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A Model of Lifetime Osteoporosis Impact

A Model of Lifetime Osteoporosis Impact Abstract The study goal was to use population-based data to model aspects of lifetime osteoporosis impact not previously studied, specifically: (1) to estimate person-years of fracturerelated functional impairment against the trajectory of functional status in the general population; (2) jointly to consider hip, vertebral, and Colles' fractures in estimating the percent of women who will ever fracture; and (3) to estimate the lifetime number of fractures expected in a cohort of 10 000 50-year-old white postmenopausal women. The model estimates that 54% of 50-year-old women will sustain osteoporosis-related fractures during their remaining lifetimes. Beyond the functional impairment expected in similarly aged, unfractured women, osteoporosis-related fractures are estimated to cause 6.7% of women to become dependent in basic activities of daily living; 7.8% are expected to require nursing home care for an average of 7.6 years. (Arch Intern Med. 1991;151:2026-2032) References 1. Riggs BL, Melton LJ. Involutional osteoporosis . N Engl J Med. 1986;314:1676-1686.Crossref 2. Cooper C. Osteoporosis: and epidemiological perspective: a review . J R Soc Med. 1989;82:753-757. 3. Cummings SR, Kelsey JL, Nevitt MC, O'Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures . Epidemiol Rev. 1985;7:178-208. 4. Cummings SR, Phillips SL, Wheat ME, et al. Recovery of function after hip fracture . J Am Geriatr Soc. 1988;36:801-806. 5. Cobey JC, Cobey JH, Conant L, Weil UH, Greenwald WF, Southwick WO. Indicators of recovery from fractures of the hip . Clin Orthop. 1976;117:258-262. 6. Mossey JM, Mutran E, Knott K, Craik R. Determinants of recovery 12 months after hip fracture: the importance of psychosocial factors . Am J Public Health. 1989;79:279-286.Crossref 7. Jensen JS, Tondevold E, Sorensen PH. Costs of treatment of hip fractures: a calculation of the consumption of the resources of hospitals and rehabilitation institutions . Acta Orthop Scand. 1980;51:289-296.Crossref 8. Fitzgerald JF, Moore PS, Dittus RS. The care of elderly patients with hip fracture: changes since implementation of the prospective payment system . N Engl J Med. 1988;319:1392-1397.Crossref 9. Phillips S, Fox N, Jacobs J, Wright WE. The direct medical costs of osteoporosis for American women aged 45 and older, 1986 . Bone. 1988;9:271-279.Crossref 10. Hillner BE, Hollenberg JP, Pauker SG. Postmenopausal estrogens in prevention of osteoporosis: benefit virtually without risk if cardiovascular effects are considered . Am J Med. 1986;80:1115-1127.Crossref 11. Melton LJ, Kan SH, Wahner HW, Riggs BL. Lifetime fracture risk: an approach to hip fracture risk assessment based on bone mineral density and age . J Clin Epidemiol. 1988;41:985-994.Crossref 12. Cummings SR, Black DM, Rubin SM. Lifetime risks of hip, Colles' or vertebral fracture and coronary heart disease among white postmenopausal women . Arch Intern Med. 1989;149:2445-2448.Crossref 13. Ross PD, Wasnich RD, Maclean CJ, Hagino R, Vogel JM. A model for estimating the potential costs and savings of osteoporosis prevention strategies . Bone. 1988;9:337-347.Crossref 14. Weinstein MC, Schiff I. Cost-effectiveness of hormone replacement therapy in the menopause . Obstet Gynecol Surv. 1983;36:445-455.Crossref 15. Beck JR, Pauker SG. The Markov process in medical prognosis . Med Decis Making. 1983;3:419-458.Crossref 16. Melton LJ III, O'Fallon WM, Riggs BL. Secular trends in the incidence of hip fractures . Calcif Tissue Int. 1987;41:57-64.Crossref 17. Owen RA, Melton LJ, Johnson KA, Ilstrup DM, Riggs BL. Incidence of Colles' fracture in a North American community . Am J Public Health. 