1. Nahid Rianon, M.D., Dr.P.H. The University of Texas Health Science Center at Houston Osteoporosis Educational Series, Lecture 1of 3: A Public Health Problem of Older Age

2. Goal and Objectives GOAL: The goal of this presentation is to demonstrate the public health importance of osteoporosis as a disease of old age and the clinical definition of osteoporosis LEARNING OBJECTIVES: At the end of this presentation, attendees will be able to – Learn the clinical definition of osteoporosis. – Describe the health impact of osteoporotic fractures from an individual to health care system level. – Identify the generally recommended DEXA site to diagnose osteoporosis. 2

3. Pre Quiz Question 1 of 5 Approximately how much is spent annually for health care related to osteoporosis and associated fractures in the USA? (pick the one that best fits the answer) a)More than $20 billion per year b)About $7 billion per year c)About $100 million per year d)Less than 5 billion per year

4. Pre Quiz Question 2 of 5 Which of the following is the MOST common site for fracture for age related bone loss or osteoporosis in the elderly population? (pick the one that best fits the answer) a)Ribs b)Hip c)Vertebrae d)Tibia

5. Pre Quiz Question 3 of 5 Which one of the following statements best fits the clinical criteria for definition of osteoporosis due to age related bone loss? a)A T-score of -2.5 for spine or femur neck bone mineral density (BMD) b)A vertebral fracture in a 25 year old man due to a fall from the 4th floor of a building c)A family history of hip fracture in the mother d)A normal chest x-ray reporting osteopenic changes in bones

6. Pre Quiz Question 4 of 5 Which of the following sites is a generally recommended site for DEXA scan to diagnose osteoporosis? a)Heel b)Wrist c)Hip d)Finger

7. Pre Quiz Question 5 of 5 Almost every elderly person recovers to their baseline functional state after a hip fracture. a)True b)False

8.  Osteoporosis & related fractures - important public health problems of old age  ~10 million Americans suffers from osteoporosis  ~34 million are at risk  More than 2 million fractures in the USA in 2005 were attributable to osteoporosis  547,000 vertebral fractures  297,000 hip fractures  397,000 wrist fractures Osteoporosis in the Elderly

9. For Women:  Incidence of fractures per year exceeds that of stroke, myocardial infarction (MI) and breast cancer combined  ~1:2 Caucasian women ≥ 50 years experience a fracture in their lifetimes  1 in 3 for vertebral fractures  1 in 6 for hip fracture For Men:  Fracture risk is higher than that of prostate cancer  21% ≥ 50 years will experience a fracture Osteoporotic Fractures

10.  Common sites:  Vertebral body, femur neck & wrists Osteoporotic Fractures: Where and How  Fractures without much force or any trauma:  Turning in bed, fall from a standing height

11. Osteoporosis and Health Care Events

12. Health Care Cost ~$22 billion is spent annually for osteoporosis and related fracture in the USA ~$7 billion is spent annually for breast cancer in the USA

13. Fractures can decrease quality of life:  Physical: pain, compressed abdomen, spinal deformity  Functional: decreased mobility  Psychosocial: depression  Rate of recurrent vertebral fracture after the initial one ~5-20% Osteoporosis and Quality of Life

14. If one survives a hip fracture — ~50% with hip fractures will never walk without assistance ~25% will require long-term care Osteoporosis and Quality of Life

15. Osteoporosis: Measure of Bone Health Revised definition: Compromised bone strength that increases risk of fracture NIH Consensus Conference 2000  Bone Strength is characterized by  Bone density and  Other bone qualities, e.g., micro-architecture influenced by bone remodeling, bone turnover, mineralization and other factors that are more difficult to quantify, such as “damage accumulation”

16. DEXA scan - Left hip Usual sites for DEXA is lumbar spine and left hip DEXA scan - Lumbar spine Clinical Diagnosis of Osteoporosis Osteoporosis = A T- score of <-2.5 for BMD Osteopenia = A T- score of -1 to -2.5 for BMD

17. BMD Decreases with Advanced Age ASBMR 2011

18. Females Males Johnell O & Kenis J, 2006; Osteopor Int. Hip Fracture Worldwide in Year 2000

19. Approximately how much is spent annually for health care related to osteoporosis and associated fractures in the USA? (pick the one that best fits the answer) a)More than $20 billion per year b)About $7 billion per year c)About $100 million per year d)Less than 5 billion per year Post Quiz Question 1 of 5

20. Post Quiz Question 2 of 5 Which of the following is the MOST common site for fracture for age related bone loss or osteoporosis in the elderly population? (pick the one that best fits the answer) a)Ribs b)Hip c)Vertebrae d)Tibia

21. Post Quiz Question 3 of 5 Which one of the following statements best fits the clinical criteria for definition of osteoporosis due to age related bone loss? a)A T-score of -2.5 for spine or femur neck bone mineral density (BMD) b)A vertebral fracture in a 25 year old man due to a fall from the 4th floor of a building c)A family history of hip fracture in the mother d)A normal chest x-ray reporting osteopenic changes in bones

22. Post Quiz Question 4 of 5 Which of the following sites is a generally recommended site for DEXA scan to diagnose osteoporosis? a)Heel b)Wrist c)Hip d)Finger

23. Post Quiz Question 5 of 5 Almost every elderly person recovers to their baseline functional state after a hip fracture. a)True b)False

24. Thank you Questions?

25. 25  American Cancer Society. Cancer Facts and Figures 1996  Blume S, Curtis J. Medical costs of osteoporosis in the elderly Medicare population. Osteoporos Int. 2010 Dec 17  Lavelle W & Cheney R, 2006, The Spine Journal: 488-493 and Lindsay R et al., 2001, JAMA: 285-323.  National Osteoporosis Foundation. Physician’s Guide; Belle Mead, NJ:Exerpta Medica, Inc. 1998  NIH Consensus Conference 2000  Riggs BL, et al. Bone. 1995;17(Suppl):505S  State of Health Care Quality 2007, National Committee for Quality Assurance, Washington D.C., page 27  US Office of the Surgeon General  Van Staa T, et al. Bone. 2001;29:517 References

26. Brought to you by TEXAS. The Training Excellence in Aging Studies (TEXAS) program promotes geriatric training from medical school through the practicing physician level. This project is funded by the Donald W. Reynolds Foundation to the division of Geriatrics and Palliative Medicine within the department of Internal Medicine at The University of Texas Health Science Center at Houston (UTHealth). TEXAS would also like to recognize the following for contributions: Houston Geriatric Education Center Harris County Hospital District Memorial Hermann Foundation Huffington Lecture Series The TEXAS Advisory Board Othello "Bud" and Newlyn Hare UTHealth Medical School Office of the Dean UTHealth School of Nursing UTHealth Consortium on Aging UTHealth Multimedia Scriptorium (www.uth.tmc.edu/scriptorium) Ben Earwicker for the use if his photos (www.garrisonphoto.org/sxc) Photographs use for the cover are allowed by the morgueFile free photo agreement and the Royalty Free usage agreement at Stock.xchng. They appear on the cover in this order: Wallyir at morguefile.com/archive/display/221205 Mokra at www.sxc.hu/photo/572286 Clarita at morguefile.com/archive/display/33743 Copyrighted images cannot be used in whole or part without the explicit permission of the owner.