This site uses cookies to deliver our services and to show you relevant ads and presentations. By clicking on "Accept", you acknowledge that you have read and understand our Cookie Policy , Privacy Policy , and our Terms of Use.
X

Download International Osteoporosis Foundation and European PowerPoint Presentation


Login   OR  Register
X


Iframe embed code :



Presentation url :

X

Description :

View and free download International Osteoporosis Foundation and European powerpoint presentation which is uploaded by honey an active user in belonging ppt presentation Health & Wellness category.

Tags :

International Osteoporosis Foundation and European

Home / Health & Wellness / Health & Wellness Presentations / International Osteoporosis Foundation and European PowerPoint Presentation

International Osteoporosis Foundation and European PowerPoint Presentation

Ppt Presentation Embed Code   Zoom Ppt Presentation

About This Presentation


Description : View and free download International Osteoporosis Foundation and European powerpoint presentation wh... Read More

Tags : International Osteoporosis Foundation and European

Published on : Dec 06, 2013
Views : 396 | Downloads : 0


Download Now

Share on Social Media

             

PowerPoint is the world's most popular presentation software which can let you create professional International Osteoporosis Foundation and European powerpoint presentation easily and in no time. This helps you give your presentation on International Osteoporosis Foundation and European in a conference, a school lecture, a business proposal, in a webinar and business and professional representations.

The uploader spent his/her valuable time to create this International Osteoporosis Foundation and European powerpoint presentation slides, to share his/her useful content with the world. This ppt presentation uploaded by slidesfinder in this Health & Wellness category is available for free download,and can be used according to your industries like finance, marketing, education, health and many more.

SlidesFinder.com provides a platform to marketers, presenters and educationists along with being the preferred search engine for professional PowerPoint presentations on the Internet to upload their International Osteoporosis Foundation and European ppt presentation slides to help them BUILD THEIR CROWD!!

