New Learnings on Osteoporosis
Piet Geusens, MD, PhD
Biomed Institute, Limburg University Center, Diepenbeek, Belgium and
Department of Rheumatology, University Hospital, Maastricht, Netherlands
Before recent data became available, we thought we understood some things about osteoporosis. These understandings included the belief that vertebral fractures are usually symptomatic (or that only the symptomatic vertebral fractures are of concern), hip fractures are the only osteoporotic fractures that are seriously debilitating and lead to death, and that osteoporosis progresses slowly and steadily over many years. Recent data suggest that each of these ideas is wrong.
We now know that vertebral fractures are very common and that only about one third of them come to clinical attention. All vertebral fractures, whether they are symptomatic or identified radiographically, are associated with increased risk of future fracture, with increases in pain, and with decreased levels of physical activity.
While it is well known that hip fractures lead to increased mortality, recent data show that both vertebral and other nonvertebral fractures also lead to increased mortality even among relatively healthy older women. The increase in mortality may be a reflection of poor health status in addition to the fracture itself or to the fracture itself. More research must be done to better understand these increased death rates.
Data from recent clinical studies provides evidence that osteoporosis is not a slowly progressing disease. Evaluation of the data from postmenopausal women receiving calcium and vitamin D supplementation, demonstrates that the risk of further vertebral fracture is substantially increased within the first year of an incident vertebral fracture. In fact, one woman in five fractured again within one year. These findings indicate the need for rapid intervention in patients with vertebral fracture in order to reduce the risks of further vertebral fractures.
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