Silver Book

Osteoporosis

More than 54 million Americans face the threat of osteoporosis; which causes more than 2 million fractures each year. These fractures can have a profound impact on quality of life—often leading to pain, disability, loss of independence, and even death—and cost the U.S. an estimated billion each year. Fortunately, scientists are continuing to make exciting breakthroughs that are helping to keep bones healthy and prevent debilitating fractures. The Alliance for Aging Research partnered with the National Osteoporosis Foundation to produce this volume.

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    • 2.3 million osteoporotic bone fractures were suffered by Medicare beneficiaries in 2015
      2.3 million osteoporotic bone fractures were suffered by Medicare beneficiaries in 2015.  
    • Osteoporosis prevalence among Mexican American, Non-Hispanic White, and women >80 years old
      Osteoporosis is most common among: Mexican American women (20.4%) Non-Hispanic white women (15.8%) and women aged 80 and older (34.9%).  
    • Tools to Prevent Secondary Osteoporosis Fractures are Not Being Used
       
    • Secondary Osteoporosis Fractures are Costly
       
    • Preventing Secondary Osteoporotic Fractures Yields Big Medicare Savings
       
    • 50% of Repeat Osteoporotic Fractures Could be Avoided
       
    • Reducing secondary bone fractures can reduce medicare spending
      Reducing 5-20 percent of “secondary” bone fractures in 2015 could have reduced Medicare FFS spending by $310 million to $1.2 billion over a follow-up period that lasted up to 2 to…  
    • New osteoporotic fractures, mobidity, and mortality
      Over 40% of Medicare FFS beneficiaries with a new osteoporotic fracture were hospitalized within a week after their fracture and nearly 20% died within 12 months following a new osteoporotic…  
    • Americans at risk for osteoporosis
      54 million Americans age 50 and over either already have or are at risk of osteoporosis.  
    • By 2030, an estimated 64.3 million American adults will have low bone mass.  
    • By 2030, an estimated 11.9 million American adults will have osteoporosis.  
    • By 2020, an estimated 58.2 million American adults will have low bone mass.  
    • By 2020, an estimated 10.7 million American adults will have osteoporosis.  
    • More than 48 million American adults have low bone mass–putting them at increased risk for osteoporosis and broken bones.  
    • Approximately 9 million adults in the U.S. have osteoporosis.  
    • Fifty percent of people who fracture a hip will be unable to walk without assistance.  
    • In the United States today, more than 40 million people either already have osteoporosis or are at high risk due to low bone mass.  
    • An Alzheimer’s disease treatment breakthrough that slowed its progression and began to show its effects in 2015, would reduce the costs of care for all people with the disease by…  
    • The rate of hospitalizations citing an osteoporosis diagnosis and an injury increased 55% between 1995 and 2006  
    • Characteristics of hospitalizations citing an osteoporosis diagnosis compared to hospitalizations for all conditions, 2006  
    • In 2006, injurious osteoporosis hospital stays averaged $900 more in hospital costs than all stays noting an osteoporosis diagnosis ($9,600 versus $8,700) and had a longer length of stay (5.5…  
    • The average age of patients with injurious osteoporosis was 79.5 years in 2006–more than 21 years older than the average hospitalization (58.1 years).  
    • Patients hospitalized with osteoporosis and injury were 4 times as likely to be discharged to a long-term care facility, such as a nursing home or rehabilitation center (56.5% versus 15.9%)…  
    • Patients who have an osteoporosis diagnosis and an injury were admitted to the emergency room more often than the average hospitalization–67.3% versus 55.7%, respectively.  
    • In 2006, treatments of hip and leg fractures and dislocations were performed in 16.4% of all injurious osteoporosis hospital stays, and 8.1% of these stays noted a hip replacement.  
    • In 2006, close to 90% of all hopsital stays involving an injury likely due to osteoporosis occurred among patients 65 years and older; 37% occurred among patients 85 and older.  
    • In 2006, injuries were recorded in 1/4 of all hospital patients with an osteoporosis diagnosis. Pathological fractures (i.e. spontaneous and stress fractures), hip fractures, and fractures of the ribs, vertebrae…  
    • In 2006, there were about 254,000 hospital stays that involved an injury likely due to osteoporosis–a 55% increase since 1995. In 2006, the related hospital costs totaled $2.4 billion.  
    • 30 drugs are currently in development for osteoporosis.  
    • A recent study found that more postmenopausal women who took the drug denosumab gained at least 3% of bone mass at the hip and spine than those who took…  
    • A systematic review of osteoporosis therapies found good evidence that many are effective in preventing fractures, but concluded that the data are insufficient to determine if any one therapy is…  
    • Patients with vertebral fractures who underwent kyphoplasty, a procedure that stabilizes fractures of the spine, were found in one study to have reduced pain, fewer new fractures, and less healthcare…  
