20. Do you know? Do you know what is your T – Score? Take one minute test! Do you know what are your chances of getting fractures in next 10 years? Go online FRAX site! For Treatment consult your physician or your “ Osteoporosis Society ”
21. Do you know your...Blood pressure? Cholesterol level? Weight? T-score? http://www.usbjd.org/projects/Fit2aT_op.cfm Program especially aimed at men and women in mid-40s to late 60s
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24. 25 15 35 40 30 40 35 35 25 30 25 30 20 20 40 The global median age 2010 Be scared of 2050 Hip fractures in USA, Europe, & Oceania – 57% in the year 1990 Hip fractures in Asia, Africa, and South America will be 71% in 2050
25. Percentage of aging population of world 2010 <5% 9% 14% >15% >15% Be scared of 2050 Osteoporosis affects 75 million people in Europe, Japan and USA, and causes 2.3 million fractures annually in Europe and the USA alone.
27. Sex ratio of population aged over 65 years per country (2006 CIA World Fact book) smooth scale from blue to red: Blue: below 0.39 males/female White: 0.79 males/female (World) Red: above 1.29 males/female (Grey: no data) Male / Female ratio in world population
46. Disease expands through marriage of marketing and machines A sidewalk sign at Kelley-Ross Pharmacy in Seattle advertises bone-density screening. Such screening has proliferated in recent years, targeting younger, healthier people. BETTY UDESEN / THE SEATTLE TIMES
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62. A fall to the side increases the risk of hip fracture by about 6 times, compared to falls in other directions.
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64. Go for BMD Go for FRAX One minute test Fracture Index Absolute fracture risk 13 seconds to complete "up and go test“ Watch. Be careful. Don't fall Osteoporosis ahead!
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78. The Number Game Source: “Changing Disease Definitions: Implications for Disease Prevalence,” Dr.Lisa Schwartz and Steven Woloshin, Effective Clinical Practice, March/April 1999. Diagnosis Old Definition New definition People under Old People under New % increase Year Diabetes Fasting Sugar > 140mg/dl Fasting > 126mg/dl 11.7 M 1.7 M 14% 1997 Hypertension BP > 160/100 BP> 140/90 38.7 M 13.5 M 35% 1997 Cholesterol > 250mg/dl > 200mg/dl 49.5 M 42.6 M 86% 1998 Obesity (BMI) BMI> 27kg/m ² BMI> 25kg/m ² 70.6 M 30.5 M 43% 1998 Pre hypertension Nil 120/80 to 139/89 Nil 45 M - 2003
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84. Create a non-profit organization “ Bone Measurement Institute” . Set up own factory to manufacture small, portable peripheral scanning machines. & make machines affordable for individual doctors and clinics. Tie-ups with other manufacturers. lobby directly or through other organizations to governments to pass legislation allowing medical insurance plans. Create Direct To Consumer TV commercials. Own scientific journals,, write or help in writing articles, and sponsor articles in reputed journals. Formation of National and International “Societies” & “Foundations” of Bone, Bone and Mineral,, Densitometry, Osteoporosis, and Calcified Tissue. Event creation like Bone and joint decade, and world osteoporosis day. Game Plan
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89. Bone Measurement Institute On its board were six of the most respected osteoporosis researchers in the country. The institute itself had a rather slim staff: Jeremy Allen was the only employee. "There was no payroll, there was no building, there was no office with the name 'Bone Measurement Institute,’ Allen says. Essentially Allen's desk at Merck was the only physical space the Bone Measurement Institute actually inhabited. "I was it," he says.
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98. Hype about hip fractures? Published in The New York Times, May 10, 2010, Company With Osteoporosis Treatment Wins the ‘Super Bowl’ By LORA KOLODNY Courtesy of McCombs School of Business, Texas Venture Labs Biologics MD team competing at Global Moot Corp.