User Presentation
Related Presentation
Free PowerPoint Templates
Slide 1 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue
Slide 2 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures
Slide 3 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country
Slide 4 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org
Slide 5 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis
Slide 6 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM
Slide 7 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75
Slide 8 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999
Slide 9 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society
Slide 10 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285
Slide 11 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY
Slide 12 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231
Slide 13 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556
Slide 14 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85
Slide 15 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45
Slide 16 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE
Slide 17 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE Vertebral Fractures Substantially Increase the Risk of New Fragility Fractures Women with vertebral fractures have a 5-fold increased risk of a new vertebral fracture and a 2-fold increased risk of hip fracture Black et al., J Bone Miner Res 1999 Melton et al, Osteoporos Int 1999 One woman in five will suffer from another vertebral fracture within a year Lindsay et al., JAMA, 2001
Slide 18 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE Vertebral Fractures Substantially Increase the Risk of New Fragility Fractures Women with vertebral fractures have a 5-fold increased risk of a new vertebral fracture and a 2-fold increased risk of hip fracture Black et al., J Bone Miner Res 1999 Melton et al, Osteoporos Int 1999 One woman in five will suffer from another vertebral fracture within a year Lindsay et al., JAMA, 2001 Effect of Prior Vertebral Fracture on Risk of Subsequent Vertebral Fracture Adapted from Lindsay R et al., JAMA 2001, 285:320 First Year of Study 2725 postmenopausal women randomised to placebo Incidence of New Vertebral Fracture (%) No. of Vertebral Fractures at Baseline 0 1 1 2 0 5 10 RR=5.1 (3.1, 8.4) RR=2.6 (1.4, 4.9) 15 RR=7.3 (4.4, 12.3)
Slide 19 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE Vertebral Fractures Substantially Increase the Risk of New Fragility Fractures Women with vertebral fractures have a 5-fold increased risk of a new vertebral fracture and a 2-fold increased risk of hip fracture Black et al., J Bone Miner Res 1999 Melton et al, Osteoporos Int 1999 One woman in five will suffer from another vertebral fracture within a year Lindsay et al., JAMA, 2001 Effect of Prior Vertebral Fracture on Risk of Subsequent Vertebral Fracture Adapted from Lindsay R et al., JAMA 2001, 285:320 First Year of Study 2725 postmenopausal women randomised to placebo Incidence of New Vertebral Fracture (%) No. of Vertebral Fractures at Baseline 0 1 1 2 0 5 10 RR=5.1 (3.1, 8.4) RR=2.6 (1.4, 4.9) 15 RR=7.3 (4.4, 12.3) All Types of Vertebral Fractures are Associated With Morbidity Nevitt MC et al., Arch Intern Med.2000, 160:77 Limited Activity Bed Rest 0 25 50 75 100 Patients (%) No Incident Fracture Radiographic Fracture Clinical Fracture 36.8 3.9 76.2 26.9 93.2 52.7 Due to back pain
Slide 20 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE Vertebral Fractures Substantially Increase the Risk of New Fragility Fractures Women with vertebral fractures have a 5-fold increased risk of a new vertebral fracture and a 2-fold increased risk of hip fracture Black et al., J Bone Miner Res 1999 Melton et al, Osteoporos Int 1999 One woman in five will suffer from another vertebral fracture within a year Lindsay et al., JAMA, 2001 Effect of Prior Vertebral Fracture on Risk of Subsequent Vertebral Fracture Adapted from Lindsay R et al., JAMA 2001, 285:320 First Year of Study 2725 postmenopausal women randomised to placebo Incidence of New Vertebral Fracture (%) No. of Vertebral Fractures at Baseline 0 1 1 2 0 5 10 RR=5.1 (3.1, 8.4) RR=2.6 (1.4, 4.9) 15 RR=7.3 (4.4, 12.3) All Types of Vertebral Fractures are Associated With Morbidity Nevitt MC et al., Arch Intern Med.2000, 160:77 Limited Activity Bed Rest 0 25 50 75 100 Patients (%) No Incident Fracture Radiographic Fracture Clinical Fracture 36.8 3.9 76.2 26.9 93.2 52.7 Due to back pain Vertebral Fractures in Summary Are the most common osteoporotic fractures Are associated with excess mortality Are associated with significant morbidity, even if they do not come to clinical attention Increase the risk of subsequent vertebral fracture(s) by 5 fold and of other fragility fractures (including hip) by 2 fold
Slide 21 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE Vertebral Fractures Substantially Increase the Risk of New Fragility Fractures Women with vertebral fractures have a 5-fold increased risk of a new vertebral fracture and a 2-fold increased risk of hip fracture Black et al., J Bone Miner Res 1999 Melton et al, Osteoporos Int 1999 One woman in five will suffer from another vertebral fracture within a year Lindsay et al., JAMA, 2001 Effect of Prior Vertebral Fracture on Risk of Subsequent Vertebral Fracture Adapted from Lindsay R et al., JAMA 2001, 285:320 First Year of Study 2725 postmenopausal women randomised to placebo Incidence of New Vertebral Fracture (%) No. of Vertebral Fractures at Baseline 0 1 1 2 0 5 10 RR=5.1 (3.1, 8.4) RR=2.6 (1.4, 4.9) 15 RR=7.3 (4.4, 12.3) All Types of Vertebral Fractures are Associated With Morbidity Nevitt MC et al., Arch Intern Med.2000, 160:77 Limited Activity Bed Rest 0 25 50 75 100 Patients (%) No Incident Fracture Radiographic Fracture Clinical Fracture 36.8 3.9 76.2 26.9 93.2 52.7 Due to back pain Vertebral Fractures in Summary Are the most common osteoporotic fractures Are associated with excess mortality Are associated with significant morbidity, even if they do not come to clinical attention Increase the risk of subsequent vertebral fracture(s) by 5 fold and of other fragility fractures (including hip) by 2 fold COST OF OSTEOPOROSIS
Slide 22 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE Vertebral Fractures Substantially Increase the Risk of New Fragility Fractures Women with vertebral fractures have a 5-fold increased risk of a new vertebral fracture and a 2-fold increased risk of hip fracture Black et al., J Bone Miner Res 1999 Melton et al, Osteoporos Int 1999 One woman in five will suffer from another vertebral fracture within a year Lindsay et al., JAMA, 2001 Effect of Prior Vertebral Fracture on Risk of Subsequent Vertebral Fracture Adapted from Lindsay R et al., JAMA 2001, 285:320 First Year of Study 2725 postmenopausal women randomised to placebo Incidence of New Vertebral Fracture (%) No. of Vertebral Fractures at Baseline 0 1 1 2 0 5 10 RR=5.1 (3.1, 8.4) RR=2.6 (1.4, 4.9) 15 RR=7.3 (4.4, 12.3) All Types of Vertebral Fractures are Associated With Morbidity Nevitt MC et al., Arch Intern Med.2000, 160:77 Limited Activity Bed Rest 0 25 50 75 100 Patients (%) No Incident Fracture Radiographic Fracture Clinical Fracture 36.8 3.9 76.2 26.9 93.2 52.7 Due to back pain Vertebral Fractures in Summary Are the most common osteoporotic fractures Are associated with excess mortality Are associated with significant morbidity, even if they do not come to clinical attention Increase the risk of subsequent vertebral fracture(s) by 5 fold and of other fragility fractures (including hip) by 2 fold COST OF OSTEOPOROSIS Some Costs of Osteoporosis in Europe In Europe the total direct costs of osteoporotic fractures are over €31 billion and are expected to increase to more that €76 billion in 2050. Kanis JA & Johnell O. - Osteoporos Int 2005 (in press) In France osteoporotic hip fractures are estimated to cost about €1 billion every year* In Spain the total direct hospital cost of osteoporotic fractures in 1995 was approximately €222 million* In England & Wales the total direct hospital cost of osteoporotic fractures in 1999 was approximately €847 million* *Osteoporosis in the European Community: A Call to Action. IOF Nov, 2001
Slide 23 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE Vertebral Fractures Substantially Increase the Risk of New Fragility Fractures Women with vertebral fractures have a 5-fold increased risk of a new vertebral fracture and a 2-fold increased risk of hip fracture Black et al., J Bone Miner Res 1999 Melton et al, Osteoporos Int 1999 One woman in five will suffer from another vertebral fracture within a year Lindsay et al., JAMA, 2001 Effect of Prior Vertebral Fracture on Risk of Subsequent Vertebral Fracture Adapted from Lindsay R et al., JAMA 2001, 285:320 First Year of Study 2725 postmenopausal women randomised to placebo Incidence of New Vertebral Fracture (%) No. of Vertebral Fractures at Baseline 0 1 1 2 0 5 10 RR=5.1 (3.1, 8.4) RR=2.6 (1.4, 4.9) 15 RR=7.3 (4.4, 12.3) All Types of Vertebral Fractures are Associated With Morbidity Nevitt MC et al., Arch Intern Med.2000, 160:77 Limited Activity Bed Rest 0 25 50 75 100 Patients (%) No Incident Fracture Radiographic Fracture Clinical Fracture 36.8 3.9 76.2 26.9 93.2 52.7 Due to back pain Vertebral Fractures in Summary Are the most common osteoporotic fractures Are associated with excess mortality Are associated with significant morbidity, even if they do not come to clinical attention Increase the risk of subsequent vertebral fracture(s) by 5 fold and of other fragility fractures (including hip) by 2 fold COST OF OSTEOPOROSIS Some Costs of Osteoporosis in Europe In Europe the total direct costs of osteoporotic fractures are over €31 billion and are expected to increase to more that €76 billion in 2050. Kanis JA & Johnell O. - Osteoporos Int 2005 (in press) In France osteoporotic hip fractures are estimated to cost about €1 billion every year* In Spain the total direct hospital cost of osteoporotic fractures in 1995 was approximately €222 million* In England & Wales the total direct hospital cost of osteoporotic fractures in 1999 was approximately €847 million* *Osteoporosis in the European Community: A Call to Action. IOF Nov, 2001 Osteoporosis Results in More Disability & Direct Hospital Cost Than Many Other Diseases 8% of vertebral fractures are hospitalised and 2% require long-term nursing care Ross et al., Am Journal of Medicine 1997, 103(2A):30S – 42S Annual cost of acute hospitalisation in Switzerland in 1992: 600 million Swiss francs (US$350 million) Lippuner et al., Osteoporosis Int 1997, 7:414-25 – Number of bed days (men & women) 891,000 for COPD 701,000 for osteoporosis 533,000 for stroke 328,000 for myocardial infarction 201,000 for breast cancer Osteoporosis # 1 when looking at women only
