Erican osteoporosis researchers encounter harsh realities
Latin America faces growing osteoporosis epidemic, North American diagnosis and treatment determined by socioeconomicsStudies carried out in Latin America and North America emphasize the growing economic impact of osteoporosis on public health systems. A Latin American study of vertebral fractures in women has found that rates of osteoporosis are higher than previously estimated. North American studies show that people with the least socioeconomic status are less likely to be screened for the disease, even when screening is free. Studies also suggest that diagnosis and treatment of men younger than 65 is not cost effective unless their probability of developing the disease is greater than one in five.
In Latin America, Soft Bones Meet Hard Facts
Though the prevalence of osteoporosis in Latin American women is comparable to rates in other populations/counties, it is higher than predicted by prior, smaller studies that focused on hip fracture. That's one conclusion from LAVOS, or the Latin American Vertebral Osteoporosis Study, the first large-scale study designed to estimate the prevalence of vertebral fractures in Latin America. LAVOS shows that osteoporosis in women aged 50 and older is most prevalent in Mexico (19.5%) followed by Colombia, Argentina, Brazil, and Puerto Rico (12.1%). In people over 80 years old, the prevalence reaches almost 40% in Mexico.
These findings should serve as a wake up call to Latin American countries, which face a growing osteoporosis crisis. "Some estimates suggest that the incidence of hip fractures is steady or actually decreasing in Europe and North America, but life expectancy in Latin America is increasing dramatically and by 2025 we are going to have a big increase in the number of older people. Chronic diseases like osteoporosis will become part of the main health care agenda," said Dr. Patricia Clark, from the Clinical Epidemiology Unit CMN Siglo XXI-IMMS and National Autonomous University of Mexico, who presented preliminary findings today at the IOF World Congress on Osteoporosis in Toronto, Canada (see conference Abstract No. OC1).
LAVOS was started in 2001 and recruited almost 2000 women. The volunteers were tested for vertebral fractures and bone density, and were asked to fill out a questionnaire to evaluate their risk factors, lifestyles, and demographics.
Vertebral fractures are a very important diagnostic test for osteoporosis because they happen more often than hip fractures. A vertebral fracture also substantially increases the risk that a person may suffer a second, perhaps more serious, fracture. Bone fractures, particularly hip fractures, are a major cause of morbidity worldwide. About 20% of those who suffer a hip fracture die within a year.
"It is extremely important for us to have a reliable estimate of the prevalence of osteoporosis in Latin America," said Clark, the coordinator of the multinational study. She also emphasized that LAVOS was designed with internationally recognized protocols so the results could be directly compared to similar studies carried out in other regions, including Europe, North America, and China. All bone mineral density scans and x-rays were evaluated at single centers under the guidance of Dr. Sergio Ragi, Vitoria, Brazil, and Dr. Fidencio Cons, Mexicali, Mexico respectively.
The study has just been completed and the data are now being analyzed with the first published findings slated to appear later this year in the journal Osteoporosis International, published jointly by IOF and the U.S. National Osteoporosis Foundation (NOF). The researchers hope that the success of the study will spur Latin American governments to give osteoporosis more attention and funding and encourage international funding agencies to support these type of studies in the Latin-American region.
In North America, Diagnosis and Treatment Depend on Economics
In the Canadian province of Manitoba, women from lower socioeconomic groups were less likely to get bone mineral density (BMD) scans according to a new study reported this week at the IOF World Congress on Osteoporosis in Toronto. Low BMD is an indicator of osteoporosis and is a major risk factor for bone fracture. "In a way this result was surprising. Because BMD testing is deemed medically necessary in Canada, it is funded by the federal government and is free to the public," said William Leslie, professor of medicine at the University of Manitoba, Winnipeg, and one of the study's authors. "As such, it is not clear why the socioeconomic disparity exists."
Leslie and colleagues analyzed medical records of over 100,000 women aged 50 and older and correlated diagnostic imaging with family income. They found that BMD testing rates were consistently higher among women with greater incomes (see conference Abstract No. P139).
"We speculate that these differences may be related to several factors, such as access to care, language barriers, transportation, and consumer demand," suggest Leslie. "Further research is needed to better understand the cause of these associations and if they affect health outcomes," said Leslie.
Across the border in Minnesota, U.S.A., the cost of diagnosis and treatment among elderly men appears to be mostly prohibitive. John Schousboe and colleagues at Park Nicollet Health Services, Minneapolis, used health records from Rochester, Minnesota to estimate the cost-effectiveness of universal bone densitometry combined with five years treatment with alendronate, a bisphophonate-type osteoporosis medication that this widely used to prevent the deterioration of bone strength.
They found that the universal screen and treatment strategy was only cost-effective for men over the age of 85 (see conference Abstract No. P109). In those patients the cost of gaining each quality-adjusted life year (QALY) was less than $16,000. In 65 year old men that cost turned out to be nearly $200,000. The quality-adjusted life year is a method used to gauge the efficacy of a treatment or therapy. A QALY of 1 would be equal to one year in full health.
The authors conclude that if society is willing to pay $50,000 for every QALY gained, then the densitometry and treatment is cost-effective for those over age 75. For younger men, the study suggests that this type of care is only cost-effective if targeted to those with a high probability of developing the disease.
"The figures seem high, but that is because we are trying to prevent future adverse health events and many individuals need to be tested to find the minority with osteoporosis and then many with osteoporosis have to be treated to prevent one fracture, said Schousboe. In other words, the cost of one QALY is spread throughout the population.
"$50,000 per QALY is not much. In Great Britain, for example, interventions that cost about that much are considered cost-effective," said Schousboe.
Osteoporosis, in which the bones become porous and break easily, is one of the world's most common and debilitating diseases. The result: pain, loss of movement, inability to perform daily chores, and in many cases, death. One out of three women over 50 will experience osteoporotic fractures, as will one out of five men 1, 2, 3.
Unfortunately, screening for people at risk is far from being a standard practice. Osteoporosis can, to a certain extent, be prevented, it can be easily diagnosed and effective treatments are available.
The International Osteoporosis Foundation (IOF) is the only worldwide organization dedicated to the fight against osteoporosis. It brings together scientists, physicians, patient societies and corporate partners. Working with its 172 member societies in 85 locations, and other healthcare-related organizations around the world, IOF encourages awareness and prevention, early detection and improved treatment of osteoporosis.
1 Melton U, Chrischilles EA, Cooper C et al. How many women have osteoporosis? Journal of Bone Mineral Research, 1992; 7:1005-10
2 Kanis JA et al. Long-term risk of osteoporotic fracture in Malmo. Osteoporosis International, 2000; 11:669-674
3. Melton LJ, et al. Bone density and fracture risk in men. JBMR. 1998; 13:No 12:1915
IOF World Congress on Osteoporosis, held every two years, is the only global congress dedicated specifically to all aspects of osteoporosis. Besides the opportunity to learn about the latest science and developments in diagnosis, treatment and the most recent socio-economic studies, participants have the chance to meet and exchange ideas with other physicians from around the world. All aspects of osteoporosis will be covered during the Congress which will comprise lectures by invited speakers presenting cutting edge research in the field, and a large number of oral presentations and poster sessions selected from 720 submitted abstracts. More than 70 Meet the Expert Sessions covering many practical aspects of diagnosis and management of osteoporosis are also on the program.
For more information on osteoporosis and IOF please visit: www.osteofound.org
For further information, please contact:
Paul Spencer Sochaczewski, Head of Communications,
International Osteoporosis Foundation:
Andrew Leopold, Weber Shandwick Worldwide
400-207 Queen's Quay West, Toronto, Tel: +1 416 964 6444
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