Osteoporosis Osteoporosis

Geneva,Geneva, February February 27 200827 2008

Prof René Rizzoli M.D.Prof René Rizzoli M.D.

Division of Division of bone diseasesbone diseasesWHOWHO collaborating center collaborating center for for osteoporosis preventionosteoporosis prevention

Department Department of of rehabilitation and geriatricsrehabilitation and geriatricsGeneva university hospitals and Faculty Geneva university hospitals and Faculty of of medicinemedicine

Geneva, SwitzerlandGeneva, Switzerland

A A systemic skeletal diseasesystemic skeletal disease characterized characterized

by by low bone masslow bone mass and and

microarchitectural microarchitectural deteriorationdeterioration, with a, with a

consequent consequent increase in bone fragilityincrease in bone fragility with with

susceptibility to fracture.susceptibility to fracture.

Osteoporosis DefinitionOsteoporosis Definition

Consensus Development Conference: Consensus Development Conference: Am J MedAm J Med 1991;90:107-110 1991;90:107-110

OsteoporosisOsteoporosis::a 2-Stage a 2-Stage DiseaseDisease

••WithWith••Without Without FractureFracture

OsteoporosisOsteoporosis::Lecture ContentLecture Content

••Disease DefinitionDisease Definition••EpidemiologyEpidemiology••BurdenBurden••DiagnosisDiagnosis••PathophysiologyPathophysiology••ManagementManagement

00

55

1010

1515

2020

2525

3030

WomenWomen MenMen WomenWomen MenMen WomenWomen MenMen

Age Group (Years)Age Group (Years)

Minor FracturesMinor FracturesOther Major FracturesOther Major FracturesVertebral FracturesVertebral FracturesProximal Femur FracturesProximal Femur Fractures

60 60––69 7069 70––79 79 >> 80 80

Center J et al. Center J et al. Lancet.Lancet. 1999;353:878 1999;353:878––882.882.

Fractures by Age and GenderFractures by Age and GenderDubboDubbo Osteoporosis Osteoporosis EpidemiologyEpidemiology Study, Study,

19891989––19941994

Perc

ent

Perc

ent o

f of to

tal p

opul

atio

nto

tal p

opul

atio

n

Lifetime risk Lifetime risk ofof fragility fragility fracture in fracture in thetheSwedish Swedish population population at the at the age of 50 age of 50 years years (%)(%)

WomenWomen MenMen

•• Proximal Proximal femurfemur 2323 1111

•• Distal Distal forearm forearm 2121 5 5

••Vertebral Vertebral ((clinicalclinical)) 1515 8 8

••Proximal Proximal HumerusHumerus 1313 5 5

•• AnyAny 46 %46 % 22 %22 %From Kanis From Kanis et al 2000et al 2000

1 500 000 *1 500 000 *

00

500500

10001000

15001500

20002000

Osteoporotic Osteoporotic FracturesFractures

Riggs BL, Melton LJ. Bone. 1995.Heart and Stroke Facts. 1996. American Heart Association.

Cancer Facts & Figures. 1996. American Cancer Society.

**annual incidence all agesannual incidence all ages †† annual estimate women 29+annual estimate women 29+ ‡‡annual estimate women 30+annual estimate women 30+

§§1996 new cases,all ages1996 new cases,all ages

513 000 513 000 ††

228 000 228 000 ‡‡ 184 300 184 300 §§750 000750 000vertebralvertebral

250 000250 000other sitesother sites

250 000250 000forearmforearm

250 000250 000hiphip

Ann

ual i

ncid

ence

x 1

000

Ann

ual i

ncid

ence

x 1

000

HeartHeartAttackAttack

StrokeStroke BreastBreastCancerCancer

OsteoporoticOsteoporotic Fractures in Women: Fractures in Women:Comparison With Other DiseasesComparison With Other Diseases

Projected burden Projected burden of of osteoporoticosteoporotic hip fractures hip fractures worldwideworldwide

0

200

400

600

800

NorthAmerica

Europe LatinAmerica

Asia

19502050

3250

Estimated n°of hipFractures (1000s)

Number Number of hip fractures: of hip fractures: 1990: 1.66 million1990: 1.66 million; ; 2050: 6.26 million2050: 6.26 millionAdapted from Adapted from Cooper C., Cooper C., Melton Melton U, U, Osteoporosis Osteoporosis IntInt 2:285-289, 1992 2:285-289, 1992

If If the prevalence the prevalence of hip fractureof hip fracturecontinues to continues to rise at current rise at current rates, rates, it mayit may

well be that well be that in in the next the next few few decadesdecades,,orthopaedists will orthopaedists will do do little else little else but but treattreat

this problemthis problem..

W. C. HayesW. C. Hayes, In: , In: Bone Bone Formation Formation and Repairand Repair((American Academy American Academy of of Orthopaedic Orthopaedic Surgeons) 1994Surgeons) 1994

BurdenBurden

Degree Degree of of dependencedependence

5050 7070 8080 90906060

normal normal agingaging

ForearmForearmfracturefracture

VertebralVertebralfracturefracture

Hip fractureHip fracture

Age (Age (yearsyears))

Morbidity After Vertebral FracturesMorbidity After Vertebral Fractures

•• Back painBack pain•• Loss of heightLoss of height•• Deformity (Deformity (kyphosiskyphosis, protuberant abdomen), protuberant abdomen)•• Reduced pulmonary functionReduced pulmonary function•• Diminished quality of life: loss of self-esteem,Diminished quality of life: loss of self-esteem,

distorted body image, dependence on narcoticdistorted body image, dependence on narcoticanalgesics, sleep disorder, depression, loss ofanalgesics, sleep disorder, depression, loss ofindependenceindependence

A A Fragility Fragility Fracture -> FractureFracture -> Fracture