Slide 24 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE Vertebral Fractures Substantially Increase the Risk of New Fragility Fractures Women with vertebral fractures have a 5-fold increased risk of a new vertebral fracture and a 2-fold increased risk of hip fracture Black et al., J Bone Miner Res 1999 Melton et al, Osteoporos Int 1999 One woman in five will suffer from another vertebral fracture within a year Lindsay et al., JAMA, 2001 Effect of Prior Vertebral Fracture on Risk of Subsequent Vertebral Fracture Adapted from Lindsay R et al., JAMA 2001, 285:320 First Year of Study 2725 postmenopausal women randomised to placebo Incidence of New Vertebral Fracture (%) No. of Vertebral Fractures at Baseline 0 1 1 2 0 5 10 RR=5.1 (3.1, 8.4) RR=2.6 (1.4, 4.9) 15 RR=7.3 (4.4, 12.3) All Types of Vertebral Fractures are Associated With Morbidity Nevitt MC et al., Arch Intern Med.2000, 160:77 Limited Activity Bed Rest 0 25 50 75 100 Patients (%) No Incident Fracture Radiographic Fracture Clinical Fracture 36.8 3.9 76.2 26.9 93.2 52.7 Due to back pain Vertebral Fractures in Summary Are the most common osteoporotic fractures Are associated with excess mortality Are associated with significant morbidity, even if they do not come to clinical attention Increase the risk of subsequent vertebral fracture(s) by 5 fold and of other fragility fractures (including hip) by 2 fold COST OF OSTEOPOROSIS Some Costs of Osteoporosis in Europe In Europe the total direct costs of osteoporotic fractures are over €31 billion and are expected to increase to more that €76 billion in 2050. Kanis JA & Johnell O. - Osteoporos Int 2005 (in press) In France osteoporotic hip fractures are estimated to cost about €1 billion every year* In Spain the total direct hospital cost of osteoporotic fractures in 1995 was approximately €222 million* In England & Wales the total direct hospital cost of osteoporotic fractures in 1999 was approximately €847 million* *Osteoporosis in the European Community: A Call to Action. IOF Nov, 2001 Osteoporosis Results in More Disability & Direct Hospital Cost Than Many Other Diseases 8% of vertebral fractures are hospitalised and 2% require long-term nursing care Ross et al., Am Journal of Medicine 1997, 103(2A):30S – 42S Annual cost of acute hospitalisation in Switzerland in 1992: 600 million Swiss francs (US$350 million) Lippuner et al., Osteoporosis Int 1997, 7:414-25 – Number of bed days (men & women) 891,000 for COPD 701,000 for osteoporosis 533,000 for stroke 328,000 for myocardial infarction 201,000 for breast cancer Osteoporosis # 1 when looking at women only UNDER-DIAGNOSIS OF VERTEBRAL FRACTURES: WHAT IS THE SIZE OF THE PROBLEM?
Slide 25 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE Vertebral Fractures Substantially Increase the Risk of New Fragility Fractures Women with vertebral fractures have a 5-fold increased risk of a new vertebral fracture and a 2-fold increased risk of hip fracture Black et al., J Bone Miner Res 1999 Melton et al, Osteoporos Int 1999 One woman in five will suffer from another vertebral fracture within a year Lindsay et al., JAMA, 2001 Effect of Prior Vertebral Fracture on Risk of Subsequent Vertebral Fracture Adapted from Lindsay R et al., JAMA 2001, 285:320 First Year of Study 2725 postmenopausal women randomised to placebo Incidence of New Vertebral Fracture (%) No. of Vertebral Fractures at Baseline 0 1 1 2 0 5 10 RR=5.1 (3.1, 8.4) RR=2.6 (1.4, 4.9) 15 RR=7.3 (4.4, 12.3) All Types of Vertebral Fractures are Associated With Morbidity Nevitt MC et al., Arch Intern Med.2000, 160:77 Limited Activity Bed Rest 0 25 50 75 100 Patients (%) No Incident Fracture Radiographic Fracture Clinical Fracture 36.8 3.9 76.2 26.9 93.2 52.7 Due to back pain Vertebral Fractures in Summary Are the most common osteoporotic fractures Are associated with excess mortality Are associated with significant morbidity, even if they do not come to clinical attention Increase the risk of subsequent vertebral fracture(s) by 5 fold and of other fragility fractures (including hip) by 2 fold COST OF OSTEOPOROSIS Some Costs of Osteoporosis in Europe In Europe the total direct costs of osteoporotic fractures are over €31 billion and are expected to increase to more that €76 billion in 2050. Kanis JA & Johnell O. - Osteoporos Int 2005 (in press) In France osteoporotic hip fractures are estimated to cost about €1 billion every year* In Spain the total direct hospital cost of osteoporotic fractures in 1995 was approximately €222 million* In England & Wales the total direct hospital cost of osteoporotic fractures in 1999 was approximately €847 million* *Osteoporosis in the European Community: A Call to Action. IOF Nov, 2001 Osteoporosis Results in More Disability & Direct Hospital Cost Than Many Other Diseases 8% of vertebral fractures are hospitalised and 2% require long-term nursing care Ross et al., Am Journal of Medicine 1997, 103(2A):30S – 42S Annual cost of acute hospitalisation in Switzerland in 1992: 600 million Swiss francs (US$350 million) Lippuner et al., Osteoporosis Int 1997, 7:414-25 – Number of bed days (men & women) 891,000 for COPD 701,000 for osteoporosis 533,000 for stroke 328,000 for myocardial infarction 201,000 for breast cancer Osteoporosis # 1 when looking at women only UNDER-DIAGNOSIS OF VERTEBRAL FRACTURES: WHAT IS THE SIZE OF THE PROBLEM? A Retrospective Study Suggests that Vertebral Fractures are Under-Diagnosed Gehlbach et al.,Osteoporos Int 2000, 11:577 934 hospitalised women with a lateral chest x-ray 0 20 40 60 80 100 120 140 Patients (n) 132 65 23 25 Fracture identified by study radiologists Fracture noted in radiology report Fracture noted in medical record Received osteoporosis treatment
Slide 26 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE Vertebral Fractures Substantially Increase the Risk of New Fragility Fractures Women with vertebral fractures have a 5-fold increased risk of a new vertebral fracture and a 2-fold increased risk of hip fracture Black et al., J Bone Miner Res 1999 Melton et al, Osteoporos Int 1999 One woman in five will suffer from another vertebral fracture within a year Lindsay et al., JAMA, 2001 Effect of Prior Vertebral Fracture on Risk of Subsequent Vertebral Fracture Adapted from Lindsay R et al., JAMA 2001, 285:320 First Year of Study 2725 postmenopausal women randomised to placebo Incidence of New Vertebral Fracture (%) No. of Vertebral Fractures at Baseline 0 1 1 2 0 5 10 RR=5.1 (3.1, 8.4) RR=2.6 (1.4, 4.9) 15 RR=7.3 (4.4, 12.3) All Types of Vertebral Fractures are Associated With Morbidity Nevitt MC et al., Arch Intern Med.2000, 160:77 Limited Activity Bed Rest 0 25 50 75 100 Patients (%) No Incident Fracture Radiographic Fracture Clinical Fracture 36.8 3.9 76.2 26.9 93.2 52.7 Due to back pain Vertebral Fractures in Summary Are the most common osteoporotic fractures Are associated with excess mortality Are associated with significant morbidity, even if they do not come to clinical attention Increase the risk of subsequent vertebral fracture(s) by 5 fold and of other fragility fractures (including hip) by 2 fold COST OF OSTEOPOROSIS Some Costs of Osteoporosis in Europe In Europe the total direct costs of osteoporotic fractures are over €31 billion and are expected to increase to more that €76 billion in 2050. Kanis JA & Johnell O. - Osteoporos Int 2005 (in press) In France osteoporotic hip fractures are estimated to cost about €1 billion every year* In Spain the total direct hospital cost of osteoporotic fractures in 1995 was approximately €222 million* In England & Wales the total direct hospital cost of osteoporotic fractures in 1999 was approximately €847 million* *Osteoporosis in the European Community: A Call to Action. IOF Nov, 2001 Osteoporosis Results in More Disability & Direct Hospital Cost Than Many Other Diseases 8% of vertebral fractures are hospitalised and 2% require long-term nursing care Ross et al., Am Journal of Medicine 1997, 103(2A):30S – 42S Annual cost of acute hospitalisation in Switzerland in 1992: 600 million Swiss francs (US$350 million) Lippuner et al., Osteoporosis Int 1997, 7:414-25 – Number of bed days (men & women) 891,000 for COPD 701,000 for osteoporosis 533,000 for stroke 328,000 for myocardial infarction 201,000 for breast cancer Osteoporosis # 1 when looking at women only UNDER-DIAGNOSIS OF VERTEBRAL FRACTURES: WHAT IS THE SIZE OF THE PROBLEM? A Retrospective Study Suggests that Vertebral Fractures are Under-Diagnosed Gehlbach et al.,Osteoporos Int 2000, 11:577 934 hospitalised women with a lateral chest x-ray 0 20 40 60 80 100 120 140 Patients (n) 132 65 23 25 Fracture identified by study radiologists Fracture noted in radiology report Fracture noted in medical record Received osteoporosis treatment A Large Prospective Study Demonstrates Under-Diagnosis of Vertebral Fractures is a Worldwide Problem Vertebral fractures were markedly under-diagnosed in radiology reports in a multicenter, multinational study population of osteoporotic women (n=2451) in which 789 (32%) women had 1 vertebral fracture at baseline. Adjudicated discrepancies (n=350) between local and central readings due to undetected vertebral fracture (68%) or equivocal terminology in the local radiology report (32%) yielded a false-negative rate of 34%. Under-diagnosis of vertebral fractures was observed in all geographic regions (false-negative rates: North America 45.2%, Latin America 46.5%, Europe/South Africa/Australia 29.5%). The false-positive rate was 5% globally. Under-diagnosis of vertebral fracture is a worldwide problem attributable in part to a lack of radiographic detection or use of ambiguous terminology in the radiology report, or both. Delmas et al., J Bone Miner Res 2005, in press.
Slide 27 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE Vertebral Fractures Substantially Increase the Risk of New Fragility Fractures Women with vertebral fractures have a 5-fold increased risk of a new vertebral fracture and a 2-fold increased risk of hip fracture Black et al., J Bone Miner Res 1999 Melton et al, Osteoporos Int 1999 One woman in five will suffer from another vertebral fracture within a year Lindsay et al., JAMA, 2001 Effect of Prior Vertebral Fracture on Risk of Subsequent Vertebral Fracture Adapted from Lindsay R et al., JAMA 2001, 285:320 First Year of Study 2725 postmenopausal women randomised to placebo Incidence of New Vertebral Fracture (%) No. of Vertebral Fractures at Baseline 0 1 1 2 0 5 10 RR=5.1 (3.1, 8.4) RR=2.6 (1.4, 4.9) 15 RR=7.3 (4.4, 12.3) All Types of Vertebral Fractures are Associated With Morbidity Nevitt MC et al., Arch Intern Med.2000, 160:77 Limited Activity Bed Rest 0 25 50 75 100 Patients (%) No Incident Fracture Radiographic Fracture Clinical Fracture 36.8 3.9 76.2 26.9 93.2 52.7 Due to back pain Vertebral Fractures in Summary Are the most common osteoporotic fractures Are associated with excess mortality Are associated with significant morbidity, even if they do not come to clinical attention Increase the risk of subsequent vertebral fracture(s) by 5 fold and of other fragility fractures (including hip) by 2 fold COST OF OSTEOPOROSIS Some Costs of Osteoporosis in Europe In Europe the total direct costs of osteoporotic fractures are over €31 billion and are expected to increase to more that €76 billion in 2050. Kanis JA & Johnell O. - Osteoporos Int 2005 (in press) In France osteoporotic hip fractures are estimated to cost about €1 billion every year* In Spain the total direct hospital cost of osteoporotic fractures in 1995 was approximately €222 million* In England & Wales the total direct hospital cost of osteoporotic fractures in 1999 was approximately €847 million* *Osteoporosis in the European Community: A Call to Action. IOF Nov, 2001 Osteoporosis Results in More Disability & Direct Hospital Cost Than Many Other Diseases 8% of vertebral fractures are hospitalised and 2% require long-term nursing care Ross et al., Am Journal of Medicine 1997, 103(2A):30S – 42S Annual cost of acute hospitalisation in Switzerland in 1992: 600 million Swiss francs (US$350 million) Lippuner et al., Osteoporosis Int 1997, 7:414-25 – Number of bed days (men & women) 891,000 for COPD 701,000 for osteoporosis 533,000 for stroke 328,000 for myocardial infarction 201,000 for breast cancer Osteoporosis # 1 when looking at women only UNDER-DIAGNOSIS OF VERTEBRAL FRACTURES: WHAT IS THE SIZE OF THE PROBLEM? A Retrospective Study Suggests that Vertebral Fractures are Under-Diagnosed Gehlbach et al.,Osteoporos Int 2000, 11:577 934 hospitalised women with a lateral chest x-ray 0 20 40 60 80 100 120 140 Patients (n) 132 65 23 25 Fracture identified by study radiologists Fracture noted in radiology report Fracture noted in medical record Received osteoporosis treatment A Large Prospective Study Demonstrates Under-Diagnosis of Vertebral Fractures is a Worldwide Problem Vertebral fractures were markedly under-diagnosed in radiology reports in a multicenter, multinational study population of osteoporotic women (n=2451) in which 789 (32%) women had 1 vertebral fracture at baseline. Adjudicated discrepancies (n=350) between local and central readings due to undetected vertebral fracture (68%) or equivocal terminology in the local radiology report (32%) yielded a false-negative rate of 34%. Under-diagnosis of vertebral fractures was observed in all geographic regions (false-negative rates: North America 45.2%, Latin America 46.5%, Europe/South Africa/Australia 29.5%). The false-positive rate was 5% globally. Under-diagnosis of vertebral fracture is a worldwide problem attributable in part to a lack of radiographic detection or use of ambiguous terminology in the radiology report, or both. Delmas et al., J Bone Miner Res 2005, in press. Awareness & Treatment of Vertebral Fractures in Europe is Low Despite… Known disability associated with all fractures Excess mortality associated with vertebral and hip fractures €31 billion total direct hospital costs in Europe A validated radiographic diagnosis technique Effective and safe treatments Evidence based guidelines for diagnosis and management