1982;72:605-607.Crossref 18. Melton LJ, Kan SH, Frye MA, Wahner HW, O'Fallon WM, Riggs BL. Epidemiology of vertebral fractures in women . Am J Epidemiol. 1989;129:1000-1011. 19. Manton KG. A longitudinal study of functional change and mortality in the United States . J Gerontol. 1988;43:S153-S161.Crossref 20. Branch LG, Meyers AR. Assessing physical function in the elderly . Clin Geriatr Med. 1987;13:29-51. 21. Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research: Principles and Quantitative Methods . Belmont, Calif: Lifetime Learning Publications; 1982. 22. Cornoni-Huntley J, Brock DW, Ostfeld AM, Taylor JO, Wallace RB, eds. Established Populations for Epidemiologic Study of the Elderly: Resource Data Book . Bethesda, Md: National Institutes of Health; 1986. US Dept of Health and Human Services NIH publication 86-2443. 23. Hing E. Use of nursing homes by the elderly: preliminary data from the 1985 National Nursing Home Survey . In: Advance Data From Vital and Health Statistics, No. 135 . Hyattsville, Md: National Center for Health Statistics; (May 14) , 1987. US Dept of Health and Human Services publication (PHS) 87-1250. 24. Miller CW. Survival and ambulation following hip fracture . J Bone Joint Surg Am. 1978;60:930-934. 25. Jette AM, Harris BA, Cleary PD, Campion EW. Functional recovery after hip fracture . Arch Phys Med Rehabil. 1987;68:735-740. 26. Keene JS, Anderson CA. Hip fractures in the elderly: discharge predictions with a functional rating scale . JAMA. 1982;248:564-567.Crossref 27. Campion EW, Jette AM, Cleary PD, Harris BA. Hip fracture: a prospective study of hospital course, complications, and costs . J Gen Intern Med. 1987;2:78-82.Crossref 28. Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE. Survival experience of aged hip fracture patients . Am J Public Health. 1989;79:274-278.Crossref 29. Weiss NS, Liff JM, Ure CL, Ballard JH, Abbott GH, Daling JR. Mortality following hip fracture . J Chronic Dis. 1983;12:879-882.Crossref 30. Vital Statistics of the United States, 1986, Life Tables, Volume II, Section 6 . Washington, DC: National Center for Health Statistics; 1988. US Dept of Health and Human Services publication PHS-88-1147. 31. Barns B, Dunovan K. Functional outcomes after hip fracture . Phys Ther. 1987;11:1675-1679. 32. Baker BR, Duckworth T, Wilkes E. Mental state and other prognostic factors in femoral fractures of the elderly . J R Coll Gen Pract. 1978;28:557-559. 33. Kauffman TL, Albright L, Wagner C. Rehabilitation outcomes after hip fracture in persons 90 years and older . Arch Phys Med Rehabil. 1987;68:369-371. 34. Jensen JS, Tondevold E, Sorensen PH. Social rehabilitation following hip fractures . Acta Orthop Scand. 1979;50:777-785.Crossref 35. Leech JA, Dulberg C, Kellie S, Pattee L, Gay J. Relationship of lung function to severity of osteoporosis in women . Am Rev Respir Dis. 1990;141:68-71.Crossref 36. Leidig G, Minne HW, Sauer P, et al. A study of complaints and their relation to vertebral destruction in patients with osteoporosis . Bone Miner. 1990;8:217-229.Crossref 37. Oster G, Colditz GA, Kelly NL. The Economic Costs of Smoking and Benefits of Quitting . Lexington, Mass: Lexington Books; 1984. 38. Vinokur AD. Application of quality of life and well-being measurement as input into cost-effectiveness analyses . Drug Info J. 1988;22:311-316. 39. Melton LJ. Epidemiology of fractures . In: Riggs BL, Melton LJ, eds. Osteoporosis Etiology, Diagnosis, and Management . New York, NY: Raven Press; 1988:133-154. 40. Cummings SR, Kelsey JL, Nevitt MC, O'Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures . Epidemiol Rev. 1985;7:178-208. 41. Cooper C. Osteoporosis: an epidemiological perspective: a review . J R Soc Med 1989;82:753-757. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400100100017