    • Raloxifene, a selective estrogen receptor modulator (SERM), has been shown to decrease vertebral fractures by up to 50% after 3 years.  
    • By 2020, more than 50% of Americans over the age of 50 will be diagnosed with or at risk of developing osteoporosis.  
    • Even though women are more likely to sustain a hip fracture, men who suffer a hip fracture are twice as likely as women to die within 1-2 years of that…  
    • One study found that women age 65 and older who suffered a vertebral fracture were more than twice as likely to suffer back pain than women who hadn’t.  
    • Four months after a hip fracture, less than 20% of patients recovered their prefracture competence in activities.  
    • Physician visits for osteoporosis increased 4-fold (from 1.3 million to 6.3 million) from 1994 to 2003.  
    • In 2005, osteoporosis was responsible for more than 2 million fractures in men and women over the age of 50, including approximately: 297,000 hip fractures 547,000 vertebral fractures 380,000 wrist fractures 810,000 fractures at…  
    • Of the 34 million Americans with low bone mass–around 22 million (65%) are women and 12 million (35%) are men.  
    • Osteoporosis affects an estimated 44 million Americans over the age of 50–10 million have been diagnosed with the disease and 34 million more are estimated to have low bone mass,…  
    • At the age of 50, a white man has a: 6% chance of experiencing a hip fracture 5% chance of experiencing a vertebral fracture 2.5% chance of experiencing a forearm fracture  
    • At the age of 50, a white woman has a: 17.5% chance of experiencing a hip fracture 15.6% chance of experiencing a vertebral fracture 16% chance of experiencing a forearm fracture  
    • Alendronate, a bisphosphonate, has been shown to reduce risk of hip fracture by around 53%, clinical vertebral fracture by 45%, and wrist fracture by 30%.  
    • Risedronate, a bisphosphonate, has been shown to increase vertebral bone mineral density (BMD) by around 5% and hip BMD by 2% to 3% in postmenopausal women with osteoporosis.  
    • Risedronate, a bisphosphonate, has been shown to reduce vertebral fractures by around 41%, hip fractures by 30%, and non-vertebral fractures by 39%.  
    • Ibandronate, a bisphosphonate, taken daily has been shown to reduce the risk of new vertebral fractures by around 62%.  
    • Treatment with zoledronic acid over a 3-year period reduced risk of vertebral fracture by around 70% and risk of hip fracture by 41%, and increased bone mineral density (BMD) by…  
    • A study that looked at a combination of calcium and Vitamin D found that hip fractures were reduced by around 43%.  
    • A meta-analysis of clinical trials found that Vitamin D supplements reduced the risk of vertebral fractures by around 37%.  
    • A meta-analysis of clinical trials found that calcium supplements reduced the risk of vertebral fractures by around 23%.  
    • A study of a number of osteoporosis treatments found cost-effectiveness ratios as low as $55,000 per QALY.  
    • Each year, osteoporotic fractures in the U.S. lead to: >432,000 hospital admissions ~2.5 million medical office visits ~180,000 nursing home admissions  
    • The annual number of osteoporosis-related fractures is expected to rise by almost 50% to more than 3 million by 2025.  
    • The Study of Osteoporotic Fractures, which began over 20 years ago, found that bone mineral density (BMD) of the hip is one of the best predictors of fracture for women,…  
    • Raloxifene, a selective estrogen receptor modulator (SERM) has been shown to increase vertebral bone mineral density (BMD) by 2% to 3% after 3 years.  
    • Teriparatide, or human recombinant PTH, has been shown to increase vertebral bone mineral density (BMD) by 9% to 13%.  
    • Alendronate, a bisphosphonate, has been shown to increase vertebral bone mineral density (BMD) by as much as 8% over 3-years in postmenopausal women with osteoporosis.  
    • Randomized controlled trials give evidence that pharmacologic therapy can reduce risk of fractures by 40 to 50%.  
    • Clinical studies in nutrition and physical activity interventions have proven that fractures can be prevented, even in older individuals, and that they do not need to be a natural consequence…  
    • Vertebral fractures are associated with a 20% reduction in QALY (Quality Adjusted Life Year) in the first 12 months, and a 15% reduction in the first 2 years.  
    • Women age 85 years and older are close to 8 times more likely to be hospitalized because of a hip fracture than women ages 65-74.  
    • Around 70% of all osteoporosis-related fractures occur in patients age 65 and older.  
    • An estimated 30% of postmenopausal white women have osteoporosis and 54% have osteopenia. By the age of 80, that number increases to an estimated 70% of white women with…  
    • Treatment with bisphosphonates are highly cost-effective in women over the age of 70 with osteoporosis and a previous fracture.  
    • Hip fracture prevention in at-risk, postmenopausal women saves $333 million annually.  
    • Researchers are looking at the use of micro-computed tomography and magnetic resonance imaging to better understand the relationship between bone structure and fracture risk. Other tools are being evaluated for…  
    • Genetics can account for up to 75% of bone mineral density (BMD). Researchers have identified a gene that strongly influences peak bone mass in mice. The gene was not previously…  