Slide 28 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE Vertebral Fractures Substantially Increase the Risk of New Fragility Fractures Women with vertebral fractures have a 5-fold increased risk of a new vertebral fracture and a 2-fold increased risk of hip fracture Black et al., J Bone Miner Res 1999 Melton et al, Osteoporos Int 1999 One woman in five will suffer from another vertebral fracture within a year Lindsay et al., JAMA, 2001 Effect of Prior Vertebral Fracture on Risk of Subsequent Vertebral Fracture Adapted from Lindsay R et al., JAMA 2001, 285:320 First Year of Study 2725 postmenopausal women randomised to placebo Incidence of New Vertebral Fracture (%) No. of Vertebral Fractures at Baseline 0 1 1 2 0 5 10 RR=5.1 (3.1, 8.4) RR=2.6 (1.4, 4.9) 15 RR=7.3 (4.4, 12.3) All Types of Vertebral Fractures are Associated With Morbidity Nevitt MC et al., Arch Intern Med.2000, 160:77 Limited Activity Bed Rest 0 25 50 75 100 Patients (%) No Incident Fracture Radiographic Fracture Clinical Fracture 36.8 3.9 76.2 26.9 93.2 52.7 Due to back pain Vertebral Fractures in Summary Are the most common osteoporotic fractures Are associated with excess mortality Are associated with significant morbidity, even if they do not come to clinical attention Increase the risk of subsequent vertebral fracture(s) by 5 fold and of other fragility fractures (including hip) by 2 fold COST OF OSTEOPOROSIS Some Costs of Osteoporosis in Europe In Europe the total direct costs of osteoporotic fractures are over €31 billion and are expected to increase to more that €76 billion in 2050. Kanis JA & Johnell O. - Osteoporos Int 2005 (in press) In France osteoporotic hip fractures are estimated to cost about €1 billion every year* In Spain the total direct hospital cost of osteoporotic fractures in 1995 was approximately €222 million* In England & Wales the total direct hospital cost of osteoporotic fractures in 1999 was approximately €847 million* *Osteoporosis in the European Community: A Call to Action. IOF Nov, 2001 Osteoporosis Results in More Disability & Direct Hospital Cost Than Many Other Diseases 8% of vertebral fractures are hospitalised and 2% require long-term nursing care Ross et al., Am Journal of Medicine 1997, 103(2A):30S – 42S Annual cost of acute hospitalisation in Switzerland in 1992: 600 million Swiss francs (US$350 million) Lippuner et al., Osteoporosis Int 1997, 7:414-25 – Number of bed days (men & women) 891,000 for COPD 701,000 for osteoporosis 533,000 for stroke 328,000 for myocardial infarction 201,000 for breast cancer Osteoporosis # 1 when looking at women only UNDER-DIAGNOSIS OF VERTEBRAL FRACTURES: WHAT IS THE SIZE OF THE PROBLEM? A Retrospective Study Suggests that Vertebral Fractures are Under-Diagnosed Gehlbach et al.,Osteoporos Int 2000, 11:577 934 hospitalised women with a lateral chest x-ray 0 20 40 60 80 100 120 140 Patients (n) 132 65 23 25 Fracture identified by study radiologists Fracture noted in radiology report Fracture noted in medical record Received osteoporosis treatment A Large Prospective Study Demonstrates Under-Diagnosis of Vertebral Fractures is a Worldwide Problem Vertebral fractures were markedly under-diagnosed in radiology reports in a multicenter, multinational study population of osteoporotic women (n=2451) in which 789 (32%) women had 1 vertebral fracture at baseline. Adjudicated discrepancies (n=350) between local and central readings due to undetected vertebral fracture (68%) or equivocal terminology in the local radiology report (32%) yielded a false-negative rate of 34%. Under-diagnosis of vertebral fractures was observed in all geographic regions (false-negative rates: North America 45.2%, Latin America 46.5%, Europe/South Africa/Australia 29.5%). The false-positive rate was 5% globally. Under-diagnosis of vertebral fracture is a worldwide problem attributable in part to a lack of radiographic detection or use of ambiguous terminology in the radiology report, or both. Delmas et al., J Bone Miner Res 2005, in press. Awareness & Treatment of Vertebral Fractures in Europe is Low Despite… Known disability associated with all fractures Excess mortality associated with vertebral and hip fractures €31 billion total direct hospital costs in Europe A validated radiographic diagnosis technique Effective and safe treatments Evidence based guidelines for diagnosis and management Effective therapies are widely available and can reduce vertebral, hip and other fractures by 30% to 65%.
Slide 29 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE Vertebral Fractures Substantially Increase the Risk of New Fragility Fractures Women with vertebral fractures have a 5-fold increased risk of a new vertebral fracture and a 2-fold increased risk of hip fracture Black et al., J Bone Miner Res 1999 Melton et al, Osteoporos Int 1999 One woman in five will suffer from another vertebral fracture within a year Lindsay et al., JAMA, 2001 Effect of Prior Vertebral Fracture on Risk of Subsequent Vertebral Fracture Adapted from Lindsay R et al., JAMA 2001, 285:320 First Year of Study 2725 postmenopausal women randomised to placebo Incidence of New Vertebral Fracture (%) No. of Vertebral Fractures at Baseline 0 1 1 2 0 5 10 RR=5.1 (3.1, 8.4) RR=2.6 (1.4, 4.9) 15 RR=7.3 (4.4, 12.3) All Types of Vertebral Fractures are Associated With Morbidity Nevitt MC et al., Arch Intern Med.2000, 160:77 Limited Activity Bed Rest 0 25 50 75 100 Patients (%) No Incident Fracture Radiographic Fracture Clinical Fracture 36.8 3.9 76.2 26.9 93.2 52.7 Due to back pain Vertebral Fractures in Summary Are the most common osteoporotic fractures Are associated with excess mortality Are associated with significant morbidity, even if they do not come to clinical attention Increase the risk of subsequent vertebral fracture(s) by 5 fold and of other fragility fractures (including hip) by 2 fold COST OF OSTEOPOROSIS Some Costs of Osteoporosis in Europe In Europe the total direct costs of osteoporotic fractures are over €31 billion and are expected to increase to more that €76 billion in 2050. Kanis JA & Johnell O. - Osteoporos Int 2005 (in press) In France osteoporotic hip fractures are estimated to cost about €1 billion every year* In Spain the total direct hospital cost of osteoporotic fractures in 1995 was approximately €222 million* In England & Wales the total direct hospital cost of osteoporotic fractures in 1999 was approximately €847 million* *Osteoporosis in the European Community: A Call to Action. IOF Nov, 2001 Osteoporosis Results in More Disability & Direct Hospital Cost Than Many Other Diseases 8% of vertebral fractures are hospitalised and 2% require long-term nursing care Ross et al., Am Journal of Medicine 1997, 103(2A):30S – 42S Annual cost of acute hospitalisation in Switzerland in 1992: 600 million Swiss francs (US$350 million) Lippuner et al., Osteoporosis Int 1997, 7:414-25 – Number of bed days (men & women) 891,000 for COPD 701,000 for osteoporosis 533,000 for stroke 328,000 for myocardial infarction 201,000 for breast cancer Osteoporosis # 1 when looking at women only UNDER-DIAGNOSIS OF VERTEBRAL FRACTURES: WHAT IS THE SIZE OF THE PROBLEM? A Retrospective Study Suggests that Vertebral Fractures are Under-Diagnosed Gehlbach et al.,Osteoporos Int 2000, 11:577 934 hospitalised women with a lateral chest x-ray 0 20 40 60 80 100 120 140 Patients (n) 132 65 23 25 Fracture identified by study radiologists Fracture noted in radiology report Fracture noted in medical record Received osteoporosis treatment A Large Prospective Study Demonstrates Under-Diagnosis of Vertebral Fractures is a Worldwide Problem Vertebral fractures were markedly under-diagnosed in radiology reports in a multicenter, multinational study population of osteoporotic women (n=2451) in which 789 (32%) women had 1 vertebral fracture at baseline. Adjudicated discrepancies (n=350) between local and central readings due to undetected vertebral fracture (68%) or equivocal terminology in the local radiology report (32%) yielded a false-negative rate of 34%. Under-diagnosis of vertebral fractures was observed in all geographic regions (false-negative rates: North America 45.2%, Latin America 46.5%, Europe/South Africa/Australia 29.5%). The false-positive rate was 5% globally. Under-diagnosis of vertebral fracture is a worldwide problem attributable in part to a lack of radiographic detection or use of ambiguous terminology in the radiology report, or both. Delmas et al., J Bone Miner Res 2005, in press. Awareness & Treatment of Vertebral Fractures in Europe is Low Despite… Known disability associated with all fractures Excess mortality associated with vertebral and hip fractures €31 billion total direct hospital costs in Europe A validated radiographic diagnosis technique Effective and safe treatments Evidence based guidelines for diagnosis and management Effective therapies are widely available and can reduce vertebral, hip and other fractures by 30% to 65%. Updated from Delmas, Lancet 2002 Antifracture Efficacy of Antiosteoporotic Agents Incident vertebral fractures - Relative risk RR ± 95% CI RLX 60 (MORE)* RLX 60 (MORE)** ALN 5/10 (FIT1)* ALN 5/10 (FIT2)** RIS 5 (VERT - NA)* RIS 5 (VERT - MN)* CT 200 (PROOF)* Teriparatide 20µg Strontium ranelate (SOTI)* Strontium ranelate (SOTI + TROPOS)** 0.2 0.6 1.0 * with prev vert fracture(s) ** without prev vert fractures 0.8 0.4
