Women need to be educated on osteoporosis risk factors and treatment: Study

Columbia leads landmark international study of more than 60,000 women; highlights need for public education about osteoporosis risk factors and treatment

Underscoring what researchers call a serious global public health concern, results from a new study led by Columbia University Medical Center reveal that many women at an elevated level of risk for osteoporosis-associated fractures fail to perceive the implications of the risk factors.

"We found that many women aren't making the connection between their risk factors and the serious consequences of fractures," said the lead author Ethel Siris, M.D., director of the Toni Stabile Osteoporosis Center at NewYork-Presbyterian Hospital/Columbia University Medical Center, and the Madeline C. Stabile Professor of Clinical Medicine at Columbia University College of Physicians and Surgeons. "Without a clear understanding of their risks, women cannot begin to protect themselves from fracture."

This study, part of the Global Longitudinal Study of Osteoporosis in Women (GLOW), which is based at the Center for Outcomes Research at the University of Massachusetts Medical School, was published online by the journal Osteoporosis International on April 2, 2010. The study, conducted at 17 GLOW study sites worldwide, included more than 60,000 postmenopausal women in 10 countries in Europe, North America and Australia.

Results showed that among postmenopausal women diagnosed with osteoporosis - a condition associated with a high risk for fractures, as it causes bones to become fragile and more likely to break - only 43 percent thought their risk of a fracture was higher than other women their age. Additionally, only one in three (33 percent) women who reported two or more major risk factors for fracture, perceived themselves as being at higher risk for fracture than their age-matched peers.

Because many fractures can be prevented by appropriate treatment, it is important that elevated risk be recognized.

One in two women will suffer an osteoporosis-related fracture after age 50; these fractures often carry with them chronic pain, reduced mobility, loss of independence and in the case of hip fracture, an increased risk of death. Because the likelihood of fractures increases substantially with age, fracture numbers are projected to rise as the population ages. Osteoporosis-related fractures are an international public health problem; in addition to the human suffering associated with these fractures, they also are the source of enormous health-care costs.

Improved education of physicians and postmenopausal women about osteoporosis risk factors is urgently needed, according to the study authors. If left untreated, osteoporosis can progress painlessly until a fracture occurs. Several risk factors for fractures have been identified and should be considered by physicians treating women age 55 and older:

• older age
• low weight
• parental hip fracture
• personal history of fracture (clavicle, arm, wrist, spine, rib, hip, pelvis, upper leg, lower leg, ankle) since age 45
• two or more falls in the past year
• current use of cortisone or prednisone (steroids often prescribed for a number of medical conditions)
• rheumatoid arthritis
• cigarette smoking
• consumption of three or more alcoholic beverages daily

Other risk factors for fractures include a variety of medical conditions and medications. Tools for diagnosis and risk assessment, including bone-density testing and the World Health Organization FRAX fracture risk-assessment tool, are widely available; still, the connection between identified risk factors and serious fracture outcomes is not being made by a majority of women at highest risk.

"We hope the insight we obtain from GLOW will help physicians and patients work together to identify those at risk for fracture and to enhance understanding of the meaning of that risk," said Siris. "Education is critical if we are to reduce the burden of fractures worldwide."

GLOW is a prospective, international cohort study of women 55 years of age and older who visited their primary-care physician during the two years prior to enrollment in the study. More than 60,000 women were recruited by more than 700 primary-care physicians in 17 cities in 10 countries (Australia, Belgium, Canada, France, Germany, Italy, Netherlands, Spain, United Kingdom and the United States). GLOW is gathering information on osteoporosis risk factors, treatments, patient behaviors and fracture outcomes during a five-year period. Self-perceived risk of fracture was assessed using a five-point scale ranging from "much lower" to "much higher" risk than other women of the same age.

Of the 28,000 U.S. women participating in GLOW, 3,500 were from New York, enrolled at the Helen Hayes Hospital in West Haverstraw, an affiliate hospital of NewYork-Presbyterian Healthcare System. A quarter (25 percent) of these women reported an osteoporosis diagnosis, 23 percent had a previous fracture, 17 percent were low weight, 37 percent reported recent falls, and 20 percent a parental hip fracture. Despite the high prevalence of risk factors, only 36 percent of women with two or more major risk factors perceived themselves to be at higher risk of a fracture than their peers. This failure by women to appreciate their personal risk of fracture presents a barrier to them receiving appropriate management and safe and effective treatments.