Experts Predict Hip-Fracture Epidemic

Better nutrition, treatment now could prevent global crisis, they say

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By Ed Edelson
HealthDay Reporter

FRIDAY, June 16, 2006 (HealthDay News) -- The world faces an epidemic of hip fractures over the next few decades as more and more people's bones weaken from osteoporosis as they age.

So conclude researchers who estimate that at least 6.3 million people worldwide will suffer a hip fracture in the year 2050 -- more than triple the 1.7 million cases recorded in 1990.

The new projections assume that the current fracture incidence rate remains stable -- something that's not likely to happen, the researchers said.

Already, "fracture rates seem to be rising in many parts of the world," wrote researchers Drs. Philip Sambrook of Royal North Shore Hospital in Sydney, Australia, and Cyrus Cooper of the University of Southampton in England. "On the assumption that age-adjusted rates will rise by only 1 percent per year, the number of hip fractures worldwide could be as high as 8.2 million by 2050."

They report their findings in the June 17 issue of The Lancet.

The trend toward more fractures could be turned around, however, if doctors and the public take advantage of what's known about osteoporosis prevention.

One key preventive strategy: "We should be looking at the younger population to maximize calcium," said Dr. Joseph Fetto, associate professor of orthopedics at the New York University Hospital for Joint Diseases.

Osteoporosis is a degenerative weakening of bones, with bone strength largely determined by the body's store of calcium. According to Fetto, the research has shown that calcium content peaks relatively early in life -- in the 20s -- declining slowly but steadily as the decades go on.

"The maximum amount of calcium early in life is determined by intake in the diet," he said. Therefore, the predicted epidemic of hip fractures could be prevented if today's younger people get adequate amounts of calcium, magnesium, zinc and vitamin D in their diets, by supplements if necessary, Fetto said.

It would not be an expensive proposition, he said. "The World Health Organization has shown that it would cost about 30 cents a day to prevent osteoporosis," Fetto said.

In contrast, the cost of dealing with osteoporotic fractures is calculated in the billions of dollars, not pennies per day, the new study found. In 1997, the estimated worldwide costs of hip fractures topped $131.5 billion, the researchers estimated. "More recently, the combined annual costs of all osteoporotic fractures have been estimated to be $20 billion in the U.S.A. and about $30 billion in the European Union," they wrote.

Hospitalization accounts for some of those costs. Hip-replacement operations after fracture are costly. Between 250,000 and 300,000 hip-replacement surgeries are done each year in the United States, Fetto estimated, and about 1.5 million hip fractures are treated in this country annually.

Used properly, other available treatments could also help reduce those numbers, said Dr. Joseph M. Lane, professor of orthopedic surgery at the Hospital for Special Surgery in New York City.

Drugs such as Fosamax can help prevent bone loss, he said. "If people took those drugs, we could cut the anticipated rate by 50 percent, purely by following the medical recommendations," he said.

Money is one reason Americans don't take the necessary medications, Lane said. "In Canada, where medicine is free, the anticipated number of hip fractures has dropped," he said.

Doctors have learned another lesson about reducing the risk of major hip fractures, Lane said: Swift treatment of minor fractures can effectively cut the risk for a major break.

Right now, he said, medical groups such as the American Academy of Orthopaedic Surgeons are developing programs to ensure that small fractures are treated quickly. "The academy feels that a small fracture is a call to arms," Lane said.

More information

Find out more on osteoporosis at the American Academy of Orthopaedic Surgeons.

SOURCES: Joseph Fetto, M.D., associate professor of orthopedics, New York University Hospital for Joint Diseases, New York City; Joseph M. Lane, M.D., professor, orthopedic surgery, Hospital for Special Surgery, New York City; June 17, 2006, The Lancet

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