Women unaware of risk of dangerous osteoporosis fractures

Only one in three Australian women diagnosed with osteoporosis are aware they are at higher risk of sustaining dehabilitating bone fractures, according to a landmark international study published with input from University of Sydney researchers.

The GLOW study, coordinated by the University of Massachusetts Medical School, involved more than 60,000 postmenopausal women in 10 countries including Australia, and is published in the March Osteoporosis International journal.

The study found only 43 percent of postmenopausal women diagnosed with osteoporosis, a condition putting them at high risk for fractures, thought their risk of a fracture was higher than other women their age.

Of the 2904 Sydney postmenopausal women enrolled in the GLOW study, only 34 percent with two or more major risk factors perceived themselves to be at higher risk of a fracture than their peers.

Out of this group, 21 percent reported an osteoporosis diagnosis, 25 percent had sustained a previous fracture and a concerning 38 percent had reported recent falls. A total of 18 percent recorded low weight and 18 percent reported at least one of their parents had sustained a hip fracture.

Professor Philip Sambrook from the University's Department of Rheumatology said this failure by postmenopausal women to appreciate their personal risk of fracture presented a barrier to them receiving appropriate management of their condition and safe and effective treatments.

"We've found that many women aren't making the connection between their risk factors and the serious consequences of fractures," he said.

"Without a clear understanding of their risks, women cannot begin to protect themselves from fracture.

"One in two women will suffer an osteoporosis-related fracture after age 50 – these fractures often carry with them chronic pain, reduced mobility, loss of independence, and especially in the case of hip fracture, an increased risk of death.

"Osteoporosis-related fractures are an international public health problem; in addition to the human suffering associated with these fractures, they are also the source of enormous health care costs."

According to Professor Sambrook, improved education of both physicians and postmenopausal women about osteoporosis risk factors is urgently needed.

"Osteoporosis causes bones to become fragile and therefore more likely to break. If left untreated, the disease can progress painlessly until a fracture occurs."

Several risk factors for fractures have been identified and should be considered by physicians treating women age 55 and over: 

• Older age;
• Low weight;
• Parental hip fracture;
• Personal history of fracture (clavicle, arm, wrist, spine, rib, hip, pelvis, upper leg, lower leg, ankle) since age 45;
• Two or more falls in the past year;
• Current use of cortisone or prednisone (steroids often prescribed for a number of medical conditions);
• Rheumatoid arthritis;
• Cigarette smoking;
• Consumption of three or more alcoholic beverages daily.

"Since many fractures can be prevented by appropriate treatment, it is important that elevated risk be recognised," Professor Sambrook said.

"We hope the insight we obtain from GLOW will help physicians and patients work together to both identify those at risk for fracture and to enhance understanding of the meaning of that risk.

"Education is critical if we are to reduce the burden of fractures worldwide."

(Source: University of Sydney: Osteoporosis International: April 2010)

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