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Getting Smart About Fracture Risks: What Women With Osteoporosis Must Know

April 9, 2010

Underscoring what researchers call a serious global public health concern, results from a new study led by Columbia University Medical Center reveal that many women at an elevated level of risk for osteoporosis-associated fractures fail to perceive the implications of the risk factors. "We found that many women aren't making the connection between their risk factors and the serious consequences of fractures," said the lead author Ethel Siris, MD, director of the Toni Stabile Osteoporosis Center at NewYork-Presbyterian Hospital/Columbia University Medical Center and the Madeline C. Stabile Professor of Clinical Medicine at Columbia University College of Physicians and Surgeons. "Without a clear understanding of their risks, women cannot begin to protect themselves from fracture." This study, part of the Global Longitudinal Study of Osteoporosis in Women (GLOW), based at the Center for Outcomes Research at the University of Massachusetts Medical School, was published online by the journal Osteoporosis International on April 2, 2010. Results showed that among postmenopausal women diagnosed with osteoporosis—a serious condition associated with a high risk for fractures because it causes bones to become fragile and more likely to break—only 43 percent thought their risk of a fracture was higher than other women their age. Additionally, only 33 percent, or one in three women, who reported two or more major risk factors for fracture, perceived themselves as being at higher risk for fracture than their age-matched peers. Because many fractures can be prevented by appropriate treatment, it is important that women with an elevated risk be identified. One in two women will suffer an osteoporosis-related fracture after age 50; these fractures often carry with them chronic pain, reduced mobility, loss of independence and, in the case of hip fracture, an increased risk of death. Because the likelihood of fractures increases substantially with age, fracture numbers are projected to rise as the population ages. Osteoporosis-related fractures are an international public health problem; in addition to the human suffering associated with these fractures, they also are the source of enormous healthcare costs. Improved education of physicians and postmenopausal women about osteoporosis risk factors is urgently needed, according to the study authors. If left untreated, osteoporosis can progress painlessly until a fracture occurs.

Know the leading risk factors for fractures in women:
• older age
• low weight
• parental hip fracture
• personal history of fracture (clavicle, arm, wrist, spine, rib, hip, pelvis, upper leg, lower leg, ankle) since age 45
• two or more falls in the past year
• current use of cortisone or prednisone (steroids often prescribed for a number of medical conditions)
• rheumatoid arthritis
• cigarette smoking
• consumption of three or more alcoholic beverages daily

Other risk factors for fractures include a variety of medical conditions and medications. Tools for diagnosis and risk assessment, including bone-density testing and the World Health Organization FRAX fracture risk-assessment tool, are widely available; still, the connection between identified risk factors and serious fracture outcomes is not being made by a majority of women at highest risk.
"We hope the insight we obtain from GLOW will help physicians and patients work together to identify those at risk for fracture and to enhance understanding of the meaning of that risk," said Siris. "Education is critical if we are to reduce the burden of fractures worldwide."

GLOW is a prospective, international cohort study of women 55 years of age and older who visited their primary-care physician during the two years prior to enrollment in the study. More than 60,000 women were recruited by more than 700 primary-care physicians in 17 cities in 10 countries (Australia, Belgium, Canada, France, Germany, Italy, Netherlands, Spain, United Kingdom and the United States). GLOW is gathering information on osteoporosis risk factors, treatments, patient behaviors and fracture outcomes during a five-year period. Self-perceived risk of fracture was assessed using a five-point scale ranging from "much lower" to "much higher" risk than other women of the same age.