Objective The aim of this study was to quantify the global burden of osteoporotic fracture worldwide. Methods The incidence of hip fractures was identified by systematic review and the incidence of osteoporotic fractures was imputed from the incidence of hip fractures in different regions of the world. Excess mortality and disability weights used age- and sex-specific data from Sweden to calculate the Disability Adjusted Life Years (DALYs) lost due to osteoporotic fracture. Results In the year 2000 there were an estimated 9.0 million osteoporotic fractures of which 1.6 million were at the hip, 1.7 million at the forearm and 1.4 million were clinical vertebral fractures. The greatest number of osteoporotic fractures occurred in Europe (34.8%). The total DALYs lost was 5.8 million of which 51% were accounted for by fractures that occurred in Europe and the Americas. World-wide, osteoporotic fractures accounted for 0.83% of the global burden of non-communicable disease and was 1.75% of the global burden in Europe. In Europe, osteoporotic fractures accounted for more DALYs lost than common cancers with the exception of lung cancer. For chronic musculo-skeletal disorders the DALYs lost in Europe due to osteoporosis (2.0 million) were less than for osteoarthrosis (3.1 million) but greater than for rheumatoid arthritis (1.0 million). Conclusion We conclude that osteoporotic fractures are a significant cause of morbidity and mortality, particularly in the developed countries.

An estimate of the worldwide prevalence and disability associated with osteoporotic fractures.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(96)07088-2.pdf

Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures

Objective: To determine the ability of measurements of bone density in women to predict later fractures. Design: Meta-analysis of prospective cohort studies published between 1985 and end of 1994 with a baseline measurement of bone density in women and subsequent follow up for fractures. For comparative purposes, we also reviewed case control studies of hip fractures published between 1990 and 1994. Subjects: Eleven separate study populations with about 90000 person years of observation time and over 2000 fractures. Main outcome measures: Relative risk of fracture for a decrease in bone mineral density of one standard deviation below age adjusted mean. Results: All measuring sites had similar predictive abilities (relative risk 1.5 (95% confidence interval 1.4 to 1.6)) for decrease in bone mineral density except for measurement at spine for predicting vertebral fractures (relative risk 2.3 (1.9 to 2.8)) and measurement at hip for hip fractures (2.6 (2.0 to 3.5)). These results are in accordance with results of case-control studies. Predictive ability of decrease in bone mass was roughly similar to (or, for hip or spine measurements, better than) that of a 1 SD increase in blood pressure for stroke and better than a 1 SD increase in serum cholesterol concentration for cardiovascular disease. Conclusions: Measurements of bone mineral density can predict fracture risk but cannot identify individuals who will have a fracture. We do not recommend a programme of screening menopausal women for osteoporosis by measuring bone density. Key messages Measuring bone mineral density has been suggested as a method of identifying individuals at high risk of fracture in a preventive context Our meta-analysis of prospective studies showed that all studies measuring bone density at any site had similar predictive ability for a decrease of 1 SD in bone density except for measurements at hip and spine, which have better predictive ability for fractures in hip and spine respectively Predictive ability of decrease in bone mass was roughly similar to (or, for hip or spine measurements, better than) that of a 1 SD increase in blood pressure for stroke and better than a 1 SD increase in serum cholesterol concentration for cardiovascular disease Although bone mineral density measurements can predict fracture risk, they cannot identify individuals who will have a fracture, and a screening programme for osteoporosis cannot be recommended

Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures

Musculoskeletal conditions are a major burden on individuals, health systems, and social care systems, with indirect costs being predominant. This burden has been recognized by the United Nations and WHO, by endorsing the Bone and Joint Decade 2000-2010. This paper describes the burden of four major musculoskeletal conditions: osteoarthritis, rheumatoid arthritis, osteoporosis, and low back pain. Osteoarthritis, which is characterized by loss of joint cartilage that leads to pain and loss of function primarily in the knees and hips, affects 9.6% of men and 18% of women aged > 60 years. Increases in life expectancy and ageing populations are expected to make osteoarthritis the fourth leading cause of disability by the year 2020. Joint replacement surgery, where available, provides effective relief. Rheumatoid arthritis is an inflammatory condition that usually affects multiple joints. It affects 0.3-1.0% of the general population and is more prevalent among women and in developed countries. Persistent inflammation leads to joint destruction, but the disease can be controlled with drugs. The incidence may be on the decline, but the increase in the number of older people in some regions makes it difficult to estimate future prevalence. Osteoporosis, which is characterized by low bone mass and microarchitectural deterioration, is a major risk factor for fractures of the hip, vertebrae, and distal forearm. Hip fracture is the most detrimental fracture, being associated with 20% mortality and 50% permanent loss in function. Low back pain is the most prevalent of musculoskeletal conditions; it affects nearly everyone at some point in time and about 4-33% of the population at any given point. Cultural factors greatly influence the prevalence and prognosis of low back pain.

