Osteoporosis

A Lifecourse Epidemiology Approach to Skeletal Health

Nicholas C Harvey, Cyrus Cooper, Nicholas C Harvey, Cyrus Cooper

• Publisher: CRC Press
• Year: 2018
• Print ISBN: 9781138196162
• eBook ISBN: 9781351234603
• Topic: Medicine
• Subtopic: Clinical Medicine

This is the first book to document comprehensively the 'state of the art' in the lifecourse epidemiology of osteoporosis. In detailed chapters, expert contributors describe the current and projected future burden of disease, developments in the understanding of risk factors for osteoporosis from cradle to grave, the underlying mechanisms, and advances in approaches to risk assessment and treatment. It is essential reading for all students on postgraduate courses in bone health, as well as an important reference for practitioners and researchers in osteoporosis, epidemiology, and related fields.

1The burden of osteoporosis

Elizabeth M Curtis, Nicholas C Harvey and Cyrus Cooper

Introduction

Global Burden of Osteoporosis and Fracture

Variation in Fracture Rates by Age and Sex

Epidemiology of Hip, Spine and Wrist Fractures

Risk of Subsequent Fracture Within Individuals

Genetic Influences on Fracture Risk

Global Variation in Fracture Rates

Global Trends in Fracture Incidence Over Time and Future Projections

Conclusion

References

Introduction

Osteoporosis constitutes a major public health problem, through its association with age-related fractures, particularly of the hip, vertebrae, distal forearm and humerus, with serious consequences in terms of morbidity and mortality. Worldwide, osteoporosis causes more than 8.9 million fractures annually, which means that on average, an osteoporotic fracture occurs every 3 seconds (1). In this chapter we describe the burden placed on individuals, healthcare systems and societies globally by osteoporotic fractures.

Global Burden of Osteoporosis and Fracture

The Global Burden of Disease study demonstrated the massive impact of musculoskeletal conditions on populations worldwide: the number of disability adjusted life years (DALYs) attributable to musculoskeletal disorders has increased by 17.7% between 2005 and 2013 (2). ‘Low back pain’ ranked top, ‘neck pain’ fourth, ‘other musculoskeletal’ tenth and ‘osteoarthritis’ thirteenth in the WHO rankings of causes for years lived with disability worldwide in 2013 (3), with osteoporotic fractures playing a major part in the ‘back pain’ and ‘other musculoskeletal’ categories. The 2004 US Surgeon General’s report estimated that 10 million Americans over the age of 50 years have osteoporosis, leading to 1.5 million fragility fractures of the hip, spine, wrist, humerus, pelvis, scapula or ribs each year (4), with another 34 million Americans at risk of the disease. The cost to the US is around $17.9 billion per annum. Currently the US National Osteoporosis Foundation estimates that 54 million Americans suffer from either osteoporosis or osteopenia (5). In the European Union (EU), a report estimated that in 2010, 6.6% of men and 22.1% of women aged over 50 years had osteoporosis, and that there were 3.5 million fragility fractures (6). The annual direct costs attributable to fracture treatment in the EU equate to approximately €24 billion, though when indirect costs such as long-term care and fracture prevention therapies are taken into account, this figure rises to €37 billion per year across the 27 countries of the EU (6) Table 1.1. This amounted to 1,180,000 quality-adjusted life-years lost during 2010.

Table 1.1Impact of osteoporosis-related fractures across Europe

	Hip	Spine	Wrist
Lifetime risk in women (%)	23	29	21
Lifetime risk in men (%)	11	14	5
Cases/year	620,000	810,000	574,000
Hospitalisation (%)	100	2−10	5
Relative survival	0.83	0.82	1.00

Source: Data derived from Hernlund E et al. Arch Osteoporos. 2013 Dec;8(1-2):136.

Note: Costs: All sites combined ~ €37 billion.

A British study indicated similar population risks (7), with 1 in 2 women and 1 in 5 men aged 50 years expected to have an osteoporosis-related fracture in their remaining lifetime. In addition to the associated m...

Table of contents

• Cover
• Half Title Page
• Title Page
• Copyright Page
• Contents
• Preface
• Editors
• Contributors
• Chapter 1 The burden of osteoporosis
• Chapter 2 DOHaD: The concept, its implications and applications
• Chapter 3 Early growth, bone development and risk of adult fracture
• Chapter 4 Maternal nutrition, lifestyle and anthropometry during pregnancy and offspring bone development
• Chapter 5 Vitamin D in early life: From observation to intervention
• Chapter 6 Nutrition and bone health during childhood and adolescence: A global perspective
• Chapter 7 Developmental plasticity, epigenetic mechanisms and early life influences on adult health and disease: Fundamental concepts
• Chapter 8 Epigenetic mechanisms in bone development
• Chapter 9 The material and structural basis of the growth-related gain and age-related loss of bone strength
• Chapter 10 Risk factors for post peak bone loss and osteoporotic fracture: Lessons from population studies
• Chapter 11 Risk factors for post peak bone loss and osteoporotic fracture: Lessons from novel imaging studies
• Chapter 12 Assessment of fracture risk
• Chapter 13 Therapeutic approaches to bone protection in adulthood
• Chapter 14 A lifecourse perspective on bone health and disease: Scientific and social implications
• Epilogue
• Index