Osteoporosis: Fracture Risk Assessment Tool

Osteoporosis is a detrimental bone condition, the tissue in the bones deteriorate and thus the bones become progressively brittle which presents a risk for rupture. Osteoporosis impacts more than 44 million Americans and is linked to a suggested 2 million bone fractures each year. According to the National Osteoporosis Foundation, the amount of fissures due to osteoporosis may escalate above 3 million by the year 2025. Osteoporosis is typically undetected and advances with slight warning signs until a fissure ensues. Effects of osteoporosis encompass height reduction and a curved upper back, anyone can have osteoporosis, however it is prevalent in elderly women and many may break a bone due to this condition. Recovery and prevention are vital in combating osteoporosis, though it may never be eradicated one can take measures to stabilize bone density and gain strength.

As generally stated in the introduction, osteoporosis is a skeletal disorder that involves the strength and integrity of one’s bones. The WHO defines osteoporosis as, “a systemic skeletal disorder characterized by low-bone mass, deterioration of bone tissue, increased bone fragility, and its susceptibly to recurrent fractures.” 2 The most important factor to take into account when addressing osteoporosis is the mass of bone, also referred to as, bone mineral density (BMD). As bone mass begins to decline, typically in the older population, specifically postmenopausal women, individuals are at an increased risk for fractures.3 As a result of this serious condition, many people are affected by morbidity, mortality, and economic difficulty.1

Osteoporosis is the most common disease of the bone and the incidence of this condition is rising. Osteoporosis is estimated to effect 3 million people in the UK. A decreasing bone density in patient, especially in those above the age of 50, leads to bones becoming weak and therefore, there is an increased likelihood of fragility fractures. This condition is preventable and treatable however, it is often left undiagnosed and therefore, has major cost implications on the NHS. (National Osteoporosis Society, 2013a)

(Kling, J. M., Clarke, B. L., & Sandhu, N. P., 2014, p. 567). Osteoporosis risk factors

Osteoporosis is an age related disorder, more common in females compared to males. Osteoporosis is defined as a “skeletal disorder characterized by compromised bone strength predisposing to increased risk of fractures (Manolagaas, 2014). Osteoporosis is defined as “a disease characterized by low bone mass and deterioration of bone tissue (What is osteoporosis?2014). Osteoporosis is sometimes also referred as “silent thief” as the bone loss occurs very slowly and silently without any symptoms (Osteoporosis facts & statistics.2014). The most common site for fracture due to osteoporosis is hip followed by humerus (Woltman & den Hoed, 2010) . Osteoporosis can occur at any age, although it is a disorder common in females (especially post-menopausal females). Everyone is prone to osteoporosis (Osteoporosis facts & statistics.2014). According to Osteoporosis Canada, 1 in 3 Canadian females and 1 in 5 Canadian males may suffer fractures due to osteoporosis during their lifetime (Osteoporosis facts & statistics.2014). Canadian health care system spends 1.2 billion dollars for the acute hospitalization caused by osteoporosis and in 2010 the health care system spent 3.9 billion dollars for the total treatment of osteoporosis (Osteoporosis facts & statistics.2014). Osteoporosis can be screened and diagnosed by various methods; however the dual energy x ray absorptiometry (DXA) is commonly used. If the T-score values are less than -1 and greater than -2.5SD it is termed as osteopenia,

Osteoporosis is a loss of bone mineral density often associated with old age, leading to bone fragility and fracture. Because the bones are weakened, such fractures can result from relatively minor traumas such as carrying grocery bags or even a sneeze! Fractures to the hip can be due to a fall and can significantly compromise quality of life and ability to walk. Statistics show that 1 in 4 American women and 1 in 8 American men over 50 have osteoporosis. This is a very disheartening statistic considering that osteoporosis is a largely preventable condition. Osteoporosis is also usually clinically silent until a fracture occurs, so it can go unnoticed for years. This is why bone density scans (DEXA scans) are often recommended to postmenopausal women.

Osteoporosis is a disease of bone that leads to an increased risk of fracture. In osteoporosis the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. Osteoporosis is defined by the World Health Organization (WHO) in women as a bone mineral density 2.5 standard deviations below peak bone mass (20-year-old healthy female average) as measured by DXA; the term "established osteoporosis" includes the presence of a fragility fracture.[1] Osteoporosis is most common in women after menopause, when it is called postmenopausal osteoporosis, but may also develop in men, and may occur in anyone in the presence of particular hormonal

Osteoporosis is a progressive silent disease that affects the quality of the bone, due to the decrease in bone mineral density , the bone becomes more porous and fragile, and the risk of fracture will increase , osteoporosis has no signs or symptoms , and people may not know that they have the disease until their bone becomes so weak that a sudden strain, fall will causes a bone to break, , the fractures that related to the osteoporosis cause pain, Disability, reduce mobility, long-term disability and reduced quality of life . The recovery from these fractures is slow, rehabilitation is often incomplete and patients nearly have to hospitalize or even have to home nursing. the most common sites of osteoporotic fracture are Hip, spine, distal forearm, and proximal humerus .

