Osteoperosis the "silent thief "

What is osteoporosis?
Heart disease and cancer are terms nearly everyone understands - and fears. If osteoporosis, a relative newcomer to most people's health vocabulary, were called the 'fracture disease', it would be recognised without hesitation.

One of the most serious disorders for older women, osteoporosis has been described as a 'silent thief'. Barely displaying symptoms of any underlying problems, osteoporosis results in a gradual weakening of the bone structure. With advancing age, osteoporotic bones grow increasingly porous and fragile until, with little or no warning, a hip, wrist or vertebra is fractured. Vertebrae may collapse, causing the back pain, spinal deformity and loss of height many older women experience. Because bones are so weak, many of these fractures can occur during ordinary activities stepping off a curb or lifting a shopping bag, for example.

Why does this happen? Bone is a living tissue that is constantly broken down and reformed. From birth until the early 30s, more bone is formed than is lost. Once that peak is reached, the process reverses. This is true for men and women alike, but the loss is greatly accelerated in women in the first few years after the menopause. The loss is dramatic. In the first decade after the menopause, women may lose 15-20% of spinal bone and comparable amounts at other sites. Subsequent rates of loss may average 1 % each year. This means that an 80-year-old woman who has not taken hormone therapy may have lost about 40% of her bone (Department of Health, England, 1994). Bone loss especially weakens the hip, vertebra and wrist.

Incidence: focus on women
Osteoporosis strikes older women hardest. Nine in 10 hip fractures occur in people over 50, 80% of them women (Department of Health, England, 1994). The lifetime risks from osteoporosis fractures in Caucasian women over 50 are estimated at nearly 40% (Melton, 1992). However, men are not immune. Incidence in men over 60 rises significantly (Scane, 1994).

Researchers are finding that the incidence of hip fracture differs more between communities than between the sexes, suggesting the strong role of genetics and lifestyle factors in the development of osteoporosis (Kanis, 1993). Within Europe, there is a marked geographical distribution. Rates are highest in Scandinavia, where exposure to sunlight - important to vitamin D synthesis and bone formation - is limited. Women in northern regions must also contend with snow and ice, putting them at greater risk of injury from falls, and limiting their opportunities for physical activity. Southern European women fare better. The post-war generation boom will make an already difficult situation much worse. Some researchers predict that the number of hip fractures worldwide, now estimated at 1.6 million, could rise nearly four-fold by the year 2050 to more than six million if present trends continue. Hip fractures for European women over 65 could nearly double (Cooper, 1992).

The high cost of fractures
Hip fractures and their resulting disabilities are costly in economic as well as human terms, requiring hospitalisation, rehabilitation and home care. Other fractures are also painful, disabling and costly. About 20% of European women over 70 have had at east one wrist fracture, and fractures of the forearm are common among the middle-aged and elderly. In most European countries about 15-25% of women aged 75 and over are affected by vertebral (spinal) crush fracture, which causes chronic pain and loss of height (WHO, Geneva,1994).

Indirect costs to quality of life and productivity are serious, both for those who experience hip fracture and for their carers. Within one year of a fracture, 15-20% of hip fracture patients aged 65 and older die as a result of complications arising from the fracture. Another 20-25% are unable to live independently and must rely on their families or the State for care (Cummings, 1985; WHO, Geneva, 1994). Many never return to full functioning or good health (Chrischilles, 1991) Informal care provided by family and friends, usually women over 55, also takes a hidden but substantial toll on financial and emotional well being.

Figure 9

Projected increase in incidence of hip fractures in European women over 65, 1995-2050

Osteoporosis is not widely understood
Despite the fact that osteoporosis is the most common metabolic bone disease and a major came of illness and disability worldwide, many women and their health care providers have little familiarity with the disease. In the UK, for example, as recently as 1986, 20% of general practitioners said they had never seen a case (Department of Health, England, 1994). A recent European study revealed that only 22% of women aged over 40 have been questioned about osteoporosis by their health care practitioner and only 17% have been tested for the disorder (European Osteoporosis Study 1995).

If family doctors are not sufficiently aware of osteoporosis it is not surprising that women dismiss its dangers. According to the European Osteoporosis Study, nine out of 10 women over 40 were aware of osteoporosis, but only half considered it a disease at all, and others saw it as one result of ageing and thus no great cause for alarm. Despite the fact that one in three women over 50 will develop the disorder, because of lack of accurate knowledge about osteoporosis, few expressed any personal concern.

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