1、Kenneth J. Koval, MD Laura Tosi, MD AOA Committee for the Own the Bone Pilot Project Created February 2007; Revised March 2011,Fragility Fractures,Prevalence,More than 34 million Americans suffer from osteoporosis or low bone mass 80% are women 1 in 2 women over 50 years old 1 in 4 men over 50 years
2、 old,Source: National Osteoporosis Foundation,Osteoporosis-fracture Occurrences vs Other Diseases,0,500,000,1,000,000,1,500,000,2,000,000,Osteoporotic fractures,Stroke,Breast Cancer,250,000hip,184,300,750,000 vertebral,250,000 other sites,228,000,Annual incidence of common diseases,1,500,000,Wrist F
3、ractures: 200,000+,Hip Fractures: 300,000+,Vertebral Fractures: 700,000+,Other Fractures: 300,000+,Source: National Osteoporosis Foundation, 2000,1.5 Million Fractures Annually,$14 billion annually,Burden of Disease,Approximately $38 million daily Congestive heart failure costs $8 billion annually A
4、sthma costs $9.8 billion annually,Burden of Disease,1 out of 4 osteoporotic hip fractures result in long-term nursing home care One half of these are unable to walk without assistance 24% greater risk of dying within one year,Whats the link?Fragility fractures Fractures of the distal radius, proxima
5、l humerus, vertebrae and proximal femur that result from minimal trauma, such as a fall from a standing height. Up to 95% of hospitalized fracture inpatients over 75 years of age, and 80%-90% of fractures in patients between 60 and 74 years of age can be attributed to osteoporosis.,- Fragility Fract
6、ures & Osteoporosis -,Only 23% of hip fracture patients received the care recommended on the basis of good practice standards.! Source: RAND Report,40% of postmenopausal women and 25-33% of men will eventually experience osteoporotic fractures. 20 percent of senior citizens who suffer a hip fracture
7、 die within a year Risk of mortality is 2.8-4 times greater among hip fracture patients during the first 3 months after the fracture Nearly 1 in 5 hip fracture patients ends up in a nursing home within a year,Alarming Fracture Statistics,Source: Surgeon Generals Report, 2004, Jrnl of Bone and Minera
8、l Research,Fractures cost $18 billion/year and expected to increase if action is not taken.,The Costs Continue to Grow,Risk Factors for Osteoporosis,Female Thin or small frame Low body weight Smoker,Risk Factors for Osteoporosis,Advanced age History of fragility fracture Family history- primary rela
9、tive with osteoporosis or fragility fracture,Risk Factors for Osteoporosis,Post Menopausal Hormonal imbalances can result in rapid bone loss Women can lose up to 20% of their bone mass in 5-7 years,Risk Factors for Osteoporosis,Amenorrhea, Anorexia & Bulimia Diet low in calcium Certain medications L
10、ow testosterone in men,Risk Factors for Osteoporosis,Inactive lifestyle Excessive alcohol consumption,Ethnicity & Osteoporosis,13-16% with osteoporosis now,36-49% of Mexican American women 50+ have experienced significant bone loss,Hispanic women at highest risk,Ethnicity & Osteoporosis,Caucasian &
11、Asian-American women also high risk,Ethnicity & Osteoporosis,10% of African-American women 50+ have osteoporosis 30% more have low bone density,Ethnicity & Osteoporosis,300,000 African-American women have osteoporosis 80-95% of all fractures sustained by African-Americans 64+ are osteoporotic Africa
12、n-American women more likely to die from hip fractures than White women,Underdiagnosed,Unrecognized,Underreported,Inadequately researched,Men & Osteoporosis,Men & Osteoporosis,2 million American men have osteoporosis 3 million more are at risk 1/3 of male hip fractures related to osteoporosis 1/3 of
13、 these men will not survive 1 year after fracture,Risk Factors for Fragility Fractures,Impaired vision despite correction Estrogen deficiency at an early age (45 yrs) Dementia Poor health / frailty Recent falls Lifelong low calcium intake Low physical activity,Fractures beget Fractures,Risk of futur
14、e fractures increases 1.5-9.5 fold following initial fracture History of fragility fracture is more predictive of future fracture than bone density,Diagnosis: Bone Densitometry,Recommendations for bone density Anyone with a fragility fracture All women age 65 and older Postmenopausal younger than 65
15、 with risk factors Men over 50 with risk factors,Goals Prevent future fractures Treat osteoporosis Decrease the risk of mortality after fractures,Treatment,Calcium and Vitamin D,All patients with bone loss or the potential for bone loss should be educated on the appropriate intake of calcium and vit
