Loss of independence (42%) and lost mobility (25%) ranked as the leading concerns about aging for osteoporosis patients who responded to a recent Bone Health Index Survey by the National Osteoporosis Foundation (NOF), the nation’s leading healthcare organization dedicated to preventing osteoporosis and broken bones. Caregivers of osteoporosis patients noted they were most concerned that they would be unable to manage their patient or loved one’s care (50%).
“Given that approximately 2 million broken bones are caused by osteoporosis each year, the patients’ concerns are warranted,” said Amy Porter, executive director and CEO of NOF. “Over 300,000 of those broken bones will be hip fractures — the most life-changing of all fractures. In fact, 25% of women over the age of 50 who sustain a hip fracture die in the year following the fracture, 50% never walk independently again, and 20% require permanent nursing-home placement. We can and we must do more to prevent these fractures.”
Fifty-two percent of the patients who responded to the survey said they had broken a bone, with the average number of bones broken being three. Yet, surprisingly, 44% said they were only somewhat or not concerned about fracturing again.
“It’s troubling that patients who experienced a fracture were not more concerned about another fracture,” said Dr. Andrea Singer, NOF clinical director and trustee. “The most powerful predictor for sustaining an osteoporotic fracture is a prior fracture; nearly half of patients who present with a hip fracture have previously had some other osteoporosis-related fracture.”
A majority (60%) of those who said they broke a bone were not referred for a bone-density test, such as an axial dual-energy X-ray absorptiometry (DXA) test, after the fracture to determine if osteoporosis was the underlying cause of the fracture, and less than half (47%) were prescribed an osteoporosis medication for treatment. This could prove to be devastating and costly for a rapidly aging population.
In 2010, Medicare paid more than $16 billion for direct costs of new fractures that year, and the cost is projected to grow to over $25 billion by 2025. Unlike other diseases, where there is no accurate screening test, osteoporosis is a model for disease prevention with accurate, cost-effective diagnostic tools and inexpensive treatments that work at reducing fractures. Bone-density testing is more powerful in predicting fractures than cholesterol is in predicting myocardial infarction or blood pressure in predicting stroke. Medicare beneficiaries who have a DXA bone density test have 35% fewer hip fractures and 22% fewer other fragility fractures.
Of the patients who were on osteoporosis treatment, 92% said they had read or viewed negative information about the medication. Their length of time on medication was short, with 42% saying they’d been on treatment for less than two years.
Thirty-eight percent said they were prescribed an osteoporosis medication they didn’t take. Fear of side effects from the medication was the leading factor for not taking the medication (79%). And 51% of patients who were on a medication said they stopped taking the osteoporosis medication most commonly because of the side effects they experienced (53%) or out of concern for the risk of side effects (38%).
In actuality, the number of fractures that are prevented with treatment far outweighs the risk of atypical femur fractures and osteonecrosis of the jaw. Treatment of women with osteoporosis for up to five years would result in fewer than one atypical femur fracture caused per 100 osteoporotic fractures prevented.
“Available therapies for osteoporosis are effective in preventing fractures and can reduce the risk of future fractures by about 30% to 70%,” Singer said. “New pharmacologic agents in the pipeline will expand or offer more treatment options for patients.”
Some encouraging news from the survey was that most patients and caregivers (89%) knew that proper diet and exercise, including getting the recommended daily allowance of calcium and vitamin D, is an important part of treating osteoporosis. And 90% knew that osteoporosis cannot be treated solely through diet and exercise.
“We are very pleased that our online community of patients, caregivers, and people interested in bone health continues to grow and that the members are very engaged,” Porter said. “We will use the insights gleaned from our Bone Health Index Survey to evaluate our current educational materials and activities and improve the services we provide to patients, caregivers, and healthcare professionals.”