May 24, 2004

Osteoporosis ScreeningTime to Take Responsibility

Author Affiliations

Copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2004

Arch Intern Med. 2004;164(10):1047-1048. doi:10.1001/archinte.164.10.1047

In their classic 1968 monograph, Wilson and Jungner1 defined for the World Health Organization (WHO) principles intended to serve as the basis for recommending or planning screening for early detection of a disease:

In 2004, osteoporosis clearly qualifies for screening as a societal health problem of enormous and increasing magnitude. Using WHO criteria, the prevalence of osteoporosis in US women older than 50 years is 13% to 18%, and up to 50% of women have osteopenia.2 In asymptomatic women older than 50 years, the prevalence of osteoporosis is 7.2% and of osteopenia almost 40%.3 The clinical consequence of osteopenia or osteoporosis is fracture. A 50-year-old white woman has a 40% chance of experiencing an osteoporotic fracture in her remaining lifetime.4 In the United States, the lifetime risk of hip fracture is 17.5% for women and 6.0% for men.5 With the aging of the baby boom generation, the number of hip fractures is expected to nearly double by 2040.6 Hip fracture in an elderly patient is associated with a mortality rate of 24% within 1 year.7 Though perceived as more benign than hip fracture, vertebral compression fracture (VCF) in women older than 65 years is associated with a 23% increase in age-adjusted mortality.8 The morbidity associated with both spinal and hip osteoporotic fractures is also significant. Of elderly patients surviving to 1 year following a hip fracture, only 50% are capable of fully independent living. Biomechanical consequences of 1 or more VCFs include disabling back pain, abdominal cavity compression with early satiety and bloating, and restrictive lung disease with reduced vital capacity. On average, each VCF reduces pulmonary vital capacity by 9%.9 Presence of VCFs, particularly in the lumbar spine, have been associated with significant decreases in overall health status scores, including physical function and emotional domains.10,11

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