Osteoporosis Patients Underestimate Fracture Risk

Survey Finds That 43% With Osteoporosis Consider Fracture Risk Normal

By Salynn Boyles
WebMD Health News

Reviewed By Louise Chang, MD

April 9, 2010 -- Many of the 8 million women in the United States who have osteoporosis don't recognize that they are at increased risk for fractures, a new study finds.

More than 60,000 postmenopausal women from 10 countries in Europe, North America, and Australia were asked to assess their fracture risk. Some of the women had osteoporosis and others did not.

The survey revealed that 43% of women with a diagnosis of osteoporosis perceived their fracture risk to be no higher than that of other women their age.

And only about a third of women who reported two or more major risk factors for fracture considered themselves to be at higher than average fracture risk for their age group.

About half of women will experience an osteoporosis-related fracture after age 50, but many older women either don't know they have osteoporosis or don't understand what the diagnosis means, says lead researcher Ethel Siris, MD, who directs New York-Presbyterian Hospital's osteoporosis center.

"Part of the problem is that clinicians are not doing adequate risk assessment and part of the problem is that women have not been educated about how to recognize their own fracture risks," Siris tells WebMD.

Few Women Understand Fracture Risk

Sixty-eight-year old Ann Carucci of New City, N.Y., does all she can to stay healthy and fit, including regular sessions with a personal trainer and nutritionist.

"I don't want to get old, so I'm fighting it all the way," she tells WebMD.

But she says she didn't know a lot about bone health when she was diagnosed with osteoporosis about five years ago.

"I really didn't know what it meant," she says. "But I knew I was going to do everything my doctor told me to do to make it better."

She started taking medication and continued her strength-training exercise routine. She says her bone health improved so much that her doctor eventually took her off medication.

Carucci was one of the thousands of women who took part in the newly published survey, reported in the latest issue of the journal Osteoporosis International.

The survey's main goal was to explore women's knowledge of the risk factors that increased their likelihood of getting a fracture, Siris says.

Risk factors include:

  • Being postmenopausal. Estrogen helps protect bone, and its loss at menopause is associated with bone weakening.
  • Being female. Osteoporosis does affect men, but about 80% of cases occur in women.
  • Being small-framed or thin
  • Having a parent who has had a hip fracture
  • Breaking a bone after age 45
  • Having a sedentary lifestyle, smoking cigarettes, or abusing alcohol
  • Taking steroids or certain other medications
  • Having a history of certain diseases and conditions, including rheumatoid arthritis, anorexia nervosa, and some gastrointestinal disorders

Osteoporosis: ‘Fractures Beget Fractures'

Women over 50 who have any of these risk factors should discuss bone mineral density testing with their doctor, says Siris, who is past president of the National Osteoporosis Foundation (NOF).

NOF clinical director Felicia Cosman, MD, tells WebMD that the biggest single risk factor for osteoporosis-related fracture is having a previous fracture after the age of 45.

"In older adults, any fracture that occurs in the absence of major trauma should be considered an osteoporosis-related fracture," she says. "Because these are the people at highest risk for having more fractures, the emphasis should be on making sure they get the treatment they need."

Cosman points out that hip fractures are the most common reason for nursing home admissions.

According to NOF:

  • 20% of people who are able to walk normally before a hip fracture require long-term care afterward.
  • Six months after a hip fracture, only 15% of patients can walk across a room unaided.
  • Two to three times more women get hip fractures, compared to men; but men are twice as likely to die within a year of fracturing a hip.

"Fractures beget more fractures," Cosman says. "If we can interrupt this dramatic domino effect of one fracture leading to another, we can really improve quality of life among older people."

Siris and most other investigators listing in the study reported receiving consulting fees or research and salary support from companies that market osteoporosis drugs.


What is another medical term for osteoporosis? See Answer

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SOURCES: Siris, E.S., Osteoporosis International, April 2, 2010; online edition.

Ethel S. Siris, MD, director, Toni Stabile Osteoporosis Center, New York-Presbyterian Hospital/Columbia University Medical Center, New York, N.Y.

Felicia Cosman, MD, clinical director, National Osteoporosis Foundation; associate professor of clinical medicine, Columbia University, New York City.

Ann Carucci, survey respondent, New City, N.Y.

Columbia University/New York-Presbyterian Hospital, April 2, 2010.

National Osteoporosis Foundation: "Fast Facts on Osteoporosis."

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