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Abstract

Abstract The study goal was to use population-based data to model aspects of lifetime osteoporosis impact not previously studied, specifically: (1) to estimate person-years of fracturerelated functional impairment against the trajectory of functional status in the general population; (2) jointly to consider hip, vertebral, and Colles' fractures in estimating the percent of women who will ever fracture; and (3) to estimate the lifetime number of fractures expected in a cohort of 10 000 50-year-old white postmenopausal women. The model estimates that 54% of 50-year-old women will sustain osteoporosis-related fractures during their remaining lifetimes. Beyond the functional impairment expected in similarly aged, unfractured women, osteoporosis-related fractures are estimated to cause 6.7% of women to become dependent in basic activities of daily living; 7.8% are expected to require nursing home care for an average of 7.6 years. (Arch Intern Med. 1991;151:2026-2032) References 1. Riggs BL, Melton LJ. Involutional osteoporosis . N Engl J Med. 1986;314:1676-1686.Crossref 2. Cooper C. Osteoporosis: and epidemiological perspective: a review . J R Soc Med. 1989;82:753-757. 3. Cummings SR, Kelsey JL, Nevitt MC, O'Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures . Epidemiol Rev. 1985;7:178-208. 4. Cummings SR, Phillips SL, Wheat ME, et al. Recovery of function after hip fracture . J Am Geriatr Soc. 1988;36:801-806. 5. Cobey JC, Cobey JH, Conant L, Weil UH, Greenwald WF, Southwick WO. Indicators of recovery from fractures of the hip . Clin Orthop. 1976;117:258-262. 6. Mossey JM, Mutran E, Knott K, Craik R. Determinants of recovery 12 months after hip fracture: the importance of psychosocial factors . Am J Public Health. 1989;79:279-286.Crossref 7. Jensen JS, Tondevold E, Sorensen PH. Costs of treatment of hip fractures: a calculation of the consumption of the resources of hospitals and rehabilitation institutions . Acta Orthop Scand. 1980;51:289-296.Crossref 8. Fitzgerald JF, Moore PS, Dittus RS. The care of elderly patients with hip fracture: changes since implementation of the prospective payment system . N Engl J Med. 1988;319:1392-1397.Crossref 9. Phillips S, Fox N, Jacobs J, Wright WE. The direct medical costs of osteoporosis for American women aged 45 and older, 1986 . Bone. 1988;9:271-279.Crossref 10. Hillner BE, Hollenberg JP, Pauker SG. Postmenopausal estrogens in prevention of osteoporosis: benefit virtually without risk if cardiovascular effects are considered . Am J Med. 1986;80:1115-1127.Crossref 11. Melton LJ, Kan SH, Wahner HW, Riggs BL. Lifetime fracture risk: an approach to hip fracture risk assessment based on bone mineral density and age . J Clin Epidemiol. 1988;41:985-994.Crossref 12. Cummings SR, Black DM, Rubin SM. Lifetime risks of hip, Colles' or vertebral fracture and coronary heart disease among white postmenopausal women . Arch Intern Med. 1989;149:2445-2448.Crossref 13. Ross PD, Wasnich RD, Maclean CJ, Hagino R, Vogel JM. A model for estimating the potential costs and savings of osteoporosis prevention strategies . Bone. 1988;9:337-347.Crossref 14. Weinstein MC, Schiff I. Cost-effectiveness of hormone replacement therapy in the menopause . Obstet Gynecol Surv. 1983;36:445-455.Crossref 15. Beck JR, Pauker SG. The Markov process in medical prognosis . Med Decis Making. 1983;3:419-458.Crossref 16. Melton LJ III, O'Fallon WM, Riggs BL. Secular trends in the incidence of hip fractures . Calcif Tissue Int. 1987;41:57-64.Crossref 17. Owen RA, Melton LJ, Johnson KA, Ilstrup DM, Riggs BL. Incidence of Colles' fracture in a North American community . Am J Public Health. 