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Fragility Fractures & Their Impact on Older People

https://doi.org/10.1016/j.berh.2017.10.001Get rights and content

Abstract

Osteoporotic fractures, in particular hip and vertebral, are a major health burden worldwide. The majority of these fractures occur in the elderly population, resulting in one of the most important causes of mortality and disability in older ages. Their cost for societies is enormous and is forecast to steadily increase over the coming decades globally. Low bone mineral density (BMD) remains a key preventable risk factor for fractures. Screening and treatment of individuals with high risk of fracture is cost-effective. Predictive tools including clinical risk factors, minimisation of falls risk and public authorities' support to create Fracture Liaison Services are paramount strategies.

Section snippets

Definition of osteoporosis and osteoporotic fractures

Osteoporosis is defined as a systemic skeletal disease characterised by a low bone mass and a microarchitecture deterioration of bone tissue, with a subsequent increase in bone fragility and susceptibility to fracture [1]. It behaves as a silent disease. A high percentage of affected people are not aware that they have the condition. Consequently, osteoporosis burden is better assessed by measuring the burden of its clinical outcome, i.e. osteoporotic fractures (also known as ‘fragility

Health consequences of osteoporotic fractures

The consequences of osteoporotic fractures for an individual range from chronic pain, loss of mobility, and loss of independence to institutionalisation and death [10], [11], [12].

Hip is the location of fracture leading to the poorest health outcomes, in part because of the peak incidence of such fractures occurring in populations that are 70–79 years old [10]; therefore, the incidence and subsequent loss of health is considerably higher in developed countries [10]. At 1 year after the hip

Epidemiology of osteoporotic fractures: population trends

Osteoporosis has been estimated to affect 200 million women worldwide, approximately one-tenth of women aged 60, one-fifth of women aged 70, two-fifths of women aged 80 and two-thirds of women aged 90 [39]. For a person over 50 years living in a developed country, the lifetime risk of sustaining any fracture in their remaining years of life has been estimated to be approximately 50% for women and 20% for men, and most of these will be related to osteoporosis [40], [41]. Age and female gender

Economic cost of osteoporotic fractures

The economic burden of osteoporosis results both from acute outcomes, such as hospital admission and surgery after an incident fracture, and long-term consequences related to chronic disability and costs of pharmacological and non-pharmacological interventions. Simultaneously, the costs are classified as direct (e.g. treatment of incident fractures, pharmacological prevention, institutionalisation, etc.), indirect, corresponding to the productivity losses of the sufferer and carers, and

Low bone mineral density as a preventable risk factor for fractures

For the last two decades, the operational definition of osteoporosis has been based on BMD values: osteoporosis may be diagnosed in postmenopausal women and in men aged 50 years and older if the BMD measured by dual X-ray absorptiometry (DXA) at lumbar spine, total hip or femoral neck (in certain circumstances, the 33% distal radius may be utilised) is −2.5 SD or less from the mean BMD value in young females (T-score −2.5 or less) [1] (Fig. 3). The young reference values should be obtained by

Conflict of interest statement

No conflicts of interest to declare.

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