Slide 30 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE Vertebral Fractures Substantially Increase the Risk of New Fragility Fractures Women with vertebral fractures have a 5-fold increased risk of a new vertebral fracture and a 2-fold increased risk of hip fracture Black et al., J Bone Miner Res 1999 Melton et al, Osteoporos Int 1999 One woman in five will suffer from another vertebral fracture within a year Lindsay et al., JAMA, 2001 Effect of Prior Vertebral Fracture on Risk of Subsequent Vertebral Fracture Adapted from Lindsay R et al., JAMA 2001, 285:320 First Year of Study 2725 postmenopausal women randomised to placebo Incidence of New Vertebral Fracture (%) No. of Vertebral Fractures at Baseline 0 1 1 2 0 5 10 RR=5.1 (3.1, 8.4) RR=2.6 (1.4, 4.9) 15 RR=7.3 (4.4, 12.3) All Types of Vertebral Fractures are Associated With Morbidity Nevitt MC et al., Arch Intern Med.2000, 160:77 Limited Activity Bed Rest 0 25 50 75 100 Patients (%) No Incident Fracture Radiographic Fracture Clinical Fracture 36.8 3.9 76.2 26.9 93.2 52.7 Due to back pain Vertebral Fractures in Summary Are the most common osteoporotic fractures Are associated with excess mortality Are associated with significant morbidity, even if they do not come to clinical attention Increase the risk of subsequent vertebral fracture(s) by 5 fold and of other fragility fractures (including hip) by 2 fold COST OF OSTEOPOROSIS Some Costs of Osteoporosis in Europe In Europe the total direct costs of osteoporotic fractures are over €31 billion and are expected to increase to more that €76 billion in 2050. Kanis JA & Johnell O. - Osteoporos Int 2005 (in press) In France osteoporotic hip fractures are estimated to cost about €1 billion every year* In Spain the total direct hospital cost of osteoporotic fractures in 1995 was approximately €222 million* In England & Wales the total direct hospital cost of osteoporotic fractures in 1999 was approximately €847 million* *Osteoporosis in the European Community: A Call to Action. IOF Nov, 2001 Osteoporosis Results in More Disability & Direct Hospital Cost Than Many Other Diseases 8% of vertebral fractures are hospitalised and 2% require long-term nursing care Ross et al., Am Journal of Medicine 1997, 103(2A):30S – 42S Annual cost of acute hospitalisation in Switzerland in 1992: 600 million Swiss francs (US$350 million) Lippuner et al., Osteoporosis Int 1997, 7:414-25 – Number of bed days (men & women) 891,000 for COPD 701,000 for osteoporosis 533,000 for stroke 328,000 for myocardial infarction 201,000 for breast cancer Osteoporosis # 1 when looking at women only UNDER-DIAGNOSIS OF VERTEBRAL FRACTURES: WHAT IS THE SIZE OF THE PROBLEM? A Retrospective Study Suggests that Vertebral Fractures are Under-Diagnosed Gehlbach et al.,Osteoporos Int 2000, 11:577 934 hospitalised women with a lateral chest x-ray 0 20 40 60 80 100 120 140 Patients (n) 132 65 23 25 Fracture identified by study radiologists Fracture noted in radiology report Fracture noted in medical record Received osteoporosis treatment A Large Prospective Study Demonstrates Under-Diagnosis of Vertebral Fractures is a Worldwide Problem Vertebral fractures were markedly under-diagnosed in radiology reports in a multicenter, multinational study population of osteoporotic women (n=2451) in which 789 (32%) women had 1 vertebral fracture at baseline. Adjudicated discrepancies (n=350) between local and central readings due to undetected vertebral fracture (68%) or equivocal terminology in the local radiology report (32%) yielded a false-negative rate of 34%. Under-diagnosis of vertebral fractures was observed in all geographic regions (false-negative rates: North America 45.2%, Latin America 46.5%, Europe/South Africa/Australia 29.5%). The false-positive rate was 5% globally. Under-diagnosis of vertebral fracture is a worldwide problem attributable in part to a lack of radiographic detection or use of ambiguous terminology in the radiology report, or both. Delmas et al., J Bone Miner Res 2005, in press. Awareness & Treatment of Vertebral Fractures in Europe is Low Despite… Known disability associated with all fractures Excess mortality associated with vertebral and hip fractures €31 billion total direct hospital costs in Europe A validated radiographic diagnosis technique Effective and safe treatments Evidence based guidelines for diagnosis and management Effective therapies are widely available and can reduce vertebral, hip and other fractures by 30% to 65%. Updated from Delmas, Lancet 2002 Antifracture Efficacy of Antiosteoporotic Agents Incident vertebral fractures - Relative risk RR ± 95% CI RLX 60 (MORE)* RLX 60 (MORE)** ALN 5/10 (FIT1)* ALN 5/10 (FIT2)** RIS 5 (VERT - NA)* RIS 5 (VERT - MN)* CT 200 (PROOF)* Teriparatide 20µg Strontium ranelate (SOTI)* Strontium ranelate (SOTI + TROPOS)** 0.2 0.6 1.0 * with prev vert fracture(s) ** without prev vert fractures 0.8 0.4 RECOGNITION & REPORTING OF VERTEBRAL FRACTURES
Slide 31 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE Vertebral Fractures Substantially Increase the Risk of New Fragility Fractures Women with vertebral fractures have a 5-fold increased risk of a new vertebral fracture and a 2-fold increased risk of hip fracture Black et al., J Bone Miner Res 1999 Melton et al, Osteoporos Int 1999 One woman in five will suffer from another vertebral fracture within a year Lindsay et al., JAMA, 2001 Effect of Prior Vertebral Fracture on Risk of Subsequent Vertebral Fracture Adapted from Lindsay R et al., JAMA 2001, 285:320 First Year of Study 2725 postmenopausal women randomised to placebo Incidence of New Vertebral Fracture (%) No. of Vertebral Fractures at Baseline 0 1 1 2 0 5 10 RR=5.1 (3.1, 8.4) RR=2.6 (1.4, 4.9) 15 RR=7.3 (4.4, 12.3) All Types of Vertebral Fractures are Associated With Morbidity Nevitt MC et al., Arch Intern Med.2000, 160:77 Limited Activity Bed Rest 0 25 50 75 100 Patients (%) No Incident Fracture Radiographic Fracture Clinical Fracture 36.8 3.9 76.2 26.9 93.2 52.7 Due to back pain Vertebral Fractures in Summary Are the most common osteoporotic fractures Are associated with excess mortality Are associated with significant morbidity, even if they do not come to clinical attention Increase the risk of subsequent vertebral fracture(s) by 5 fold and of other fragility fractures (including hip) by 2 fold COST OF OSTEOPOROSIS Some Costs of Osteoporosis in Europe In Europe the total direct costs of osteoporotic fractures are over €31 billion and are expected to increase to more that €76 billion in 2050. Kanis JA & Johnell O. - Osteoporos Int 2005 (in press) In France osteoporotic hip fractures are estimated to cost about €1 billion every year* In Spain the total direct hospital cost of osteoporotic fractures in 1995 was approximately €222 million* In England & Wales the total direct hospital cost of osteoporotic fractures in 1999 was approximately €847 million* *Osteoporosis in the European Community: A Call to Action. IOF Nov, 2001 Osteoporosis Results in More Disability & Direct Hospital Cost Than Many Other Diseases 8% of vertebral fractures are hospitalised and 2% require long-term nursing care Ross et al., Am Journal of Medicine 1997, 103(2A):30S – 42S Annual cost of acute hospitalisation in Switzerland in 1992: 600 million Swiss francs (US$350 million) Lippuner et al., Osteoporosis Int 1997, 7:414-25 – Number of bed days (men & women) 891,000 for COPD 701,000 for osteoporosis 533,000 for stroke 328,000 for myocardial infarction 201,000 for breast cancer Osteoporosis # 1 when looking at women only UNDER-DIAGNOSIS OF VERTEBRAL FRACTURES: WHAT IS THE SIZE OF THE PROBLEM? A Retrospective Study Suggests that Vertebral Fractures are Under-Diagnosed Gehlbach et al.,Osteoporos Int 2000, 11:577 934 hospitalised women with a lateral chest x-ray 0 20 40 60 80 100 120 140 Patients (n) 132 65 23 25 Fracture identified by study radiologists Fracture noted in radiology report Fracture noted in medical record Received osteoporosis treatment A Large Prospective Study Demonstrates Under-Diagnosis of Vertebral Fractures is a Worldwide Problem Vertebral fractures were markedly under-diagnosed in radiology reports in a multicenter, multinational study population of osteoporotic women (n=2451) in which 789 (32%) women had 1 vertebral fracture at baseline. Adjudicated discrepancies (n=350) between local and central readings due to undetected vertebral fracture (68%) or equivocal terminology in the local radiology report (32%) yielded a false-negative rate of 34%. Under-diagnosis of vertebral fractures was observed in all geographic regions (false-negative rates: North America 45.2%, Latin America 46.5%, Europe/South Africa/Australia 29.5%). The false-positive rate was 5% globally. Under-diagnosis of vertebral fracture is a worldwide problem attributable in part to a lack of radiographic detection or use of ambiguous terminology in the radiology report, or both. Delmas et al., J Bone Miner Res 2005, in press. Awareness & Treatment of Vertebral Fractures in Europe is Low Despite… Known disability associated with all fractures Excess mortality associated with vertebral and hip fractures €31 billion total direct hospital costs in Europe A validated radiographic diagnosis technique Effective and safe treatments Evidence based guidelines for diagnosis and management Effective therapies are widely available and can reduce vertebral, hip and other fractures by 30% to 65%. Updated from Delmas, Lancet 2002 Antifracture Efficacy of Antiosteoporotic Agents Incident vertebral fractures - Relative risk RR ± 95% CI RLX 60 (MORE)* RLX 60 (MORE)** ALN 5/10 (FIT1)* ALN 5/10 (FIT2)** RIS 5 (VERT - NA)* RIS 5 (VERT - MN)* CT 200 (PROOF)* Teriparatide 20µg Strontium ranelate (SOTI)* Strontium ranelate (SOTI + TROPOS)** 0.2 0.6 1.0 * with prev vert fracture(s) ** without prev vert fractures 0.8 0.4 RECOGNITION & REPORTING OF VERTEBRAL FRACTURES Vertebral Fractures Semi-quantitative reading / visual scoring Genant et al., J Bone Miner Res 1993, 8:137
Slide 32 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE Vertebral Fractures Substantially Increase the Risk of New Fragility Fractures Women with vertebral fractures have a 5-fold increased risk of a new vertebral fracture and a 2-fold increased risk of hip fracture Black et al., J Bone Miner Res 1999 Melton et al, Osteoporos Int 1999 One woman in five will suffer from another vertebral fracture within a year Lindsay et al., JAMA, 2001 Effect of Prior Vertebral Fracture on Risk of Subsequent Vertebral Fracture Adapted from Lindsay R et al., JAMA 2001, 285:320 First Year of Study 2725 postmenopausal women randomised to placebo Incidence of New Vertebral Fracture (%) No. of Vertebral Fractures at Baseline 0 1 1 2 0 5 10 RR=5.1 (3.1, 8.4) RR=2.6 (1.4, 4.9) 15 RR=7.3 (4.4, 12.3) All Types of Vertebral Fractures are Associated With Morbidity Nevitt MC et al., Arch Intern Med.2000, 160:77 Limited Activity Bed Rest 0 25 50 75 100 Patients (%) No Incident Fracture Radiographic Fracture Clinical Fracture 36.8 3.9 76.2 26.9 93.2 52.7 Due to back pain Vertebral Fractures in Summary Are the most common osteoporotic fractures Are associated with excess mortality Are associated with significant morbidity, even if they do not come to clinical attention Increase the risk of subsequent vertebral fracture(s) by 5 fold and of other fragility fractures (including hip) by 2 fold COST OF OSTEOPOROSIS Some Costs of Osteoporosis in Europe In Europe the total direct costs of osteoporotic fractures are over €31 billion and are expected to increase to more that €76 billion in 2050. Kanis JA & Johnell O. - Osteoporos Int 2005 (in press) In France osteoporotic hip fractures are estimated to cost about €1 billion every year* In Spain the total direct hospital cost of osteoporotic fractures in 1995 was approximately €222 million* In England & Wales the total direct hospital cost of osteoporotic fractures in 1999 was approximately €847 million* *Osteoporosis in the European Community: A Call to Action. IOF Nov, 2001 Osteoporosis Results in More Disability & Direct Hospital Cost Than Many Other Diseases 8% of vertebral fractures are hospitalised and 2% require long-term nursing care Ross et al., Am Journal of Medicine 1997, 103(2A):30S – 42S Annual cost of acute hospitalisation in Switzerland in 1992: 600 million Swiss francs (US$350 million) Lippuner et al., Osteoporosis Int 1997, 7:414-25 – Number of bed days (men & women) 891,000 for COPD 701,000 for osteoporosis 533,000 for stroke 328,000 for myocardial infarction 201,000 