Bone Loss In Postmenopausal Women

At an international consensus development conference, osteoporosis was defined as "a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk." In 1994, a World Health Organization (WHO) working group proposed that, in epidemiologic studies, osteoporosis could be determined when bone density at the hip, spine, or forearm is 2.5 standard deviations or more below the mean for healthy, young, adult women (a value defined as the T-score), or when a history of a fracture is present in the absence of trauma. The group also proposed that osteopenia be determined when the bone density was 1.0 to 2.5 standard deviations below the mean for young, healthy women.

According to the National Health and Nutrition Examination Survey (NHANES III), an estimated 14 million American women over age 50 years are affected by low bone density at the hip, and 5 million more have bone density that measures 2.5 standard deviations or more below the mean at the hip. The prevalence of osteoporosis in Mexican-American women is similar to that in white women, while rates in black women are approximately half that of the first two groups. The prevalence of osteoporosis increases with age for all sites, and by the WHO definition up to 70 percent of women over age 80 years have osteoporosis.

Furthermore, age is an important factor in the relationship between bone density and the absolute risk of fracture. An increase in age of 13 years increases the risk of hip fracture by the same amount as a decrease in bone density of one standard deviation. Older women have a much higher fracture rate than younger women who have the same bone density, because of increasing risk from other factors, such as a change in bone quality and the tendency to fall.

Women with osteoporosis are more likely to experience fractures. Demographic trends for hip fracture parallel those for osteoporosis. Hip-fracture incidence in white women rises from 50 per 100,000 at age 50 years to 237 per 100,000 at age 65 years. White women are generally two to three times more likely than nonwhite women to suffer a hip fracture. Hip fractures are associated with high rates of mortality and loss of independence. Wrist fracture incidence tends to increase at earlier ages than does that of hip fractures.

Vertebral fractures have also been associated with significant morbidity. Sixteen percent of postmenopausal women have osteoporosis of the lumbar spine; furthermore, five percent of 50-year-old white women and 25 percent of 80-year-old women have had at least one vertebral fracture. Vertebral fractures can cause severe pain and are associated with more than five million days of restricted activity in those age 45 years or older.

The disease burden of osteoporosis extends beyond consequences of low bone density and fractures. For example, the act of screening, diagnosis, and subsequent treatment can also affect the quality of life. Fear of fracture itself can reduce the quality of life in women who have been diagnosed as having osteoporosis.

In 1995, the total direct medical expenditure in the United States for the treatment of osteoporotic fractures in adults older than 45 years was estimated at $13.8 billion. The majority of this total ($8.6 billion) was spent for inpatient care. Hip fracture alone accounted for $8.7 billion (63 percent) of osteoporosis-related costs, while fractures at sites other than the hip accounted for approximately 37 percent of the total expenditure (about $5.1 billion). In addition to these costs is the cost of lost productivity for women with fractures, or for their family or other caregivers. As the median age of the U.S. population increases, the costs associated with osteoporotic fractures are also likely to increase.

You May be Love These Topics.

- Home relief For Postmenopausal Ovarian Cyst
- The Significance of Bleeding after the Menopause
- Calcium Effective Against Bone Loss In Postmenopausal Women

Rewrite From : images.medicinenet.com , ahrq.gov