McMaster University

McMaster University

Faculty of
Health Sciences

Most women unaware of risk for debilitating fractures

By Laura Thompson
Published: April 9, 2010
Rick Adachi
Dr. Rick Adachi, a rheumatologist and professor of medicine in the Michael G. DeGroote School of Medicine

An international osteoporosis study involving a McMaster University researcher has found that most postmenopausal women at risk for hip and other osteoporosis-related fractures fail to appreciate their actual risk of debilitating bone breaks.

The finding, the latest to emerge from the Global Longitudinal Study of Osteoporosis in Women (GLOW), underscores the need for public education about osteoporosis risk factors and treatment.

The research is published in the journal Osteoporosis International.

Dr. Rick Adachi, a rheumatologist and professor of medicine in the Michael G. DeGroote School of Medicine, is the lead investigator at the Canadian site of GLOW. The large, international observational study involves more than 60,000 postmenopausal women aged 55 and older in 10 countries in Australia, Europe and North America. GLOW participants completed a bone health questionnaire that was mailed between October 2006 and February 2008.

Of the 3,985 women from the Hamilton site enrolled in the study, 27 per cent reported an osteoporosis diagnosis, 22 per cent had a previous fracture, 14 per cent were low weight, 38 per cent reported recent falls and 17 per cent reported a hip fracture by a parent. Despite the high prevalence of risk factors, only one in three (33 per cent) Canadian women with two or more major risk factors perceived themselves to be at higher risk of a fracture than their peers.

"In keeping with the overall study findings, we found that Canadian women aren’t recognizing the risks that predispose them to fracture," said Adachi, who holds the endowed Alliance for Better Bone Health Chair in Rheumatology. "Without an improved understanding of their personal risk, women won’t protect themselves against fracture."

In the overall study population, 19 per cent of women rated their risk of a fracture as higher than other women the same age; 46 per cent said it was similar; and 35 per cent believed it to be lower.

Among all study participants with osteoporosis, only 43 per cent thought their risk of a fracture was higher than that of other women their age. And, in a finding that paralleled the Canadian data, only 33 per cent of women in GLOW who reported two or more risk factors for fracture perceived themselves as being at higher risk than their age-matched peers.

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

Improved education of both physicians and postmenopausal women about osteoporosis risk factors is urgently needed, according to the study authors. 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. They include: older age, low weight, parental hip fracture, personal history of fracture since age 45, two or more falls in the past year, current use of cortisone or prednisone, rheumatoid arthritis, cigarette smoking and consumption of three or more alcoholic beverages daily. Other risk factors include a variety of medical conditions and medications.

The lead investigator for the international study is Dr. Ethel Siris, director of the Toni Stabile Osteoporosis Center of the Columbia University Medical Center, New York-Presbyterian Hospital, who said education is critical.

"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," said Dr. Siris.

GLOW is supported by a grant from The Alliance for Better Bone Health (formerly sanofi-aventis and P&G Pharmaceuticals, now sanofi-aventis and Warner Chilcott) and is being directed by The Center for Outcomes Research, University of Massachusetts Medical School.

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