reason is that osteoporosis is a common disease among the elderly and with improvements in health care the lifetime expectancy in developed countries has increased. This means that as the fraction of elderly individuals increases in the population, osteoporosis is likely to become more prevalent. As a result, the cost of osteoporosis-related health care expenses to our society is high and highly likely to rise.

Based on fracture data, it is estimated that the lifetime risk in 50 year old white women for a fracture in the vertebrae, the proximal femur or the forearm is about 40%. For white men the risk is approximately 13%. Men and women from other ethnic groups may have similar lifetime risks although the risk of osteoporosis is higher among Caucasians and Asians than it is among African Americans [2]. Based on Bone Mineral Density (BMD) data, it is estimated that approximately 6-7 million of non-institutionalized older U.S. women have established osteoporosis and approximately 12-17 million additional women have osteopenia which also increases the risk of fracture [3].

Date of Original Release: January, 1997.