for breast cancer Osteoporosis # 1 when looking at women only UNDER-DIAGNOSIS OF VERTEBRAL FRACTURES: WHAT IS THE SIZE OF THE PROBLEM? A Retrospective Study Suggests that Vertebral Fractures are Under-Diagnosed Gehlbach et al.,Osteoporos Int 2000, 11:577 934 hospitalised women with a lateral chest x-ray 0 20 40 60 80 100 120 140 Patients (n) 132 65 23 25 Fracture identified by study radiologists Fracture noted in radiology report Fracture noted in medical record Received osteoporosis treatment A Large Prospective Study Demonstrates Under-Diagnosis of Vertebral Fractures is a Worldwide Problem Vertebral fractures were markedly under-diagnosed in radiology reports in a multicenter, multinational study population of osteoporotic women (n=2451) in which 789 (32%) women had 1 vertebral fracture at baseline. Adjudicated discrepancies (n=350) between local and central readings due to undetected vertebral fracture (68%) or equivocal terminology in the local radiology report (32%) yielded a false-negative rate of 34%. Under-diagnosis of vertebral fractures was observed in all geographic regions (false-negative rates: North America 45.2%, Latin America 46.5%, Europe/South Africa/Australia 29.5%). The false-positive rate was 5% globally. Under-diagnosis of vertebral fracture is a worldwide problem attributable in part to a lack of radiographic detection or use of ambiguous terminology in the radiology report, or both. Delmas et al., J Bone Miner Res 2005, in press. Awareness & Treatment of Vertebral Fractures in Europe is Low Despite… Known disability associated with all fractures Excess mortality associated with vertebral and hip fractures €31 billion total direct hospital costs in Europe A validated radiographic diagnosis technique Effective and safe treatments Evidence based guidelines for diagnosis and management Effective therapies are widely available and can reduce vertebral, hip and other fractures by 30% to 65%. Updated from Delmas, Lancet 2002 Antifracture Efficacy of Antiosteoporotic Agents Incident vertebral fractures - Relative risk RR ± 95% CI RLX 60 (MORE)* RLX 60 (MORE)** ALN 5/10 (FIT1)* ALN 5/10 (FIT2)** RIS 5 (VERT - NA)* RIS 5 (VERT - MN)* CT 200 (PROOF)* Teriparatide 20µg Strontium ranelate (SOTI)* Strontium ranelate (SOTI + TROPOS)** 0.2 0.6 1.0 * with prev vert fracture(s) ** without prev vert fractures 0.8 0.4 RECOGNITION & REPORTING OF VERTEBRAL FRACTURES Vertebral Fractures Semi-quantitative reading / visual scoring Genant et al., J Bone Miner Res 1993, 8:137 SQ Mild FX SQ Severe FX 1 1 3 3
Slide 33 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE Vertebral Fractures Substantially Increase the Risk of New Fragility Fractures Women with vertebral fractures have a 5-fold increased risk of a new vertebral fracture and a 2-fold increased risk of hip fracture Black et al., J Bone Miner Res 1999 Melton et al, Osteoporos Int 1999 One woman in five will suffer from another vertebral fracture within a year Lindsay et al., JAMA, 2001 Effect of Prior Vertebral Fracture on Risk of Subsequent Vertebral Fracture Adapted from Lindsay R et al., JAMA 2001, 285:320 First Year of Study 2725 postmenopausal women randomised to placebo Incidence of New Vertebral Fracture (%) No. of Vertebral Fractures at Baseline 0 1 1 2 0 5 10 RR=5.1 (3.1, 8.4) RR=2.6 (1.4, 4.9) 15 RR=7.3 (4.4, 12.3) All Types of Vertebral Fractures are Associated With Morbidity Nevitt MC et al., Arch Intern Med.2000, 160:77 Limited Activity Bed Rest 0 25 50 75 100 Patients (%) No Incident Fracture Radiographic Fracture Clinical Fracture 36.8 3.9 76.2 26.9 93.2 52.7 Due to back pain Vertebral Fractures in Summary Are the most common osteoporotic fractures Are associated with excess mortality Are associated with significant morbidity, even if they do not come to clinical attention Increase the risk of subsequent vertebral fracture(s) by 5 fold and of other fragility fractures (including hip) by 2 fold COST OF OSTEOPOROSIS Some Costs of Osteoporosis in Europe In Europe the total direct costs of osteoporotic fractures are over €31 billion and are expected to increase to more that €76 billion in 2050. Kanis JA & Johnell O. - Osteoporos Int 2005 (in press) In France osteoporotic hip fractures are estimated to cost about €1 billion every year* In Spain the total direct hospital cost of osteoporotic fractures in 1995 was approximately €222 million* In England & Wales the total direct hospital cost of osteoporotic fractures in 1999 was approximately €847 million* *Osteoporosis in the European Community: A Call to Action. IOF Nov, 2001 Osteoporosis Results in More Disability & Direct Hospital Cost Than Many Other Diseases 8% of vertebral fractures are hospitalised and 2% require long-term nursing care Ross et al., Am Journal of Medicine 1997, 103(2A):30S – 42S Annual cost of acute hospitalisation in Switzerland in 1992: 600 million Swiss francs (US$350 million) Lippuner et al., Osteoporosis Int 1997, 7:414-25 – Number of bed days (men & women) 891,000 for COPD 701,000 for osteoporosis 533,000 for stroke 328,000 for myocardial infarction 201,000 for breast cancer Osteoporosis # 1 when looking at women only UNDER-DIAGNOSIS OF VERTEBRAL FRACTURES: WHAT IS THE SIZE OF THE PROBLEM? A Retrospective Study Suggests that Vertebral Fractures are Under-Diagnosed Gehlbach et al.,Osteoporos Int 2000, 11:577 934 hospitalised women with a lateral chest x-ray 0 20 40 60 80 100 120 140 Patients (n) 132 65 23 25 Fracture identified by study radiologists Fracture noted in radiology report Fracture noted in medical record Received osteoporosis treatment A Large Prospective Study Demonstrates Under-Diagnosis of Vertebral Fractures is a Worldwide Problem Vertebral fractures were markedly under-diagnosed in radiology reports in a multicenter, multinational study population of osteoporotic women (n=2451) in which 789 (32%) women had 1 vertebral fracture at baseline. Adjudicated discrepancies (n=350) between local and central readings due to undetected vertebral fracture (68%) or equivocal terminology in the local radiology report (32%) yielded a false-negative rate of 34%. Under-diagnosis of vertebral fractures was observed in all geographic regions (false-negative rates: North America 45.2%, Latin America 46.5%, Europe/South Africa/Australia 29.5%). The false-positive rate was 5% globally. Under-diagnosis of vertebral fracture is a worldwide problem attributable in part to a lack of radiographic detection or use of ambiguous terminology in the radiology report, or both. Delmas et al., J Bone Miner Res 2005, in press. Awareness & Treatment of Vertebral Fractures in Europe is Low Despite… Known disability associated with all fractures Excess mortality associated with vertebral and hip fractures €31 billion total direct hospital costs in Europe A validated radiographic diagnosis technique Effective and safe treatments Evidence based guidelines for diagnosis and management Effective therapies are widely available and can reduce vertebral, hip and other fractures by 30% to 65%. Updated from Delmas, Lancet 2002 Antifracture Efficacy of Antiosteoporotic Agents Incident vertebral fractures - Relative risk RR ± 95% CI RLX 60 (MORE)* RLX 60 (MORE)** ALN 5/10 (FIT1)* ALN 5/10 (FIT2)** RIS 5 (VERT - NA)* RIS 5 (VERT - MN)* CT 200 (PROOF)* Teriparatide 20µg Strontium ranelate (SOTI)* Strontium ranelate (SOTI + TROPOS)** 0.2 0.6 1.0 * with prev vert fracture(s) ** without prev vert fractures 0.8 0.4 RECOGNITION & REPORTING OF VERTEBRAL FRACTURES Vertebral Fractures Semi-quantitative reading / visual scoring Genant et al., J Bone Miner Res 1993, 8:137 SQ Mild FX SQ Severe FX 1 1 3 3 Single Energy Fan-beam DXA Imaging a Potential Alternative to Conventional Radiographs Single energy imaging Fast (10 sec) scanning / breath hold Simple visual evaluation Low dose (1/100 of radiographs) Available at point of care
Slide 34 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE Vertebral Fractures Substantially Increase the Risk of New Fragility Fractures Women with vertebral fractures have a 5-fold increased risk of a new vertebral fracture and a 2-fold increased risk of hip fracture Black et al., J Bone Miner Res 1999 Melton et al, Osteoporos Int 1999 One woman in five will suffer from another vertebral fracture within a year Lindsay et al., JAMA, 2001 Effect of Prior Vertebral Fracture on Risk of Subsequent Vertebral Fracture Adapted from Lindsay R et al., JAMA 2001, 285:320 First Year of Study 2725 postmenopausal women randomised to placebo Incidence of New Vertebral Fracture (%) No. of Vertebral Fractures at Baseline 0 1 1 2 0 5 10 RR=5.1 (3.1, 8.4) RR=2.6 (1.4, 4.9) 15 RR=7.3 (4.4, 12.3) All Types of Vertebral Fractures are Associated With Morbidity Nevitt MC et al., Arch Intern Med.2000, 160:77 Limited Activity Bed Rest 0 25 50 75 100 Patients (%) No Incident Fracture Radiographic Fracture Clinical Fracture 36.8 3.9 76.2 26.9 93.2 52.7 Due to back pain Vertebral Fractures in Summary Are the most common osteoporotic fractures Are associated with excess mortality Are associated with significant morbidity, even if they do not come to clinical attention Increase the risk of subsequent vertebral fracture(s) by 5 fold and of other fragility fractures (including hip) by 2 fold COST OF OSTEOPOROSIS Some Costs of Osteoporosis in Europe In Europe the total direct costs of osteoporotic fractures are over €31 billion and are expected to increase to more that €76 billion in 2050. Kanis JA & Johnell O. - Osteoporos Int 2005 (in press) In France osteoporotic hip fractures are estimated to cost about €1 billion every year* In Spain the total direct hospital cost of osteoporotic fractures in 1995 was approximately €222 million* In England & Wales the total direct hospital cost of osteoporotic fractures in 1999 was approximately €847 million* *Osteoporosis in the European Community: A Call to Action. IOF Nov, 2001 Osteoporosis Results in More Disability & Direct Hospital Cost Than Many Other Diseases 8% of vertebral fractures are hospitalised and 2% require long-term nursing care Ross et al., Am Journal of Medicine 1997, 103(2A):30S – 42S Annual cost of acute hospitalisation in Switzerland in 1992: 600 million Swiss francs (US$350 million) Lippuner et al., Osteoporosis Int 1997, 7:414-25 – Number of bed days (men & women) 891,000 for COPD 701,000 for osteoporosis 533,000 for stroke 328,000 for myocardial infarction 201,000 for breast cancer Osteoporosis # 1 when looking at women only UNDER-DIAGNOSIS OF VERTEBRAL FRACTURES: WHAT IS THE SIZE OF THE PROBLEM? A Retrospective Study Suggests that Vertebral Fractures are Under-Diagnosed Gehlbach et al.,Osteoporos Int 2000, 11:577 934 hospitalised women with a lateral chest x-ray 0 20 40 60 80 100 120 140 Patients (n) 132 65 23 25 Fracture identified by study radiologists Fracture noted in radiology report Fracture noted in medical record Received osteoporosis treatment A Large Prospective Study Demonstrates Under-Diagnosis of Vertebral Fractures is a Worldwide Problem Vertebral fractures were markedly under-diagnosed in radiology reports in a multicenter, multinational study population of osteoporotic women (n=2451) in which 789 (32%) women had 1 vertebral fracture at baseline. Adjudicated discrepancies (n=350) between local and central readings due to undetected vertebral fracture (68%) or equivocal terminology in the local radiology report (32%) yielded a false-negative rate of 34%. Under-diagnosis of vertebral fractures was observed in all geographic regions (false-negative rates: North America 45.2%, Latin America 46.5%, Europe/South Africa/Australia 29.5%). The false-positive rate was 5% globally. Under-diagnosis of vertebral fracture is a worldwide problem attributable in part to a lack of radiographic detection or use of ambiguous terminology in the radiology report, or both. Delmas et al., J Bone Miner Res 2005, in press. Awareness & Treatment of Vertebral Fractures in Europe is Low Despite… Known disability associated with all fractures Excess mortality associated with vertebral and hip fractures €31 billion total direct hospital costs in Europe A validated radiographic diagnosis technique Effective and safe treatments Evidence based guidelines for diagnosis and management Effective therapies are widely available and can reduce vertebral, hip and other fractures by 30% to 65%. Updated from Delmas, Lancet 2002 Antifracture Efficacy of Antiosteoporotic Agents Incident vertebral fractures - Relative risk RR ± 95% CI RLX 60 (MORE)* RLX 60 (MORE)** ALN 5/10 (FIT1)* ALN 5/10 (FIT2)** RIS 5 (VERT - NA)* RIS 5 (VERT - MN)* CT 200 (PROOF)* Teriparatide 20µg Strontium ranelate (SOTI)* Strontium ranelate (SOTI + TROPOS)** 0.2 0.6 1.0 * with prev vert fracture(s) ** without prev vert fractures 0.8 0.4 RECOGNITION & REPORTING OF VERTEBRAL FRACTURES Vertebral Fractures Semi-quantitative reading / visual scoring Genant et al., J Bone Miner Res 1993, 8:137 SQ Mild FX SQ Severe FX 1 1 3 3 Single Energy Fan-beam DXA Imaging a Potential Alternative to Conventional Radiographs Single energy imaging Fast (10 sec) scanning / breath hold Simple visual evaluation Low dose (1/100 of radiographs) Available at point of care Lateral Vertebral Assessment: …Point-of-Care tools
