Epidemiology of Osteoporosis

Published on January 19, 2015   31 min
0:00
The Epidemiology of Osteoporosis, Professor Cyrus Cooper, professor of rheumatology and director, MRC Lifecourse Epidemiology Unit, University of Southampton and professor of musculoskeletal science, University of Oxford in the UK.
0:15
Osteoporosis has been recognized throughout antiquity. In the left hand, bottom corner of this slide you see a radiograph of a section of spine removed from a Saxon barrow in the 8th century, and you see quite clearly that there's a vertical compression fracture. Such fractures were reported by Hippocrates more than 400 years before Christ and have been reported throughout antiquity. In the 1820s and 1850s the term osteoporosis was coined to indicate the pathological appearance of bone when it had lost bone volume and bone structure. Sir Astley Cooper documented the most frequent fracture associated with osteoporosis in those days, hip fracture. He showed that it was more common in women than men and he showed that it increased in frequency with age. But our real understanding of osteoporosis stems from research undertaken over the last 75 years, and principally since 1990, when we have developed a uniform definition of osteoporosis based on bone density measurement, developed a number of antiresorptive and formation stimulating therapies against osteoporosis, and developed coherent risk assessment strategies.
1:37
The step change for this was the WHO definition of osteoporosis, which is shown in this next slide, that was coined in 1994 and characterized osteoporotic bone density as 2.5 standard deviations or more below the young normal mean. And it was a disorder characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to an increased risk of fracture.
2:05
In this lecture I shall cover the descriptive epidemiology of hip and other osteoporotic fractures. I shall cover fracture incidence worldwide, particularly the geographic and temporal trends. I shall explain why we see the age, period, and birth cohort effects in the epidemiology of osteoporotic fracture and I shall close with preventive strategies against fracture throughout the life course.
2:32
Much of the data relating to the frequency and burden of osteoporosis in the European Union has been collected together in a recent extensive anthology published in the Archives of Osteoporosis by a group of investigators working with the International Osteoporosis Foundation and the European Federation of Pharmaceutical Industry Associations.
2:54
The next slide shows the burden of fractures throughout Europe, focusing on the three major osteoporosis-related fractures-- those if the hip, spine, and wrist. The lifetime risk from age 50 is onwards, in European women, of the hip fracture is 14%, of a clinically diagnosed vertebral fracture, 11%, and of a wrist fracture, 13%. The cumulative risks in men are substantially lower because of the accelerated bone loss following the menopause in women, as well as the increased frailty and likelihood of falling amongst older women when compared with older men. These three fractures occur frequently in the European population; 615,000 off them each year at the hip, 516 million at the vertebra, and 560,000 at the wrist. Hip fractures were almost uniformly hospitalized, while spine and wrist fractures tend to be managed as outpatients. Hip and spine fractures, as we shall see, are associated with excess mortality, and the 3.5 million fractures at all sites combined attributable to osteoporosis in Europe account for around one-third of the global burden each year of 8.9 million fractures. The total cost of these fractures in Europe has been estimated at 39 billion Euros.
4:20
The next slide shows the data that we have for the United Kingdom. So that of men and women aged 50 year and over, you can see those with a hip and spine fracture that have had a previous fracture. In women there are 293,000 hip fracture cases who have had a previous fracture and 292,000 spine fracture cases. And again, a smaller number of men. In the UK we have around 80,000 hip fractures each year, 66,000 spine fractures that come to clinical attention, and 69,000 wrist fractures. The attributable mortality is around 2,700 for hip fracture and 1,800 for spine fracture. All sites combined account for 535,000 fractures attributable to osteoporosis in the UK each year at a cost that's been estimated at around 4.4 billion pounds.
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Epidemiology of Osteoporosis

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