Medical Impact with Osteoporossis

Fractures and their complications are the relevant clinical sequelae of osteoporosis. The most
common fractures are those of the vertebrae (spine), proximal femur (hip) and distal forearm
(wrist). However, most fractures in older adults are due at least in part to low bone mass, even
when they result from considerable trauma. The most notable exceptions are those of the
fingers, toes, face and skull, which are primarily related to trauma rather than underlying bone
strength. Fractures may be followed by full recovery or by chronic pain, disability and death.5

These fractures can also cause psychosocial symptoms, most notably depression and loss of
self-esteem, as patients grapple with pain, physical limitations, and lifestyle and cosmetic
changes. Anxiety, fear and anger may also impede recovery. The high morbidity and
consequent dependency associated with these fractures strain interpersonal relationships and
social roles for patients and their families.

Hip fractures are associated with a 8.4 to 36 percent excess mortality within one year, with a
higher mortality in men than in women3
; additionally, hip fractures are followed by a 2.5-fold
increased risk of future fractures.4
 Approximately 20 percent of hip fracture patients require
long-term nursing home care, and only 40 percent fully regain their pre-fracture level of
independence.1 Mortality is also increased following vertebral fractures, which may result in
complications that include back pain, height loss and kyphosis. Postural changes associated
with kyphosis may limit activity, including bending and reaching. Multiple thoracic fractures
may result in restrictive lung disease, and lumbar fractures may alter abdominal anatomy,
leading to constipation, abdominal pain, distention, reduced appetite and premature satiety.
The majority of vertebral fractures are initially clinically silent; however, these fractures are
often associated with symptoms of pain, disability, deformity and mortality.5
 Vertebral
fractures, whether clinically apparent or silent, are major predictors of future fracture risk, up
to 5-fold for subsequent vertebral fracture and 2- to 3-fold for fractures at other sites. Wrist
fractures are less disabling but can interfere with some activities of daily living as much as hip
or vertebral fractures. Pelvic fractures and humerus fractures are also commom and contribute
to increased morbidity and mortality.