Slide 35 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE Vertebral Fractures Substantially Increase the Risk of New Fragility Fractures Women with vertebral fractures have a 5-fold increased risk of a new vertebral fracture and a 2-fold increased risk of hip fracture Black et al., J Bone Miner Res 1999 Melton et al, Osteoporos Int 1999 One woman in five will suffer from another vertebral fracture within a year Lindsay et al., JAMA, 2001 Effect of Prior Vertebral Fracture on Risk of Subsequent Vertebral Fracture Adapted from Lindsay R et al., JAMA 2001, 285:320 First Year of Study 2725 postmenopausal women randomised to placebo Incidence of New Vertebral Fracture (%) No. of Vertebral Fractures at Baseline 0 1 1 2 0 5 10 RR=5.1 (3.1, 8.4) RR=2.6 (1.4, 4.9) 15 RR=7.3 (4.4, 12.3) All Types of Vertebral Fractures are Associated With Morbidity Nevitt MC et al., Arch Intern Med.2000, 160:77 Limited Activity Bed Rest 0 25 50 75 100 Patients (%) No Incident Fracture Radiographic Fracture Clinical Fracture 36.8 3.9 76.2 26.9 93.2 52.7 Due to back pain Vertebral Fractures in Summary Are the most common osteoporotic fractures Are associated with excess mortality Are associated with significant morbidity, even if they do not come to clinical attention Increase the risk of subsequent vertebral fracture(s) by 5 fold and of other fragility fractures (including hip) by 2 fold COST OF OSTEOPOROSIS Some Costs of Osteoporosis in Europe In Europe the total direct costs of osteoporotic fractures are over €31 billion and are expected to increase to more that €76 billion in 2050. Kanis JA & Johnell O. - Osteoporos Int 2005 (in press) In France osteoporotic hip fractures are estimated to cost about €1 billion every year* In Spain the total direct hospital cost of osteoporotic fractures in 1995 was approximately €222 million* In England & Wales the total direct hospital cost of osteoporotic fractures in 1999 was approximately €847 million* *Osteoporosis in the European Community: A Call to Action. IOF Nov, 2001 Osteoporosis Results in More Disability & Direct Hospital Cost Than Many Other Diseases 8% of vertebral fractures are hospitalised and 2% require long-term nursing care Ross et al., Am Journal of Medicine 1997, 103(2A):30S – 42S Annual cost of acute hospitalisation in Switzerland in 1992: 600 million Swiss francs (US$350 million) Lippuner et al., Osteoporosis Int 1997, 7:414-25 – Number of bed days (men & women) 891,000 for COPD 701,000 for osteoporosis 533,000 for stroke 328,000 for myocardial infarction 201,000 for breast cancer Osteoporosis # 1 when looking at women only UNDER-DIAGNOSIS OF VERTEBRAL FRACTURES: WHAT IS THE SIZE OF THE PROBLEM? A Retrospective Study Suggests that Vertebral Fractures are Under-Diagnosed Gehlbach et al.,Osteoporos Int 2000, 11:577 934 hospitalised women with a lateral chest x-ray 0 20 40 60 80 100 120 140 Patients (n) 132 65 23 25 Fracture identified by study radiologists Fracture noted in radiology report Fracture noted in medical record Received osteoporosis treatment A Large Prospective Study Demonstrates Under-Diagnosis of Vertebral Fractures is a Worldwide Problem Vertebral fractures were markedly under-diagnosed in radiology reports in a multicenter, multinational study population of osteoporotic women (n=2451) in which 789 (32%) women had 1 vertebral fracture at baseline. Adjudicated discrepancies (n=350) between local and central readings due to undetected vertebral fracture (68%) or equivocal terminology in the local radiology report (32%) yielded a false-negative rate of 34%. Under-diagnosis of vertebral fractures was observed in all geographic regions (false-negative rates: North America 45.2%, Latin America 46.5%, Europe/South Africa/Australia 29.5%). The false-positive rate was 5% globally. Under-diagnosis of vertebral fracture is a worldwide problem attributable in part to a lack of radiographic detection or use of ambiguous terminology in the radiology report, or both. Delmas et al., J Bone Miner Res 2005, in press. Awareness & Treatment of Vertebral Fractures in Europe is Low Despite… Known disability associated with all fractures Excess mortality associated with vertebral and hip fractures €31 billion total direct hospital costs in Europe A validated radiographic diagnosis technique Effective and safe treatments Evidence based guidelines for diagnosis and management Effective therapies are widely available and can reduce vertebral, hip and other fractures by 30% to 65%. Updated from Delmas, Lancet 2002 Antifracture Efficacy of Antiosteoporotic Agents Incident vertebral fractures - Relative risk RR ± 95% CI RLX 60 (MORE)* RLX 60 (MORE)** ALN 5/10 (FIT1)* ALN 5/10 (FIT2)** RIS 5 (VERT - NA)* RIS 5 (VERT - MN)* CT 200 (PROOF)* Teriparatide 20µg Strontium ranelate (SOTI)* Strontium ranelate (SOTI + TROPOS)** 0.2 0.6 1.0 * with prev vert fracture(s) ** without prev vert fractures 0.8 0.4 RECOGNITION & REPORTING OF VERTEBRAL FRACTURES Vertebral Fractures Semi-quantitative reading / visual scoring Genant et al., J Bone Miner Res 1993, 8:137 SQ Mild FX SQ Severe FX 1 1 3 3 Single Energy Fan-beam DXA Imaging a Potential Alternative to Conventional Radiographs Single energy imaging Fast (10 sec) scanning / breath hold Simple visual evaluation Low dose (1/100 of radiographs) Available at point of care Lateral Vertebral Assessment: …Point-of-Care tools Combining BMD & Vertebral Fracture Assessment: A New Approach to Improve the Diagnosis Rate of Vertebral Fractures Improve risk assessment Identify many (~30%) of “missed” fractures Improve targeting of therapy May improve patient understanding, acceptance and compliance
Slide 36 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE Vertebral Fractures Substantially Increase the Risk of New Fragility Fractures Women with vertebral fractures have a 5-fold increased risk of a new vertebral fracture and a 2-fold increased risk of hip fracture Black et al., J Bone Miner Res 1999 Melton et al, Osteoporos Int 1999 One woman in five will suffer from another vertebral fracture within a year Lindsay et al., JAMA, 2001 Effect of Prior Vertebral Fracture on Risk of Subsequent Vertebral Fracture Adapted from Lindsay R et al., JAMA 2001, 285:320 First Year of Study 2725 postmenopausal women randomised to placebo Incidence of New Vertebral Fracture (%) No. of Vertebral Fractures at Baseline 0 1 1 2 0 5 10 RR=5.1 (3.1, 8.4) RR=2.6 (1.4, 4.9) 15 RR=7.3 (4.4, 12.3) All Types of Vertebral Fractures are Associated With Morbidity Nevitt MC et al., Arch Intern Med.2000, 160:77 Limited Activity Bed Rest 0 25 50 75 100 Patients (%) No Incident Fracture Radiographic Fracture Clinical Fracture 36.8 3.9 76.2 26.9 93.2 52.7 Due to back pain Vertebral Fractures in Summary Are the most common osteoporotic fractures Are associated with excess mortality Are associated with significant morbidity, even if they do not come to clinical attention Increase the risk of subsequent vertebral fracture(s) by 5 fold and of other fragility fractures (including hip) by 2 fold COST OF OSTEOPOROSIS Some Costs of Osteoporosis in Europe In Europe the total direct costs of osteoporotic fractures are over €31 billion and are expected to increase to more that €76 billion in 2050. Kanis JA & Johnell O. - Osteoporos Int 2005 (in press) In France osteoporotic hip fractures are estimated to cost about €1 billion every year* In Spain the total direct hospital cost of osteoporotic fractures in 1995 was approximately €222 million* In England & Wales the total direct hospital cost of osteoporotic fractures in 1999 was approximately €847 million* *Osteoporosis in the European Community: A Call to Action. IOF Nov, 2001 Osteoporosis Results in More Disability & Direct Hospital Cost Than Many Other Diseases 8% of vertebral fractures are hospitalised and 2% require long-term nursing care Ross et al., Am Journal of Medicine 1997, 103(2A):30S – 42S Annual cost of acute hospitalisation in Switzerland in 1992: 600 million Swiss francs (US$350 million) Lippuner et al., Osteoporosis Int 1997, 7:414-25 – Number of bed days (men & women) 891,000 for COPD 701,000 for osteoporosis 533,000 for stroke 328,000 for myocardial infarction 201,000 for breast cancer Osteoporosis # 1 when looking at women only UNDER-DIAGNOSIS OF VERTEBRAL FRACTURES: WHAT IS THE SIZE OF THE PROBLEM? A Retrospective Study Suggests that Vertebral Fractures are Under-Diagnosed Gehlbach et al.,Osteoporos Int 2000, 11:577 934 hospitalised women with a lateral chest x-ray 0 20 40 60 80 100 120 140 Patients (n) 132 65 23 25 Fracture identified by study radiologists Fracture noted in radiology report Fracture noted in medical record Received osteoporosis treatment A Large Prospective Study Demonstrates Under-Diagnosis of Vertebral Fractures is a Worldwide Problem Vertebral fractures were markedly under-diagnosed in radiology reports in a multicenter, multinational study population of osteoporotic women (n=2451) in which 789 (32%) women had 1 vertebral fracture at baseline. Adjudicated discrepancies (n=350) between local and central readings due to undetected vertebral fracture (68%) or equivocal terminology in the local radiology report (32%) yielded a false-negative rate of 34%. Under-diagnosis of vertebral fractures was observed in all geographic regions (false-negative rates: North America 45.2%, Latin America 46.5%, Europe/South Africa/Australia 29.5%). The false-positive rate was 5% globally. Under-diagnosis of vertebral fracture is a worldwide problem attributable in part to a lack of radiographic detection or use of ambiguous terminology in the radiology report, or both. Delmas et al., J Bone Miner Res 2005, in press. Awareness & Treatment of Vertebral Fractures in Europe is Low Despite… Known disability associated with all fractures Excess mortality associated with vertebral and hip fractures €31 billion total direct hospital costs in Europe A validated radiographic diagnosis technique Effective and safe treatments Evidence based guidelines for diagnosis and management Effective therapies are widely available and can reduce vertebral, hip and other fractures by 30% to 65%. Updated from Delmas, Lancet 2002 Antifracture Efficacy of Antiosteoporotic Agents Incident vertebral fractures - Relative risk RR ± 95% CI RLX 60 (MORE)* RLX 60 (MORE)** ALN 5/10 (FIT1)* ALN 5/10 (FIT2)** RIS 5 (VERT - NA)* RIS 5 (VERT - MN)* CT 200 (PROOF)* Teriparatide 20µg Strontium ranelate (SOTI)* Strontium ranelate (SOTI + TROPOS)** 0.2 0.6 1.0 * with prev vert fracture(s) ** without prev vert fractures 0.8 0.4 RECOGNITION & REPORTING OF VERTEBRAL FRACTURES Vertebral Fractures Semi-quantitative reading / visual scoring Genant et al., J Bone Miner Res 1993, 8:137 SQ Mild FX SQ Severe FX 1 1 3 3 Single Energy Fan-beam DXA Imaging a Potential Alternative to Conventional Radiographs Single energy imaging Fast (10 sec) scanning / breath hold Simple visual evaluation Low dose (1/100 of radiographs) Available at point of care Lateral Vertebral Assessment: …Point-of-Care tools Combining BMD & Vertebral Fracture Assessment: A New Approach to Improve the Diagnosis Rate of Vertebral Fractures Improve risk assessment Identify many (~30%) of “missed” fractures Improve targeting of therapy May improve patient understanding, acceptance and compliance Conclusions Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures – Effective therapies are widely available and can reduce vertebral, hip and other fragility fractures by 30% to 65%.
