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Aging, Systemic Disease and Oral Health: Implications for Women Worldwide (Part I)

Course Number: 302

Osteoporosis: A Global Concern for Women

Osteoporosis is not typically seen or felt by the patient, referred to as “the silent disease,” since it oftentimes progresses slowly without symptoms. Bone density loss or osteoporosis is characterized by porous bone causing bones to become fragile, thin, and high risk for fracture. From the loss of bone, fractures occur more easily, and the accompanying loss of height and severe back pain can leave the patient suffering from permanent disabilities and even death if serious spinal or vertebral fractures occur.

Having low bone density or osteoporosis is affecting 54 million Americans. Roughly eight million of the ten million Americans with osteoporosis are women. It is estimated that one in two females over age 50 will suffer with a broken bone due to osteoporosis. Two million broken bones yearly have been attributed to osteoporosis and nearly 80% of older American women who have suffered broken bones are not tested or even treated for osteoporosis. A woman can lose up to 20% of bone density within five to seven years following menopause. In the US alone an estimated 52% of postmenopausal white women are osteopenic and 20% are osteoporotic.52

Osteoporosis accounts for 1.5 million fractures annually, primarily in the hip, spine, and wrist. Average rate of hip bone mass density (BMD) loss is twice as great in white women compared to African-American women and with aging increases occur in both groups (Table 2). An osteoporotic fracture risk for women over the age of 50 is 50%, equivalent to the combined risk of developing breast, uterine, and ovarian cancers. Fracture incidence is also usually higher for whites and lower for other ethnic groups in the U.S.52 However, osteoporosis is typically under recognized and undertreated in African American women and their risk for hip fracture can double every 7 years and they can be more likely to die from a hip fracture than a white woman.51

Osteoporosis related fractures are expected to be greater than 3 million by the year 2025.52

Table 2. The National Osteoporosis Foundation Guidelines indicate BMD Testing for:

  • All women age 65 and older regardless of risk factors
  • Younger postmenopausal women with one or more risk factors other than being white, postmenopausal and female
  • Estrogen-deficient women at clinical risk for osteoporosis
  • Individuals receiving, or planning to receive, long-term glucocorticosteroid therapy
  • Individuals with primary hyperparathyroidism
  • Postmenopausal women who present with fractures
  • Individuals being monitored to assess the response or efficacy of an approved osteoporosis drug therapy

Morbidity rates are reported to occur more from hip fractures, and mortality rates occurring after hip fractures are up to 24% in the first year from the fracture;52 for at least 5 years afterwards a greater risk of death may exist. Loss of independence and function can be profound among survivors along with the inability to walk independently. For those ambulatory prior to the hip fracture, now one in five require some form of long-term care. Up to six months following the fracture incidence, 85% require assistance in walking across the room and 33% are solely dependent on nursing home care for one year. Among women over 45 years of age, osteoporosis accounts for more days being spent in hospitals than any other disease including diabetes, myocardial infarction, and breast cancer.52 As indicated by statistics across Asia, Europe, Latin America and North America (Figure 8), osteoporosis and its associated morbidity is a growing concern worldwide.

Charts showing osteoporosis – Global Spotlight on Latin America, North America, Europe and Asia

Figure 8. Osteoporosis – Global Spotlight on Latin America, North America, Europe and Asia.

United States

According to the International Osteoporosis Foundation low bone mass and osteoporosis have been identified as a public health threat for over 44 million U.S. men and women ages 50 and over. It is estimated that over 52 million men and women within the same age category will be affected by osteoporosis and should the trend continue, the numbers will continue to over 61 million by 2020. Broken bones and serious falls in age 50 and over is the first sign of low bone density and often osteoporosis related.54 Subsequently, the increase in cases could create the number of hip fractures to double or triple by 2040. It is estimated over the next ten years, postmenopausal white women in the US will experience 5.2 million fractures of the hip, spine, or distal forearm leading to over $45 billion in direct medical costs.54


Approximately 1.4 million Canadians are affected by osteoporosis, most of those being postmenopausal women and the aging.54 The prevalence of osteoporosis among Canadian women age 50 years or older is about 16%. Women over the age of 50 having evidence of a vertebral fracture from an osteoporotic condition has been reported to be 1 in 4. Each year Canadian women have been reported to encounter over 30,000 hip fractures and the number of fractures is expected to quadruple by 2030.54

