Consequences of osteoporosis
Osteoporotic fractures can have significant consequences for individuals, community organisations, private industry and governments.
For the individual, fractures can lead to chronic pain, immobility, restricted activities and other limitations.1 Individuals also bear the cost of loss of income, equipment/devices to help cope with restricted activities and home care by family members.
For the community, there may be an increased demand for services such as meals on wheels and community taxi services.
The public healthcare system may have to cover (at least partially) costs for hospital and nursing home care, GP, specialist and allied health services, and medication.2
Vertebral Fracture
Osteoporosis-related fractures of the spine are the most common type of fracture in patients with osteoporosis. They can lead to changes in posture (for example, a stoop or “Dowager’s hump”), a weakening of the muscles, reduced height and spine deformity. Osteoporosis-related fracture of the spine can lead to chronic pain, loss of independence and even premature death.
Hip Fracture
Hip fractures are the most serious consequence of osteoporosis. They commonly occur when people with weakened bones fall onto their hip. They are painful, cause immediate immobility and require surgery to repair. In 2005–06, about 16,200 people were hospitalised for minimal-trauma hip fractures in Australia. On average, a person will spend at least 11 days in hospital for the treatment of their hip fracture. Rehabilitation is often required to restore muscle strength, balance and mobility. Even after a lengthy rehabilitation process, many people cannot return to the life they had before the fracture.1
Not everyone recovers after a hip fracture. Overall, about 25% of people who sustain a hip fracture die within 12 months, and this percentage is higher for elderly people.2
The incidence of hip fractures is rising and projected to increase further in Australia due to the aging population.
Recovery After a Hip Fracture
Hip fractures result in a large economic burden due to the long length of hospitalisation required for rehabilitation. The goal of rehabilitation after hip fracture surgery is to get the patient moving as quickly as possible, in order to avoid the serious complications that can happen when a person is immobilised in bed.
A physical or occupational therapist will direct the patient’s recovery after surgery. They are encouraged to move from their hospital bed to a chair several times the first day after surgery. The patient must avoid activities that put a strain on the surgical area and will need to use a walking aid, such as a walking frame or crutches. Any exercises should only be done following instruction by the surgeon or therapist.
Patients are safe to go home when they can get up and move about safely with a walking frame or crutches, are able to do exercises, and when their caregiver has made all the needed preparations to go home. Once discharged from the hospital, a therapist may see the patient for a number of in-home treatments.
Forearm and Wrist Fractures
Wrist and forearm fractures can limit a person’s ability to perform everyday tasks. For example, wrist fractures may affect the ability to write or type, prepare meals, perform personal-care tasks and manage household chores. Moreover, the fear of further fractures may prevent participation in everyday activities.1
Wrist and forearm fractures usually occur when people protect themselves with outstretched arms during a fall. The incidence of wrist fracture in both men and women increases with age and is highest in people aged 75 years and older. The chance of having a wrist or forearm fracture through life is about 9–13%.1
Pain Symptoms
Osteoporosis in-itself does not always cause pain. This contributes to the silent nature of the disease and subsequent under-diagnosis. Maybe if we experienced discomfort as our bones thinned, it would prompt more frequent visits to the doctor, with increased diagnosis and treatment!
Pain symptoms occur only when bone loss is advanced and a fracture occurs. Osteoporotic fractures can cause acute and chronic pain, although spinal fractures may occur with no pain at all. Acute pain is the normal pain associated with healing of a fracture, whereas chronic pain persists long after the bone is healed. Among adults disabled by their osteoporosis, about 65% report chronic or recurrent pain. If you experience chronic pain, talk to your doctor about ways of managing your symptoms.1
Reduced Functioning
Fractures limit how the body normally functions; the degree of limitation depends on the site and severity of the fracture and the degree of pain associated with it. For example, vertebral fractures usually lead to a gradual loss of function over time, whereas hip fractures usually result in immediate loss of function. After a hip fracture, only 50% of people regain their previous function. Institutional or at-home care may be required as a result of reduced functioning.1
Psychological Distress
A diagnosis of osteoporosis can be distressing. Many people worry about fractures and possible physical effects, and feel concerned that they may be unable to perform their normal tasks at home or at work. The pain and disability due to fractures can affect a person’s mental wellbeing, as can the loss of independence through needing assistance for everyday tasks.
The 2004–05 National Health Survey reveals that about 27% of people aged 35 years and over with osteoporosis have a high or very high level of psychological distress, compared with 12% of people aged 35 years and over without osteoporosis.1
Mortality
Few deaths are caused by fracture alone. Indeed, fractures of the wrist or forearm are associated with little, if any, increased risk of death. However, fractures that cause prolonged immobility can increase the risk of a person dying by aggravating other existing conditions or increasing the risk of acquiring diseases such as pneumonia.
In Australia, about 1 in 4 people who have a hip fracture, who are often frail and elderly, die within 12 months. An increased risk of death compared to the general population continues for at least another 4 years.1
Medication
Several different types of medication are available for treating osteoporosis. Doctors prescribe therapy based on factors such as severity of osteoporosis, current medication use and presence of other medical conditions, risk of side effects, convenience and cost.
The 2004–05 National Health Survey reported that about 43% of people were taking pharmaceutical medications for their osteoporosis. The most common were from a class of drugs called bisphosphonates.1
Lifestyle Aids and Modifications
Increasing bone density is only one approach to prevent osteoporotic fractures. Other approaches include fall prevention strategies (e.g. installing handrails, removing obstacles from floors), ensuring eyesight is corrected, walking aids and supportive footwear.
Only a small percentage (about 2%) of people with osteoporosis in the 2004–05 National Health Survey reported obtaining or using physical aids for their osteoporosis.1
Health Carers
People with osteoporosis often need support to help manage day-to-day tasks. This assistance can be provided by family, friends, volunteers, and paid care workers or service providers, but family members are the main providers of help and informal care.
According to the 2003 Survey of Disability, Ageing and Carers, 50% of carers of people with osteoporosis-associated disability spend more than 40 hours a week caring. Almost half (49.5%) of carers have been providing care for at least 10 years.1
Health and Medical Costs For Osteoporosis Patients
Osteoporosis places a financial burden on individuals with the disease and their families. Governments and insurance companies also spend large amounts on osteoporosis. Access Economics (2001) has estimated that the total health costs of osteoporosis are in the billions of dollars.1
A person with osteoporosis can incur costs for prescription medications, diagnostic tests (blood tests, X-ray and DEXA scan), devices or aids to assist with pain or disability, over-the-counter medications, herbal or natural supplements and allied health-care visits. Osteoporosis may also be associated with indirect costs such as forfeited income due to illness or early retirement and loss of income to family members who assist with care.1
The Australian Government also supports osteoporosis research. In 2007, the National Health and Medical Research Council committed over $5.5 million for research into the disease.1
References
- Australian Institute of Health and Welfare 2008. A picture of osteoporosis Australia. Arthritis series no. 6. Cat. No. PHE 99. Canberra: AIHW.
- Access Economics. The burden of brittle bones: Costing osteoporosis in Australia. September 2001.
