Screening for Osteoporosis to Prevent Fractures

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Abstract

By 2020, approximately 12.3 million individuals in the United States older than 50 years are expected to have osteoporosis. Osteoporotic fractures, particularly hip fractures, are associated with limitations in ambulation, chronic pain and disability, loss of independence, and decreased quality of life, and 21% to 30% of patients who experience a hip fracture die within 1 year. The prevalence of primary osteoporosis (ie, osteoporosis without underlying disease) increases with age and differs by race/ethnicity. With the aging of the US population, the potential preventable burden is likely to increase in future years.

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The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine.

Nicole C. Wright, Anne C Looker, Kenneth Saag … (2014)

The goal of our study was to estimate the prevalence of osteoporosis and low bone mass based on bone mineral density (BMD) at the femoral neck and the lumbar spine in adults 50 years and older in the United States (US). We applied prevalence estimates of osteoporosis or low bone mass at the femoral neck or lumbar spine (adjusted by age, sex, and race/ethnicity to the 2010 Census) for the noninstitutionalized population aged 50 years and older from the National Health and Nutrition Examination Survey 2005-2010 to 2010 US Census population counts to determine the total number of older US residents with osteoporosis and low bone mass. There were more than 99 million adults aged 50 years and older in the US in 2010. Based on an overall 10.3% prevalence of osteoporosis, we estimated that in 2010, 10.2 million older adults had osteoporosis. The overall low bone mass prevalence was 43.9%, from which we estimated that 43.4 million older adults had low bone mass. We estimated that 7.7 million non-Hispanic white, 0.5 million non-Hispanic black, and 0.6 million Mexican American adults had osteoporosis, and another 33.8, 2.9, and 2.0 million had low bone mass, respectively. When combined, osteoporosis and low bone mass at the femoral neck or lumbar spine affected an estimated 53.6 million older US adults in 2010. Although most of the individuals with osteoporosis or low bone mass were non-Hispanic white women, a substantial number of men and women from other racial/ethnic groups also had osteoporotic BMD or low bone mass. © 2014 American Society for Bone and Mineral Research.

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The effect of teriparatide [human parathyroid hormone (1-34)] therapy on bone density in men with osteoporosis.

Randal Kaufman, Elizabeth Paul, Wim Scheele … (2002)

Teriparatide [rhPTH(1-34)] increases bone mineral density and reduces the risk of vertebral fracture in women. We randomized 437 men with spine or hip bone mineral density more than 2 SD below the young adult male mean to daily injections of placebo, teriparatide 20 microg, or teriparatide 40 microg. All subjects also received supplemental calcium and vitamin D. The study was stopped after a median duration of 11 months because of a finding of osteosarcomas in rats in routine toxicology studies. Biochemical markers of bone formation increased early in the course of therapy and were followed by increases in indices of osteoclastic activity. Spine bone mineral density was greater than in placebo subjects after 3 months of teriparatide therapy, and by the end of therapy it was increased by 5.9% (20 microg) and 9.0% (40 microg) above baseline (p < 0.001 vs. placebo for both comparisons). Femoral neck bone mineral density increased 1.5% (20 microg; p = 0.029) and 2.9% (40 microg; p < 0.001), and whole body bone mineral content increased 0.6% (20 microg; p = 0.021) and 0.9% (40 microg;p = 0.005) above baseline in the teriparatide subjects. There was no change in radial bone mineral density in the teriparatide groups. Bone mineral density responses to teriparatide were similar regardless of gonadal status, age, baseline bone mineral density, body mass index, smoking, or alcohol intake. Subjects experienced expected changes in mineral metabolism. Adverse events were similar in the placebo and 20-microg groups, but more frequent in the 40-microg group. This study shows that teriparatide treatment results in an increase in bone mineral density and is a potentially useful therapy for osteoporosis in men.

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Interventions to Prevent Falls in Community-Dwelling Older Adults

Susan Curry, Michael P Pignone, Carol Mangione … (2018)

Falls are the leading cause of injury-related morbidity and mortality among older adults in the United States. In 2014, 28.7% of community-dwelling adults 65 years or older reported falling, resulting in 29 million falls (37.5% of which needed medical treatment or restricted activity for a day or longer) and an estimated 33 000 deaths in 2015.

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Author and article information

Journal

Title: JAMA

Abbreviated Title: JAMA

Publisher: American Medical Association (AMA)

ISSN (Print): 0098-7484

Publication date Created: June 26 2018

Publication date (Print): June 26 2018

Volume: 319

Issue: 24

Page: 2521

Affiliations

[1 ]University of Iowa, Iowa City

[2 ]Fairfax Family Practice Residency, Fairfax, Virginia

[3 ]Virginia Commonwealth University, Richmond

[4 ]Veterans Affairs Palo Alto Health Care System, Palo Alto, California

[5 ]Stanford University, Stanford, California

[6 ]Harvard Medical School, Boston, Massachusetts

[7 ]Oregon Health and Science University, Portland

[8 ]Columbia University, New York, New York

[9 ]University of Pennsylvania, Philadelphia

[10 ]Virginia Tech Carilion School of Medicine, Roanoke

[11 ]Nationwide Children’s Hospital, Columbus, Ohio

[12 ]Temple University, Philadelphia, Pennsylvania

[13 ]University of Alabama at Birmingham

[14 ]University of California, Los Angeles

[15 ]Brown University, Providence, Rhode Island

[16 ]Department of Medicine, Dell Medical School, University of Texas, Austin

[17 ]University of Texas, Austin

[18 ]Boston University, Boston, Massachusetts

[19 ]Northwestern University, Evanston, Illinois

[20 ]University of Hawaii, Honolulu

[21 ]Pacific Health Research and Education Institute, Honolulu, Hawaii

[22 ]Tufts University, Medford, Massachusetts

Article

DOI: 10.1001/jama.2018.7498

SO-VID: 70b843cf-9f02-447d-a02d-61741f126280

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Screening for Osteoporosis to Prevent Fractures : US Preventive Services Task Force Recommendation Statement

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Most cited references 20

The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine.

The effect of teriparatide [human parathyroid hormone (1-34)] therapy on bone density in men with osteoporosis.

Interventions to Prevent Falls in Community-Dwelling Older Adults

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