Slide 37 - International Osteoporosis Foundation & European Society of Musculoskeletal Radiology VERTEBRAL FRACTURE INITIATIVE Slide Kit Part 1: Osteoporosis and Related Fractures: An Under-diagnosed and Under-treated Public Health Issue Why is the Vertebral Fracture Initiative needed? Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures What is the Vertebral Fracture Initiative? An educational initiative to improve recognition and reporting of vertebral fractures: Pilot phase in five European countries Teaching Faculty Initiative Leaders: Harry K. Genant & Pierre D. Delmas France: Jean-Denis Larédo & Pierre D. Delmas Germany: Helmut Minne & Michael Jergas / Dieter Felsenberg Italy: Silvano Adami & Giuseppe Guglielmi Spain: Jorge Cannata & Francisco Aparisi UK: David Reid & Judith Adams A clinician and radiologist team taking the lead in each country What does the Vertebral Fracture Initiative include? 1. Presentations at radiology conferences 2. Articles in radiology & related publications 3. A resource document and a slide kit including: Part 1. Osteoporosis and Related Fractures: An Under-diagnosed and Under-Treated Public Health Issue Part 2. Recognition and Reporting of Vertebral Fractures 4. Summary handout 5. Interactive teaching programme on CD-ROM Teaching tools available from: www.osteofound.org Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. World Health Organization (WHO) , 1994 Normal bone Osteoporosis OSTEOPOROSIS: THE SIZE OF THE PROBLEM Osteoporosis is a Prevalent Disease Affects 200 million women worldwide1 - 1/3 of women aged 60 to 70 - 2/3 of women aged 80 or older Approximately 20-25% of women over the age of 50 have one or more vertebral fractures2 - United States: 25%3 - Australia: 20%4 - Western Europe: 19%5 - Scandinavia: 26%5 - Denmark: 21%6 1. International Osteoporosis Foundation 4. Jones G et al., Osteoporos Int 1996, 6:233 2. Melton LJ 3rd et al., Spine 1997, 22:2S 5. O'Neill et al., J Bone Miner Res 1996, 11:1010 3. Ettinger B et al., J Bone Miner Res 1992,7:449 6. Jensen GF et al., Clin Orthop 1982,166:75 Incidence Rates for Vertebral, Wrist & Hip Fractures in Women after Age 50 Wasnich RD, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th edition, 1999 Osteoporotic Fractures in Women: Comparison with Other Diseases Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society Projected Burden of Osteoporotic Hip Fractures Worldwide Total no. hip fractures 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C., Melton LJ, Osteoporos Int 1992, 2:285 OSTEOPOROSIS: MORTALITY & MORBIDITY Hip Fracture vs. Stroke Mortality: Death Rates per 100,000 in Older Women Hip Fracture Stroke Sweden 177 154 Denmark 154 180 Germany 131 190 Hip fracture data: age 80; Kanis JA, J Bone Miner Res 2002, 17:1237 Stroke data: ages 65-74; Sans et al., Eur Heart J 1997, 18:1231 Relative Risk of Death Following Clinical Fractures Fracture Intervention Trial (FIT)* *6459 postmenopausal women ages 55-81 years followed for an average of 3.8 years Any Symptomatic Age-Adjusted Relative Risk (95% CI) 0 1 2 5 16 Non-spine Other Forearm Spine Hip 10 6.7 8.6 Cauley JA et al., Osteoporos Int 2000, 11:556 Cumulative Survival Probability Center JR et al., Lancet 1999, 353:878 Age MEN Survival probability 0.2 0.4 0.6 0.8 0 1.0 60 65 70 75 80 85 Dubbo Population Vertebral/Major Fractures Proximal Femur Fractures Age WOMEN Survival probability 1.0 0 0.2 0.4 0.6 0.8 60 65 70 75 80 85 Mortality Rates by Number of Prevalent Vertebral Fractures Kado DM et al., Arch Intern Med 1999,159:1215 P for trend < 0.001 Mortality (per 1000 person-years) 0 5 10 15 20 25 30 35 40 0 1 2 3 4 5+ Number of Vertebral Fractures 45 Clinical Consequences Kyphosis Loss of height Bulging abdomen Acute and chronic pain Breathing difficulties, reflux and other GI symptoms Depression REDUCED QUALITY OF LIFE Vertebral Fractures Substantially Increase the Risk of New Fragility Fractures Women with vertebral fractures have a 5-fold increased risk of a new vertebral fracture and a 2-fold increased risk of hip fracture Black et al., J Bone Miner Res 1999 Melton et al, Osteoporos Int 1999 One woman in five will suffer from another vertebral fracture within a year Lindsay et al., JAMA, 2001 Effect of Prior Vertebral Fracture on Risk of Subsequent Vertebral Fracture Adapted from Lindsay R et al., JAMA 2001, 285:320 First Year of Study 2725 postmenopausal women randomised to placebo Incidence of New Vertebral Fracture (%) No. of Vertebral Fractures at Baseline 0 1 1 2 0 5 10 RR=5.1 (3.1, 8.4) RR=2.6 (1.4, 4.9) 15 RR=7.3 (4.4, 12.3) All Types of Vertebral Fractures are Associated With Morbidity Nevitt MC et al., Arch Intern Med.2000, 160:77 Limited Activity Bed Rest 0 25 50 75 100 Patients (%) No Incident Fracture Radiographic Fracture Clinical Fracture 36.8 3.9 76.2 26.9 93.2 52.7 Due to back pain Vertebral Fractures in Summary Are the most common osteoporotic fractures Are associated with excess mortality Are associated with significant morbidity, even if they do not come to clinical attention Increase the risk of subsequent vertebral fracture(s) by 5 fold and of other fragility fractures (including hip) by 2 fold COST OF OSTEOPOROSIS Some Costs of Osteoporosis in Europe In Europe the total direct costs of osteoporotic fractures are over €31 billion and are expected to increase to more that €76 billion in 2050. Kanis JA & Johnell O. - Osteoporos Int 2005 (in press) In France osteoporotic hip fractures are estimated to cost about €1 billion every year* In Spain the total direct hospital cost of osteoporotic fractures in 1995 was approximately €222 million* In England & Wales the total direct hospital cost of osteoporotic fractures in 1999 was approximately €847 million* *Osteoporosis in the European Community: A Call to Action. IOF Nov, 2001 Osteoporosis Results in More Disability & Direct Hospital Cost Than Many Other Diseases 8% of vertebral fractures are hospitalised and 2% require long-term nursing care Ross et al., Am Journal of Medicine 1997, 103(2A):30S – 42S Annual cost of acute hospitalisation in Switzerland in 1992: 600 million Swiss francs (US$350 million) Lippuner et al., Osteoporosis Int 1997, 7:414-25 – Number of bed days (men & women) 891,000 for COPD 701,000 for osteoporosis 533,000 for stroke 328,000 for myocardial infarction 201,000 for breast cancer Osteoporosis # 1 when looking at women only UNDER-DIAGNOSIS OF VERTEBRAL FRACTURES: WHAT IS THE SIZE OF THE PROBLEM? A Retrospective Study Suggests that Vertebral Fractures are Under-Diagnosed Gehlbach et al.,Osteoporos Int 2000, 11:577 934 hospitalised women with a lateral chest x-ray 0 20 40 60 80 100 120 140 Patients (n) 132 65 23 25 Fracture identified by study radiologists Fracture noted in radiology report Fracture noted in medical record Received osteoporosis treatment A Large Prospective Study Demonstrates Under-Diagnosis of Vertebral Fractures is a Worldwide Problem Vertebral fractures were markedly under-diagnosed in radiology reports in a multicenter, multinational study population of osteoporotic women (n=2451) in which 789 (32%) women had 1 vertebral fracture at baseline. Adjudicated discrepancies (n=350) between local and central readings due to undetected vertebral fracture (68%) or equivocal terminology in the local radiology report (32%) yielded a false-negative rate of 34%. Under-diagnosis of vertebral fractures was observed in all geographic regions (false-negative rates: North America 45.2%, Latin America 46.5%, Europe/South Africa/Australia 29.5%). The false-positive rate was 5% globally. Under-diagnosis of vertebral fracture is a worldwide problem attributable in part to a lack of radiographic detection or use of ambiguous terminology in the radiology report, or both. Delmas et al., J Bone Miner Res 2005, in press. Awareness & Treatment of Vertebral Fractures in Europe is Low Despite… Known disability associated with all fractures Excess mortality associated with vertebral and hip fractures €31 billion total direct hospital costs in Europe A validated radiographic diagnosis technique Effective and safe treatments Evidence based guidelines for diagnosis and management Effective therapies are widely available and can reduce vertebral, hip and other fractures by 30% to 65%. Updated from Delmas, Lancet 2002 Antifracture Efficacy of Antiosteoporotic Agents Incident vertebral fractures - Relative risk RR ± 95% CI RLX 60 (MORE)* RLX 60 (MORE)** ALN 5/10 (FIT1)* ALN 5/10 (FIT2)** RIS 5 (VERT - NA)* RIS 5 (VERT - MN)* CT 200 (PROOF)* Teriparatide 20µg Strontium ranelate (SOTI)* Strontium ranelate (SOTI + TROPOS)** 0.2 0.6 1.0 * with prev vert fracture(s) ** without prev vert fractures 0.8 0.4 RECOGNITION & REPORTING OF VERTEBRAL FRACTURES Vertebral Fractures Semi-quantitative reading / visual scoring Genant et al., J Bone Miner Res 1993, 8:137 SQ Mild FX SQ Severe FX 1 1 3 3 Single Energy Fan-beam DXA Imaging a Potential Alternative to Conventional Radiographs Single energy imaging Fast (10 sec) scanning / breath hold Simple visual evaluation Low dose (1/100 of radiographs) Available at point of care Lateral Vertebral Assessment: …Point-of-Care tools Combining BMD & Vertebral Fracture Assessment: A New Approach to Improve the Diagnosis Rate of Vertebral Fractures Improve risk assessment Identify many (~30%) of “missed” fractures Improve targeting of therapy May improve patient understanding, acceptance and compliance Conclusions Most vertebral fractures are a complication of osteoporosis and increase the likelihood of subsequent fractures Currently mild and moderate vertebral fractures are often not being recognised and reported, leading to under-diagnosis and under-treatment Radiographic diagnosis is considered the best way to identify and confirm the presence of vertebral fractures in clinical practice All vertebral fractures identified should be reported as FRACTURED to avoid ambiguity caused by other terminology Early radiographic diagnosis followed by appropriate therapy will help prevent subsequent fractures – Effective therapies are widely available and can reduce vertebral, hip and other fragility fractures by 30% to 65%. Action is needed by Radiologists to ensure: Recognition of vertebral fractures using radiography imaging techniques Reporting as FRACTURED to avoid ambiguity These actions will help patients receive effective treatment and prevent subsequent fractures This is the goal of the IOF / ESSR Vertebral Fracture Initiative