An Osteoporotic Fracture is a Sentinel Event1

Bone LOSS and menopause

Bone loss occurs earlier than you may think. Women are at an increased risk of osteoporosis beginning at menopause, which typically starts in their early 50s.2-4

Bone Loss and Menopause
*A study of the effect of age and menopause on total body calcium in pre- and postmenopausal women (n=445).3

In addition to decreased bone density, microstructural damage, such as increased cortical porosity, occurs and is visibly distinguishable within 3.6 years for a woman in her 50s.6-8

Bone Loss and Menopause

Prevalence of osteoporotic fractures in postmenopausal women 50 years and older

The risk of osteoporotic fractures also increases when menopause starts.2-4

Prevalence of Fractures

A 12-year analysis showed that osteoporotic fractures caused more hospitalizations among women aged 55 years and older than stroke, myocardial infarction, or breast cancer.10†

Hospitalizations & Osteoporosis
Hospitalizations & Osteoporosis

Using data from all payers within the US Nationwide Inpatient Sample (N=8 million), this study was a 12-year analysis of 4.9 million hospitalizations due to osteoporotic fracture, 2.9 million for myocardial infarction, 3 million for stroke, and 0.7 million for breast cancer among women aged 55 years and older.10

A separate study assessed the use of osteoporosis medication.

Hospitalizations & Osteoporosis

A retrospective, observational cohort study based on US administrative insurance claims data for adults (N=96,887). The study outcome was osteoporosis medication use (n=23,250) within the 12-month period after discharge from hip fracture hospitalization.11

An osteoporotic fracture puts postmenopausal women at risk12

Within the first 12 months after an osteoporotic fracture, postmenopausal women are at an increased risk for subsequent fractures.12

Risks of Subsequent Osteoporotic Fractures

§A cross-sectional study with postmenopausal women aged 50 to 80 (N=4140) who completed a questionnaire on risk factors for osteoporosis, fracture history, and onset of menopause. The time that elapsed between a first and subsequent clinical vertebral and nonvertebral fracture, including low-trauma and high-trauma fractures, was analyzed at various times after the first fracture.13

Risks of Subsequent Osteoporotic Fractures

||A retrospective US study using a commercial health insurance database of men (n=41,984) and women (n=88,571) aged 50 years and older with osteoporotic fractures.14

Risks of Subsequent Osteoporotic Fractures
After a recent fracture, consider OSTEOPOROSIS TREATMENT CATEGORIES.

Don't Underestimate Nonvertebral Osteoporotic Fractures

Nonvertebral fractures—fractures not related to the spine, such as in the wrist—also put patients at risk for subsequent fractures.15

A comparison study in Taiwan using datasets from insurance programs to compare the incidence of hip fracture in patients with and without distal radius fracture (n=1 million) over 1 year.16

Mortality Rates Associated with Osteoporotic Fractures17

Both vertebral and nonvertebral osteoporotic fractures were associated with increased mortality.17

Nearly 1/3

#A longitudinal, population-based epidemiology study in Australia of men and women aged 60 years and older with osteoporosis who sustained a fracture (n=614).17

1/4 of patients who had a hip fracture

**A review of international publications published between 1959 and 1998 on the outcomes after hip fractures in men and women older than 60 years.18

Use of osteoporosis treatment after a hip fracture

A retrospective, observational cohort study based on US administrative insurance claims data for adults (N=96,887). The study outcome was osteoporosis medication use (n=23,250) within the 12-month period after discharge from hip-fracture hospitalization.11

References:

1. National Coalition for Osteoporosis and Related Bone Diseases. National Action Plan for Bone Health: Recommendations From the Summit for a National Action Plan for Bone Health.

http://www.oif.org/site/DocServer/BoneHealthReport.pdf. Accessed January 10, 2017.

2. National Institutes of Health, National Institute on Aging. Menopause. 2013. https://www.nia.nih.gov/health/publication/menopause. Accessed November 9, 2016.

3. Gallagher JC, Goldgar D, Moy A. Total bone calcium in normal women: effect of age and menopause status. J Bone Miner Res. 1987;2(6):491-496.

4. Mayo Clinic. Osteoporosis: symptoms and causes. http://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/dxc-20207860. Accessed November 1, 2016.

5. Finkelstein JS, Brockwell SE, Mehta V, et al. Bone mineral density changes during the menopause transition in a multiethnic cohort of women. J Clin Endocrinol Metab. 2008;93(3):861-868.

6. Farr JN, Khosla S. Skeletal changes through the lifespan—from growth to senescence. Nat Rev Endocrinol. 2015;11(9):513-521.

7. Zimmermann EA, Schaible E, Bale H, et al. Age-related changes in the plasticity and toughness of human cortical bone at multiple length scales. Proc Natl Acad Sci USA. 2011;108(35):14416-14421. Erratum: Proc Natl Acad Sci

USA. 2012;109(29):11890.

8. Geusens P, Chapurlat R, Schett G, et al. High-resolution in vivo imaging of bone and joints: a window to microarchitecture. Nat Rev Rheumatol. 2014;10(5):304-313.

9. Kanis JA, Johnell O, Oden A, et al. Long-term risk of osteoporotic fracture in Malmö. Osteoporos Int. 2000;11(8):669-674.

10. Singer A, Exuzides A, Spangler L, et al. Burden of illness for osteoporotic fractures compared with other serious diseases among postmenopausal women in the United States. Mayo Clin Proc. 2015;90(1):53-62.

11. Solomon DH, Johnston SS, Boytsov NN, McMorrow D, Lane JM, Krohn KD. Osteoporosis medication use after hip fracture in U.S. patients between 2002 and 2011. J Bone Miner Res. 2014;29(9):1929-1937.

12. Siris ES, Miller PD, Barrett-Connor E, et al. Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment.

JAMA. 2001;286(22):2815-2822.

13. van Geel TA, van Helden S, Geusens PP, Winkens B, Dinant GJ. Clinical subsequent fractures cluster in time after first fractures. Ann Rheum Dis. 2009;68(1)99-102.

14. Balasubramanian A, Tosi LL, Lane JM, Dirschl DR, Ho PR, O’Malley CD. Declining rates of osteoporosis management following fragility fractures in the U.S., 2000 through 2009. J Bone Joint Surg Am. 2014;96(7):e52(1-8).

15. Barrett-Connor E, Sajjan SG, Siris ES, Miller PD, Chen YT, Markson LE. Wrist fracture as a predictor of future fractures in younger versus older postmenopausal women: results from the National Osteoporosis Risk Assessment

(NORA). Osteoporos Int. 2008;19(5):607-613.

16. Chen CW, Huang TL, Su LT, et al. Incidence of subsequent hip fractures is significantly increased within the first month after distal radius fracture in patients older than 60 years. J Trauma Acute Care Surg. 2013;74(1):317-321.

17. Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009;301(5):513-521.

18. Haleem S, Lutchman L, Mayahi R, Grice JE, Parker MJ. Mortality following hip fracture: trends and geographical variations over the last 40 years. Injury. 2008;39(10):1157-1163.