/pdf/burden-of-major-musculoskeletal-conditions-1xayk0ikb2.pdf

Burden of major musculoskeletal conditions

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140673602086579.pdf

Epidemiology and outcomes of osteoporotic fractures.

Hip fractures are recognized to be a major public health problem in many Western nations, most notably those in North America, Europe and Oceania. Incidence rates for hip fracture in other parts of the world are generally lower than those reported for these predominantly Caucasian populations, and this has led to the belief that osteoporosis represents less of a problem to the nations of Asia, South American and Africa. Demographic changes in the next 60 years, however, will lead to huge increases in the elderly populations of those countries. We have applied available incidence rates for hip fracture from various parts of the world to projected populations in 1990, 2025 and 2050 in order to estimate the numbers of hip fractures which might occur in each of the major continental regions. The projections indicate that the number of hip fractures occurring in the world each year will rise from 1.66 million in 1990 to 6.26 million by 2050. While Europe and North America account for about half of all hip fractures among elderly people today, this proportion will fall to around one quarter in 2050, by which time steep increases will be observed throughout Asia and Latin America. The results suggest that osteoporosis will truly become a global problem over the next half century, and that preventive strategies will be required in parts of the world where they are not currently felt to be necessary.

Hip fractures in the elderly: A world-wide projection

Hip fractures in the elderly: a worldwide projection

There is a need to identify vertebral fractures from radiographs taken at a single point in time, but considerable controversy surrounds the methods to be used We extended a data set to comprise baseline radiographs of the thoracic and lumbar spine on an age-stratified random sample of 762 Rochester, Minnesota, women and used revised methods to define vertebral deformities morphometrically Changes in the method of measuring vertebral heights, changes in the source of normal values for vertebral measurements and changes in the criteria for assessing vertebral deformity had little impact on estimated prevalence and incidence in this population The prevalence of any vertebral deformity was estimated at 253 per 100 Rochester women aged 50 years and over (95% CI, 223–282), while the incidence of a new deformity in this group was estimated at 178 per 1000 person-years (95% CI, 160–197) Projected nationally, these data suggest that over 500 000 white women in the United States develop vertebral deformities for the first time each year and that over 7 million white women aged 50 years and over might be affected at any given time These estimates are limited by the absence of a reliable ‘gold standard’ with which to determine false positive and false negative rates associated with this or any other morphometric method Information on the health consequences of vertebral deformities of various sorts would be most helpful in choosing between alternative approaches to defining them

Prevalence and incidence of vertebral deformities

The epidemiology of ankle fractures was examined among Rochester. Minnesota, residents during the 3-year period 1979-1981. Ankle fractures occurred with an overall age- and sex-adjusted incidence rate of 187 per 100,000 person-years; this is higher than in earlier population-based studies. The most frequent cause of ankle fractures was sports-related trauma. The incidence of fractures associated with moderate trauma, on the other hand, increased markedly in middle-aged women, but declined in elderly women. Diabetes mellitus and obesity were associated with fractures in middle-aged and older adults. Of accepted classifications, the Lauge-Hansen system provided the most clinically relevant information.

https://www.tandfonline.com/doi/pdf/10.3109/17453678709146395

Epidemiology of ankle fractures in Rochester, Minnesota

In this population-based descriptive study covering the 50-year period, 1945-94, there was a statistically significant increase in distal forearm fractures due to severe trauma in both women and men (p < 0.001) but no secular increase in fractures due to moderate trauma (approximately osteoporosis). Since fractures attributed to severe trauma comprised a greater proportion of the total in men (52%) than women (21%), an overall doubling of age-adjusted forearm fracture incidence in men between 1945 and 1994 was statistically significant (p < 0.001), but the 7% increase in age-adjusted rates among women was not (p = 0.90). While the epidemiological pattern of distal forearm fracture incidence in Rochester was similar to that seen elsewhere, the overall incidence rate of 287.4 per 100,000 person-years (95% CI 267.7-307.1) in 1985-94 was less than current rates in Sweden, presumably because the great increase in distal forearm fracture incidence seen, for example, in Malmo between 1953-57 and 1980-81 was not observed in Rochester. The trends in distal forearm fracture rates in Rochester men and women over the past 50 years are broadly consistent with trends in hip fracture incidence in this community over the same time span.

L. J. Melton

Papers

Hip fractures in the elderly: A world-wide projection

Hip fractures in the elderly: a worldwide projection

Prevalence and incidence of vertebral deformities

Epidemiology of ankle fractures in Rochester, Minnesota

Long-term trends in the incidence of distal forearm fractures.