Why Is Osteoporosis Considered Different?
|A symposium in conjunction with the 2nd International Meeting on Social and Economic Aspects of Osteoporosis and Bone Disease, Liège, Belgium, 7 December 2000
Pierre Delmas, MD, PhD, Professor of Medicine, Claude Bernard University of Lyon, Department of Rheumatology and Bone Diseases, Hopital E. Herriot, Lyon, France
Even though osteoporotic fractures result in similar levels of morbidity and mortality, impaired quality of life and high healthcare costs as, for example, some cardiovascular diseases, osteoporosis is not yet taken seriously enough in many countries.
Studies have shown that mortality rates from stroke and hip fracture in older women are comparable in several European countries. Other studies demonstrate that osteoporosis causes more disability than many other diseases. In fact, a Swiss study reported that the number of days women with osteoporosis-related disability spent in bed is higher than the number for chronic obstructive pulmonary disease, stroke, myocardial infarction and breast cancer.
Most striking are data showing that the risk of death for women with hip fractures is similar to the risk for other potentially fatal diseases. For example, one study showed that the lifetime risk of a 50-year-old woman dying from a hip fracture is equal to her risk of dying from breast cancer and greater than her risk of dying from endometrial cancer.
In terms of the financial burden to national healthcare systems, estimates have shown that the cost of osteoporosis is comparable to other serious diseases, including asthma and congestive heart failure. In the United States, asthma is estimated to cost US$7.5 billion, congestive heart failure US$22.5 billion, and osteoporosis US$13.8 billion.
The paradox of this revealing data is that effective therapies are available today to prevent osteoporotic fractures. Worldwide clinical trials have demonstrated that bisphosphonate medicines such as alendronate and risedronate reduce the risk of hip and spine fractures by 50%, and selective estrogen receptor modulators such as raloxifene may reduce the risk of spine fracture by 50%.
In addition, the disease now can be diagnosed accurately using technology such as dual energy x-ray absorptiometry. The measurement of bone mineral density is as good a predictor for osteoporosis fracture as blood pressure is for stroke and better than cholesterol is for heart attack.
Despite the availability of accurate diagnosis and effective treatment, many people at high risk of osteoporosis are not being diagnosed. The results of a 1997 survey showed that BMD measurement was under-utilized in the majority of European countries.
The reasons for this include the limited availability of densitometers, restrictions in personnel permitted to perform scans, low awareness of the usefulness of BMD testing, and limited or non-existent reimbursement in many countries.
A major contributing factor is that the field of osteoporosis is relatively new. While the medical community has been aware of the consequences of undiagnosed and untreated hypertension for at least 40 years, the consequences of osteoporosis have not yet attracted the critical attention of both physicians and health authorities necessary to be included in national health targets. Certainly a physician would examine and treat a patient for high cholesterol or hypertension in the presence of known risk factors. Then, why not osteoporosis, given its substantial effect on morbidity and mortality?
The neglect of osteoporosis has resulted in many painful, debilitating and deadly fractures in Europe that could otherwise have been prevented. There is no reason why osteoporosis should not be afforded the same consideration as other serious diseases by physicians and policy-makers.
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