When preparing to screen women for osteoporosis, the provider should advise the patient on the values that indicate osteoporosis. Osteoporosis is diagnosed with a T-score of -2.5 or below of the hip, femoral neck, or lumbar spine (AACE, 2010). The T-score compares an individual’s BMD with the mean value of a younger individual and expresses the difference as a standard deviation (AACE, 2010). Several types of bone densitometries can be done to obtain a T-score. The most common is the DXA method. However, a single photon absorptiometry (SPA), quantitative computed tomography (QCT), radiographic absorptiometry, and ultrasound can also be performed (AAFP, 2009). The fracture risk assessment tool (FRAX) is a tool used to determine if an individual is at risk for fractures (AACE, 2010).

Nearly 55 million Americans are estimated to have osteoporosis, making it one of the most common diseases among American seniors. According to the Centers for Disease Control, 50 percent of women and 25 percent of men over the age of 50 will end up a broken bone as a result of osteoporosis. In fact, according to May Clinic,

Fragility fracture is occasionally the first presentation of osteoporosis. The incidence of osteoporosis-related fractures has been reported to increase with age and over 50% of the incidents occurring in menopausal women aged > 75 years. Vertebral column and hip are the most common site of fracture contributing to a significant morbidity and mortality in the elderly. Additionally, patients with an episode of fracture has a higher chance for future fracture.

According to Kohl & Murray (2012), osteoporosis is defined as a musculoskeletal disorder that results in “low bone mass and structural deterioration of bone tissue” due to “low physical activity levels”, which increases the risk of bone fractures (p.118). Low bone mineral density (BMD) causes bones—most commonly in the hip, vertebrae, wrist, and pelvis-- to become fragile, making it easier to break. Discomfort and disability will be added to the body’s ability to function and when performing daily tasks. Among the 52 million Americans who have osteoporosis, an estimation of 2

Losing bone is common of the ageing process, but for some individuals it can lead to osteoporosis and a multiplied risk of fractures. Osteoporosis ("porous bone"), is a disease that intensifies the loss of bone mass and strength. It often advances without any symptoms or pain. Thus, osteoporosis is not detected until weakened bones cause painful fractures typically in the back or hips. These brittle fractures result in serious morbidity and may have lasting effects through associated depression, disability, and lower health-related quality of life. For example, two thirds of patients who suffer a hip fracture never regain the level of function they had before the fracture. Approximately 20% of hip fracture patients die within a year of the fracture, and were listed as the cause of death on 12,661 death certificates in 1999 Nine out of one hundred women with a hip fracture will die as a result of the fracture. Fractures resulting from osteoporosis can lead to pain, decrease in height, inability to stand, and inability to walk. There are roughly 10 million people with osteoporosis, women are 80% of the sufferers. After the first few years of menopause, women experience bone loss rapidly. Although, this disease also affects men, they usually have stronger, bulkier bones and do not lose their mass as naturally. In addition, men who actually have from osteoporosis, often get it later in life than women, and at drastically lower rates.

Osteoporotic fractures constitute a significant public health issue and are a major cause of morbidity, mortality, and the number of older adults admitted to the hospital (Johnell & Kanis, 2006). Being osteoporotic, aggravates the incidence of fractures in elderly. The demand for the management of osteoporosis is expanding, because of the increase in incident rate and evolving understanding of the disease (Kanis, 2002; Kanis, Johansson, Oden, & McCloskey, 2009). It was estimated that by 2050 the global prevalence of hip fracture will be increased by 240% and 310% in women and men, respectively (Gullberg, Johnell, & Kanis, 1997). Furthermore the projected number of individuals with hip fracture will be increased up to 6.26 million by 2050 (Sambrook

Osteoporosis, exactly means porous bone as show in figure(2.4),is skeletal disorder characterized by a decrease in bone mass density, and this decrease leads to structural deterioration and loss of connectivity between bone tissue, resulting in enhanced fragility and an increased risk of fracture (Bridgeman and Pathak 2011). Osteoporosis is commonly referred to as the “silent thief” as there are no noticeable symptoms associated with its progression until it manifests in the form of a fragility fracture ( Lin and Lane 2004). Although a fragility fracture can occur in any bone, fracture of the hip, spine, and wrist are particularly common in individuals with osteoporosis (ALAnazi 2014) . They have high percentages of trabecular bone, which is more vulnerable due to the higher turnover rate (Rissanen 2013) . Osteoporosis is attributable to an imbalance in bone remodeling, and thus, the understanding of the cellular events is important to target the treatment( Tamminen