1982;72:605-607.Crossref 18. Melton LJ, Kan SH, Frye MA, Wahner HW, O'Fallon WM, Riggs BL. Epidemiology of vertebral fractures in women . Am J Epidemiol. 1989;129:1000-1011. 19. Manton KG. A longitudinal study of functional change and mortality in the United States . J Gerontol. 1988;43:S153-S161.Crossref 20. Branch LG, Meyers AR. Assessing physical function in the elderly . Clin Geriatr Med. 1987;13:29-51. 21. Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research: Principles and Quantitative Methods . Belmont, Calif: Lifetime Learning Publications; 1982. 22. Cornoni-Huntley J, Brock DW, Ostfeld AM, Taylor JO, Wallace RB, eds. Established Populations for Epidemiologic Study of the Elderly: Resource Data Book . Bethesda, Md: National Institutes of Health; 1986. US Dept of Health and Human Services NIH publication 86-2443. 23. Hing E. Use of nursing homes by the elderly: preliminary data from the 1985 National Nursing Home Survey . In: Advance Data From Vital and Health Statistics, No. 135 . Hyattsville, Md: National Center for Health Statistics; (May 14) , 1987. US Dept of Health and Human Services publication (PHS) 87-1250. 24. Miller CW. Survival and ambulation following hip fracture . J Bone Joint Surg Am. 1978;60:930-934. 25. Jette AM, Harris BA, Cleary PD, Campion EW. Functional recovery after hip fracture . Arch Phys Med Rehabil. 1987;68:735-740. 26. Keene JS, Anderson CA. Hip fractures in the elderly: discharge predictions with a functional rating scale . JAMA. 1982;248:564-567.Crossref 27. Campion EW, Jette AM, Cleary PD, Harris BA. Hip fracture: a prospective study of hospital course, complications, and costs . J Gen Intern Med. 1987;2:78-82.Crossref 28. Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE. Survival experience of aged hip fracture patients . Am J Public Health. 1989;79:274-278.Crossref 29. Weiss NS, Liff JM, Ure CL, Ballard JH, Abbott GH, Daling JR. Mortality following hip fracture . J Chronic Dis. 1983;12:879-882.Crossref 30. Vital Statistics of the United States, 1986, Life Tables, Volume II, Section 6 . Washington, DC: National Center for Health Statistics; 1988. US Dept of Health and Human Services publication PHS-88-1147. 31. Barns B, Dunovan K. Functional outcomes after hip fracture . Phys Ther. 1987;11:1675-1679. 32. Baker BR, Duckworth T, Wilkes E. Mental state and other prognostic factors in femoral fractures of the elderly . J R Coll Gen Pract. 1978;28:557-559. 33. Kauffman TL, Albright L, Wagner C. Rehabilitation outcomes after hip fracture in persons 90 years and older . Arch Phys Med Rehabil. 1987;68:369-371. 34. Jensen JS, Tondevold E, Sorensen PH. Social rehabilitation following hip fractures . Acta Orthop Scand. 1979;50:777-785.Crossref 35. Leech JA, Dulberg C, Kellie S, Pattee L, Gay J. Relationship of lung function to severity of osteoporosis in women . Am Rev Respir Dis. 1990;141:68-71.Crossref 36. Leidig G, Minne HW, Sauer P, et al. A study of complaints and their relation to vertebral destruction in patients with osteoporosis . Bone Miner. 1990;8:217-229.Crossref 37. Oster G, Colditz GA, Kelly NL. The Economic Costs of Smoking and Benefits of Quitting . Lexington, Mass: Lexington Books; 1984. 38. Vinokur AD. Application of quality of life and well-being measurement as input into cost-effectiveness analyses . Drug Info J. 1988;22:311-316. 39. Melton LJ. Epidemiology of fractures . In: Riggs BL, Melton LJ, eds. Osteoporosis Etiology, Diagnosis, and Management . New York, NY: Raven Press; 1988:133-154. 40. Cummings SR, Kelsey JL, Nevitt MC, O'Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures . Epidemiol Rev. 1985;7:178-208. 41. Cooper C. Osteoporosis: an epidemiological perspective: a review . J R Soc Med 1989;82:753-757.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 1, 1991

References