Latin America

Projections from 1990 to 2050, the number of hip fractures for women and men ages 50-64 will increase by 400%. For age groups older than 65 the increase will be 700%. Among five Latin American countries (Argentina, Brazil, Colombia, Mexico and Puerto Rico), the prevalence of vertebral fractures in women 50 and older has been around 15%, with 7% occurring within the 50-60 year old age group and increasing to 28% for those greater than 80 years old.54 The prevalence in women 50 years and older for osteopenia is 50% and 25% for osteoporosis. It is projected that by 2050, 5.24 million and 2.62 million women will have osteopenia and osteoporosis respectively.54 34,000 hip fractures occur yearly in a population 50 years and older, averaging 90 fractures/day. By 2050, there are estimates for >63,000 hip fractures in women and the prevalence for the vertebral fractures is 16.2%. Hospitalization costs for the hip and vertebral fractures is anticipated to exceed 190 million USD yearly.54 In Brazil, the economic burden of osteoporosis hip fractures to private health companies is estimated at $6 million.54


By 2050, Asia is projected to experience more than 50% of all osteoporotic hip fractures globally.54 Asian women have as many and as frequent vertebral fractures as white women; however, hip fractures in comparison are less prevalent among Asian women.54 In the Japanese female population aged 50-79 years, the prevalence of osteoporosis in the spine is estimated at 35% and at the hip 9.5%.52 The total number of hip fractures is forecast to be 238,000 in 2030.54


After 75 years of age, the number of hip fractures was 4.3 per 1000 women and 2.97 per 1000 in men. The occurrence of hip fractures in Korean women increased about 4-fold during the years 1991-2001.52

Hong Kong

Even with a stabilization of hip fracture rates, fractures remain a burden on health services and society. The acute hospital cost of hip fractures is estimated at 1% of the total annual hospital budget, or 17 million USD for a population of 6 million. The incidence of hip fractures among women in Hong Kong has increased by 200% in the last 30 years.54


Indian women 30-60 years of age from low-income levels reported bone mass density levels from all skeletal sites to be lower than values reported from developed countries, attributed to factors such as inadequate nutrition. A high prevalence of osteopenia was reported at 52% while osteoporosis was reported at 29%.54


Osteoporosis affects about 2.2 million Australian women and 27% of the women aged 60 and older are osteoporotic and 51% are osteopenic.54 However, women 50 and older are at a 42% lifetime risk of suffering from an osteoporotic fracture versus men with a 27% risk. Australian women are suffering from 20,000 hip fractures yearly and at an increased rate of 40% every ten years resulting in osteoporotic medical costs totaling $7.4 billion yearly and $1.9 billion are direct costs.54


In the EU, the annual number of fractures will rise from 3.5 million in 2010 to 4.5 million in 2025, an increase of 28%.54 According to the International Osteoporosis Foundation (IOF), the under-utilization of bone mineral density measurements (BMD) in the majority of European countries accounts for limited availability of densitometers, restrictions in personnel allowed to perform such testing, and perhaps the unawareness of usefulness demonstrated from BMD testing along with non-existent or limited reimbursement.52


Within the age range of 25-74 years, the prevalence from any fracture was 45% for men and 40% for women within the ages 65-74 years. In a 1998 report, the European Commission estimated the incidence of hip fractures in Germany will increase from 117,000 in the year 2000 to 240,000 by the year 2040.54


It has been reported that 13% of patients who suffer a fracture typically die 3 months post fracture and this percentage increases to 38% after 24 months. After experiencing a vertebral fracture, it has been reported 45% of patients suffer from functional damage while 50% are afflicted by partial or total disability. Approximately 2 million women have been reported to suffer from osteoporosis in Spain. It is prevalent among 26.1% of the women 50 years and older, and the increase in new cases has been documented in women more than men.54


Between 2000-2020, osteoporotic hip, vertebral and wrist fracture are predicted to rise by 33%, 27% and 19%, respectively, if current prevention and treatment patterns are maintained. Osteoporosis has ranked number one in Switzerland among other common diseases in women. Of reported fractures, 51% were considered osteoporotic related.54 The annual hospital costs (in terms of duration of stay) for osteoporotic fractures was greater than those being treated for myocardial infarction, stroke and breast cancer; nevertheless, slightly lower than for chronic obstructive pulmonary disease. For women, the costs associated with osteoporosis were higher than for all the combined diseases.54


In Finland during 1992-2002, (a ten-year period) the total number of hip fractures for women increased by 70%.54 In 2005, Denmark estimated the prevalence of osteoporosis among women 50 years and older at 41%. The risk of sustaining a second hip fracture during the first 12 months after an initial hip fracture is considered high. Denmark’s economic burden from new and prior fractures soars to millions of dollars yearly (equivalent to the US dollar); by 2025 the burden will increase 27% creating soaring expenses and financial burdens to the country.54