16、amin D,+,=,Stronger Bones!,Stronger Bones!,Treatment,There is a high prevalence of vitamin D insufficiency in: Nursing home residents Hospitalized patients Adults with hip fractures,Treatment,2. Exercise,Physical activity makes bones and muscles stronger and helps prevent bone loss. All types of phy
17、sical activity can contribute to bone healthHigh impact exercise programs may be the most effective at preventing fragility fractures,Treatment,3. Fall Prevention,Each year, more than 1.6 million older U.S. adults go to emergency departments for fall-related injuries. Among older adults, falls are t
18、he number one cause of: FracturesHospital admissions for traumaLoss of independenceInjury deaths,Source: National Institute of Health/National Institute on Aging,Fall,3 factors that contribute to fractures,Force,Fragility,Treatment,4. BMD/DXA Testing,Single most important diagnostic test to predict
19、whether a person will have a fracture in the future. It helps diagnose osteoporosis and predict the risk for having a fracture by comparing bone density to the bones of an average healthy young adult,Treatment,5. Cessation of smoking,Smoking can reduce bone mass, increase fracture risk and should be
20、 avoided for a variety of health reasons,Treatment,6. Pharmacotherapy Treatment & prevention,Bisphosphonates are approved by the FDA and can help stop or slow bone loss, or help form new bone, and reduce the risk of fractures,Treatment,Bisphosphonates,Bisphosphonates are bone-building drugs that pre
21、vent bone resorption and remain important treatment options for patients at risk of debilitating fractures. But, where does the impact on dental health figure into the equation? What is the true incidence of osteonecrosis of the jaw (ONJ)?,Source: Bamias A. Osteonecrosis of the jaw in cancer after t
22、reatment with bisphosphonates: incidence and risk factors. J Clin Oncol 2005;23(34):8580-7.,Approximately 125 cases of osteonecrosis have been linked to bisphosphonate usage. The majority of these cases have been administered through an IV to cancer patients,The Facts,A man with a hip fracture has a
23、 1:3 chance of dying within a year A woman with a hip fracture has a 1:4 chance of dying within a year The risk for ONJ among patients taking oral bisphosphonates is likely to be 1:100,000,Bisphosphonates,Bisphosphonate Associated Fracture,May occur with long term bisphosphonate use Relatively rare
24、occurrence compared to fragility fractures Risk/benefit analysis still favors bisphosphonate use,Source: Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. Park-Wyllie LY, Mamdani MM, Juurlink DN, Hawker GA, Gunraj N, Austin PC, Whelan DB, Weiler PJ, Laupac
25、is A. JAMA. 2011 Feb 23;305(8):783-9.,7. Patient NoteProvide the patient with written information regarding fragility fractures and preventive measures that can be taken. Encourage them to speak with their primary care physicians for additional follow-up after the fracture has healed,Treatment,8. Ph
26、ysician Referral,A letter sent to the primary care physician can provide information regarding the patients fracture and recommend appropriate measures be taken,Treatment,Use handrails on stairs, bathroom Keep rooms free of clutter Keep floors clean but not slippery Wear supportive, low-heeled shoes
27、. Dont walk in socks; floppy slippers Use 100 watt bulbs in all rooms Install ceiling lighting in bedrooms Use rubber matt in shower/tubKeep a flashlight at bedsideCheck posture in mirror often,Fall Prevention in the Home,Bibliography,Bisphosphonate use and the risk of subtrochanteric or femoral sha
28、ft fractures in older women. Park-Wyllie LY, Mamdani MM, Juurlink DN, Hawker GA, Gunraj N, Austin PC, Whelan DB, Weiler PJ, Laupacis A. JAMA. 2011 Feb 23;305(8):783-9.,The American Orthopaedic Associations “own the bone“ initiative to prevent secondary fractures. Tosi LL, Gliklich R, Kannan K, Koval
29、 KJ. J Bone Joint Surg Am. 2008 Jan;90(1):163-73.,Primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force. Michael YL, Whitlock EP, Lin JS, Fu R, OConnor EA, Gold R; US Preventive Services Task Force. Ann Intern
30、 Med. 2010 Dec 21;153(12):815-25. Review.,Bisphosphonates for osteoporosis. Favus MJ. N Engl J Med. 2010 Nov 18;363(21):2027-35.,Keep floors free from clutter Use portable phone; keep phone and electrical wires out of walkways Skid-proof backing on carpets / scatter rugs Keep weeks supply of prescri
31、ption medications on hand Daily contact with family member / neighbor Contract with monitoring company for 24 hour response time in emergency,More Home Fall Prevention,Return to General/PrinciplesIndex,E-mail OTA about Questions/Comments,If you would like to volunteer as an author for the Resident Slide Project or recommend updates to any of the following slides, please send an e-mail to otaaaos.org,
