Friday, October 30, 2009

Osteoporosis

One of the things I did last year was complete a project on Osteoporosis for a Master of Public Health degree. In the process I learned quite a bit. The statistics are sobering:

1 in 2 women will have a fracture after the age of 50
1 in 4 men will have a fracture after age 50.
Each year there are 300,000 hip fractures and 700,000 spine fractures from osteoporosis.

That's a lot of people! That's a lot of fractures!
It's also a lot of pain and a lot of people ending up in nursing homes from hip fractures.

In any case, you would think that this is a big deal among patients and physicians but it continues to be a very silent epidemic.

For example, most women get a mammogram at least every 2 years (over 65%). Most women never get a bone density scan (DXA scan) more than once (less than 35% get a DXA scan more than once). Yet women are much more likely to get a fracture than breast cancer.

Even after a hip fracture, most patients never get put on calcium and vitamin D (only 35% do) and most patients never even get a prescription for a osteoporosis medication (less than 15%).

About half of people who are prescribed an osteoporosis medication stop in within the year and of the half who continue it, on average they take half their medication.

In other words, the take home message is that Osteoporosis is severely underdetected and undertreated. Probably no more than 5% of people in the United States with osteoporosis are taking their medication regularly to maximally prevent a fracture.

So what can you do?
1. Ask for a DXA scan to be detected
2. Read this website to calculate your own fracture risk.
3. Take calcium and vitamin D every day if you are older than 13.
4. Take a bisphosphonate like Actonel, Fosamax or Reclast.
5. Exercise and don't smoke.

On the 4th point, I actually do not care a whole lot which Bisphosphonate a person takes. People often ask me what medication is better than another and what type of calcium is ideal. I hope I've convinced you that that does not matter. It's better to take anything than nothing. I would take whatever is cheapest myself and what is covered on insurance. And for sure, I would take the generic over the brand because like I said I'm cheap. For those who are forgetful, Reclast which is a once yearly bisphosphonate is wonderful. I'd recommend it.

That's my 2 cents on Osteoporosis!

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