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102. Fewer Hip fractures: A study of Canadian Hospital data found that rates of hip fractures have declined significantly over past two decades. Source: JAMA, 2009;302[8]:883-889. Published in The New York Times
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106. Bisphosphonates have reduced vertebral fractures in clinical trials of efficacy when about 90% of patients complied with three years of treatment. However, if a T score of –2.5 is used as the indication for treatment, the cost of preventing one vertebral fracture is about £23 500, and 70% of fractures would still occur in the population. Adjusting the threshold to treat more people would sharply increase the costs per averted fracture. Drug treatment is not a panacea
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110. Under idealized circumstances, 577 postmenopausal women must be treated for one year to avert one hip fracture, at a cost of about £120 000. Among women older than 80 (a high risk population), for whom drug therapy would theoretically be most effective, prevention of one hip fracture costs about £28 500. This case-finding strategy, however, would prevent only about 20% of hip fractures occurring in the total population.
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112. Cochrane Review Alendronate & Risedronate women with low BMD + fragility fracture of Spine: Fracture of the spine - 12 out of 100 women with placebo - 6 out of 100 women with alendronate Fracture in the hip or wrist - 2 out of 100 women with placebo - 1 out of 100 women with alendronate Fractures in bones other than the spine - 9 out of 100 women placebo - 7 out of 100 women alendronate
113. women with normal BMD and no fragility fractures of their spine: Fracture of the spine - 3 out of 100 women with placebo - 1 out of 100 women with alendronate Fractures in bones other than the spine: - 1 out of 100 women with placebo - 1 out of 100 women with alendronate - 3 out of 100 women with placebo - 4 out of 100 women with alendronate - 13 out of 100 women with placebo - 12 out of 100 women with alendronate
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120. A lie told often enough becomes the truth. Vladimir Lenin
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Notas del editor
Nord Med. 1991;106(5):145-7. [Consensus Development Conference. Prevention and treatment of osteoporosis] [Article in Danish] Christiansen C, Riis P . Klinisk kemisk afd, Københavns Amts sygehus i Glostrup. Abstract A consensus development conference sponsored by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the European Foundation for Osteoporosis and Bone Disease and the American National Osteoporosis Foundation was held in Copenhagen in October 1990. The consensus statement is presented (also published in Am J Med 1991; 90:107-10).
Men are more likely than women to die in the year after a hip fracture, with mortality rates for men estimated at up to 37.5% . - Ebeling PR. Clinical practice. Osteoporosis in men. N Engl J Med. 2008; 358:1474-82. [PMID: 18385499]
Harwood RH, Foss AJ, Osborn F, Gregson RM, Zaman A, Masud T. Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial. Br J Ophthalmol 2005;89:53-9 McKiernan FE. A simple gait-stabilizing device reduces outdoor falls and nonserious injurious falls in fall-prone older people during the winter. J Am Geriatr Soc 2005;53:943-7
New York University ☼ Average height of a white American woman is 5’ 4” (160 cm) and the weight is 62 kg.
The CKS topic on Osteoporosis — treatment (and prevention of fragility fractures) is currently being updated and will be published when the National Institute for Health and Clinical Excellence has reviewed its guidance on Alendronate, etidronate , risedronate , raloxifene , strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women .
William D. Leslie, M.D., M.Sc., of the University of Manitoba, Winnipeg, Canada, and colleagues analyzed nationwide hospitalization data from the Canadian Institute for Health Information for 1985 to 2005. A total of 570,872 individuals were hospitalized for hip fracture during this time period. Over the 21 years, age-adjusted rates of hip fracture declined 31.8 percent in females and 25 percent in males. The largest percentage decrease was observed among individuals age 55 to 64 years; hip fracture rates decreased by almost one-half in females and about one-third in males in this age range. Detailed analyses identified a more rapid decline beginning around 1996. &quot;For the overall population, the average age-adjusted annual percentage decrease in hip fracture rates was 1.2 percent per year from 1985 to 1996 and 2.4 percent per year from 1996 to 2005,&quot; the authors write. &quot;Similar trends have been reported in other countries, including the United States,&quot; the authors write. The reasons for the decrease are not clear, they note. The decline began before the widespread availability of bone density testing or pharmacological treatments for osteoporosis, and there is little evidence to suggest that improvements in physical activity, calcium intake, vitamin D status or prevention of falls are responsible. &quot;Overweight and obesity are epidemic in modern societies and may contribute to reduced fracture rates,&quot; they write.
Siris ES, Chen Y-T, Abbott TA, Barrett-Connor E, Miller PD, Wehren LE, et al. Bone mineral density thresholds for pharmacological interventions to prevent fractures. Arch Intern Med 2004;164:1108-12.