The Better Bones Blog

by Dr. Susan Brown, PhD.

How many women experience an osteoporotic fracture?

A few months ago one of our readers asked me to estimate just how many people in the U.S. actually experience an osteoporotic fracture. Sometimes it is difficult to tell fact from fiction and to sort out a pharmaceutical-induced “osteoporosis scare” perception from real fracture data.

Taking this reader’s question to heart, I asked myself , “How do we really know how many people actually have an osteoporotic fracture?”  It became quickly obvious that this is not an easy question to answer, largely because many people suffer “silent”spinal fractures that are never reported to physicians. In fact, it is estimated that two-thirds of all spinal fractures are undiagnosed; thus, they never enter into the official statistics. For example, my father at age 85 was in a car accident and it was incidentally discovered on x-ray that he had had two previous spinal fractures in his upper back. He had never noticed any pain, nor had any reason to think there might be a spinal deformity. Even now at age 98 he has no back pain, but has lost several inches of height.

Equally, many rib fractures are never reported. What we do know about, however, are most of the hip fractures that occur. The total number of hip fractures in the US is held to be somewhat over 300,000 a year. Some hip fractures, however, do slip by the statistics, such as the one experienced by my grandmother. At the age of 101, she fell in the bathtub and fractured her hip. She refused to go to the doctor and said that she “had taken care” of her two sons for a hundred years and they should now take care of her. She went to bed and remained there for one year to the day, at which point she died in her sleep.

So groups like the National Osteoporosis Foundation have made it their business to estimate how many osteoporotic fractures do occur. Their statistic is that one half of women age 50 and older will experience one or another osteoporotic fracture during their lifetime. Here’s a link to that statistic on their website:www.nof.org/diseasefacts.htm. They also report that one in four men over the age of 50 will also have an osteoporotic fracture in their remaining lifetime.

Granted it is in the best interest of the National Osteoporosis Foundation to seek out the highest possible fracture statistic estimates, and they likely include a great many inconsequential spinal vertebral fractures that were never noticed by the people experiencing them.

In my estimation of fracture incidence, I tend to include only fractures of significance and do not pay much attention to the undiagnosed spinal vertebral fractures. In this sense it is probably fair to say that 30% of US Caucasian women will experience one or another meaningful osteoporotic fractures in their lifetime. For example, looking at spinal fractures alone, I would mention a recent 15-year study looking at 2,700 US Caucasian women. At the onset of the study the average age was 69. Over the next 15 years, 18% of these women suffered a spinal fracture. Finally, the longer you live, the more likely you are to fracture. By the age of 90 about 32% of all females and 17% of all males in the US have experienced a hip fracture (See Susan Ott’s website:http://courses.washington.edu/bonephys/).
References:

Cooper, C. and Melton, L.J. 1992. Vertebral fracture: How large the silent epidemic? BMJ, 304, 793-794.
Cauley, J. et al. 2007. Long-term risk of incident vertebral fractures. JAMA, 298(23), 2761-2767.

Bone mineral density alone does not predict fracture

Recently, two international studies verified what we in the Center for Better Bones have been saying for years about the fact that you cannot predict who will fracture by bone mineral density.

In a 2006 German study, it was determined that 7.8 million Germans have osteoporosis as defined by bone density.   That is, 7.8 million Germans have a bone density that is -2.5 standard deviations or more below the average bone mineral density of a young adult.  Of this total, only 4.3% were found to experience one or more clinically recognized fractures.  That is, even though millions of people have osteoporosis as defined by bone density, only 4 out of 100 of these people with osteoporosis actually experienced a meaningful fracture.

Looking at their data another way, a second group of international researchers looked at data from two large trials (the SOTI and TROPOS trials) comparing fracture incidence with bone mineral density among 6740 women.  Overall, of all the fractures that occurred in both studies, only 18% occurred in women with an “osteoporotic” bone density (that is, a bone density of equal to or greater than -2.5 SD T score).  The vast majority of women who fractured had an “osteopenia” bone density, not an “osteoporotic” bone density.

 

References:

Haussler, B., et al. 2007. Epidemiology, treatment and costs of osteoporosis in Germany: The bone EVA study. Osteoporosis International 18(1):77-84. (Epub ahead of print Sep 2006)

Seeman, E., et al. 2008. Strontium ranelate reduces the risk of vertebral fractures in patients with osteopenia. Jr. Bone and Mineral Research, 23(3), 433-438.

Wholesome, low calorie drinks that alkalize

Cup of tea

The lowest calorie, most wholesome beverage is spring water with a high mineral content, such as the European “mineral waters.”

Juices made of alkalizing vegetables like kale, collards, celery, bok choy, parsley, lettuces, cabbage, and the like are also potent alkalizers containing relatively few calories. In addition, the “acid-tasting” juices of lemons and limes are transformed through metabolism to alkalizing agents.

Thus, the juice of a whole lemon or a whole lime mixed in cold or hot water is an excellent beverage that aids in alkalizing. Equally, 1-2 tablespoons of apple cider vinegar mixed in water, with or without a bit of honey, helps to alkalize and improve digestion. Tea made from fresh ginger root is another favorite low-calorie alkalizing and detoxifying beverage.

 


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