Consequences

Vertebral fractures are a well-recognized consequence of postmenopausal bone loss and are the most common occurring osteoporotic fractures.¹⁴It is estimated that less than one third of all vertebral fractures are clinically diagnosed. However, all vertebral fractures, whether symptomatic or radiographically identified, are associated with increased mortality and morbidity, including back pain and decreased activity, with consequent increased days of bed rest. Vertebral fractures are associated with increased risk of further vertebral fractures, with resulting height loss and kyphosis, as well as increased risk of nonvertebral fractures.^{15, 16} This increased risk remains after correction for bone mineral density (BMD), itself a potent risk factor for fracture.

Vertebral compression fractures vary in degree from mild wedges to complete compression. Kyphosis "Dowager's hump" caused by vertebral compression fractures is disfiguring. The protruding abdomen which is a result of the kyphosis is an unrecognized aspect of osteoporosis.¹⁴ Height loss associated with osteoporosis is one of the aspects of the disease that is most distressing to many women. Patients with kyphosis have decreased pulmonary capacity. In severe cases this leads to shortness of breath and pulmonary symptoms of restrictive lung disease. Patients with kyphosis may develop reflux esophagitis due to the changes in abdominal space.

The frequency of hip fractures increases exponentially with age, particularly after age 70. ¹⁷, ¹⁹ One in six Caucasian women will fracture her hip and this is greater than the risk of developing breast or gynecologic cancer. Between 18 to 33% of hip fracture patients die within one year of their fracture. The risk of death in women with hip fracture is approximately 2 to 4 times greater in the year after hip fracture compared to women without hip fracture. In 1991, about 300,000 Americans age 45 and over were admitted to hospitals with hip fractures and osteoporosis was the underlying cause of most of these injuries.

Each year, men suffer 1/3 of all the hip fractures that occur, and 1/3 of these men will not survive more than a year. In addition to hip fracture, men also experience painful and debilitating fractures of the spine, wrist, and other bones due to osteoporosis.¹

The rate of hospitalization for hip fracture differs by sex. The hip fracture hospitalization rate for persons aged >65 years is significantly higher for women than men. During 1988-1996, the rates for women increased significantly, from 972 per 100,000 to 1,356; for men, rates remained stable.⁶ A Healthy People 2010 objective is to reduce the hip fracture hospitalization rate among women aged >65 years to no more than 879 per 100,000. ⁶

The rise in average age of presentation with proximal femoral fracture is associated with a persistently high mortality (33%) and morbidity, demonstrates a study from Britain.¹⁸ The authors of this study concluded that despite advancing standards of care the mortality and morbidity of femoral neck fractures remains high, placing an ever increasing burden on the health system.

HIP FRACTURE MORTALITY ACCORDING TO AGE

Adapted with permission from Keene GS et al. BMJ. 1993;307:1248-1250.

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