    • Teriparatide, or human recombinant PTH, has been shown to decrease vertebral fractures by 65% to 69%, and non-vertebral fragility fractures by around 53%.  
    • Reducing risk of fracture from 8% to 2% reduces the 5-year fracture incidence from approximately 34% to 10%.  
    • An increase in bone mineral density (BMD) testing and osteoporosis treatment was associated with a decrease in hip fracture incidence.  
    • Over the next 20 years, the non-White population will comprise a growing proportion of the costs of osteoporosis-related fractures, increasing from $1.9 billion (12% of total costs) in 2005, to…  
    • The cumulative cost of incident fractures is predicted to rise from $209 billion during the 10-year period of 2006 to 2015, to $228 for the 10-year period of 2016 to…  
    • During the 10-year period of 2006 to 2015,annual costs of osteoporosis will increase by more than 20%.  
    • By 2025, annual direct costs from osteoporosis are estimated to rise to around $25.3 billion.  
    • Over the next 20 years, the non-White population will comprise a growing proportion of the number of fractures, increasing from 282,000 fractures (13% of total fractures) in 2005, to over…  
    • The number of men over the age of 50 and diagnosed with osteoporosis or at risk for the disease, will increase from 14 million in 2002 to over 17 million…  
    • The number of women over the age of 50 and diagnosed with osteoporosis or at risk for the disease, will increase from 30 million in 2002 to more than 35…  
    • By 2020, an estimated 61 million Americans over the age of 50 will be affected by osteoporosis–14 million will be diagnosed with the disease and 47 million more will have…  
    • By 2010, an estimated 52 million Americans over the age of 50 will be affected by osteoporosis–12 million will be diagnosed with the disease and 40 million more will have…  
    • From 2001 to 2003, about 2.39 million fractures occurred among women aged 65 and older with osteoporosis–this cost Medicare $12.96 billion.  
    • The cost of a hip fracture for one individual over their lifetime can be more than $81,000–nearly half can be attributed to nursing facility costs.  
    • During the first year after a hip fracture, the average cost in the U.S. ranges from $36,000 to over $47,000 per patient.  
    • Hip fractures account for 72% of total costs related to osteoporosis related fractures.  
    • In 2005, osteoporosis-related fractures cost nearly $17 billion–$19 billion if costs of prevalent fractures are included.  
    • The 1-year morality after a hip fracture increases from 20% in individuals younger than 70 years, to close to 40% in those between 80 and 89.9 years old.  
    • Around 1 in 5 people who experience a hip fracture die within a year.  
    • Hip fracture raises the risk of mortality by 2.8 to 4 times during the first 3 months after the fracture.  
    • The risk of death in the first few weeks after hip fracture is 10 times more than the expected death rate.  
    • Women who experience a vertebral fracture are 2 to 3 times more likely to die of pulmonary causes than women without a fracture.  
    • Relatively healthy hip fracture patients report a 52% reduction in QALY (Quality Adjusted Life Year) in the first 12 months, and a 21% reduction in the first 2 years.  
    • A study that measured QALY (Quality Adjusted Life Year) reductions in people suffering from osteoporotic fractures found reductions ranging from 0.05 to 0.55 on a scale of 0 (represents death)…  
    • In a National Osteoporosis Foundation survey of women who had already had an osteoporotic fracture: 89% feared breaking another bone 80% were afraid they would be less able to perform daily activities 80%…  
    • Two or more vertebral fractures increase risk of a subsequent vertebral fracture by 12-fold.  
    • A prior vertebral fracture increases risk of another vertebral fracture by 5-fold for the year following.  
    • Osteoporosis accounts for close to 14% of all nursing home days.  
    • Of those who were ambulatory before their hip fracture, 1 in 5 end up needing long-term care afterwards–a situation that participants in this study said was less desirable than death.  
    • Six months after a hip fracture, many patients are unable to return to their activities of daily living at pre-fracture status: 49% could dress themselves–compared to 86% before the fracture 32% could…  
    • Half of people who fracture a hip will never be able to walk again without assistance.  
    • Six months after a hip fracture, only 15% of patients can walk across a room without assistance.  
    • More than 1/4 of individuals who suffer a hip fracture become disabled within a year.  
    • About 315,000 Americans aged 45 and older were admitted to hospitals with hip fractures in 2001–a majority with osteoporosis as the underlying cause.  
    • 1 in 2 women, and 1 in 4 men, over the age of 50 will have an osteoporosis-related fracture during their lifetime.  
    • “This 73-year-old wife and grandmother suffered her first fracture 18 years ago and has had eight additional fractures since that time. Each caused tremendous pain and required long hospital stays…  
    • Low bone mass affects 43.9% of adults aged 50 and older.    
    • Of the 10 million Americans with osteoporosis–close to 8 million (80%) are women and over 2 million (20%) are men.  
    • 4 out of 5 people with osteoporosis are women.