Osteoporosis is a silent epidemic

Osteoporosis can be treated as a silent epidemic, affecting 200 million women in the world, but too often overlooked and neglected, warned experts meeting in Paris, during a press conference on the theme " osteoporosis, a therapeutic strategy in the long term. "
Underdiagnosed and inadequately treated
Under-diagnosed and under-treated, the disease nevertheless real is considered by WHO as a public health problem. In France, it reaches 3 to 4 million women, post-menopausal women 3. He is credited with between 35,000 and 45,000 wrist fractures per year, from 40,000 to 65,000 50,000 vertebral fractures and hip fractures (or more precisely the upper end of the femur).

But it seems that these figures are underestimated, in the opinion of rheumatologists and epidemiologists. In fact, they point out, the fractures related to osteoporosis arrive at the head of all diseases, to all heart attacks, strokes and breast cancer.

A rate of fractures is expected to double
It is estimated that 40% of women aged 50 will suffer an osteoporotic fracture in the wrist, spine or proximal femur before the end of their lives. In the current state of the low support diagnosis and treatment of disease and in the absence of any improvement in the situation, there is concern that this rate is expected to double by 2040!

The first fracture often announces the following. Long silent but nevertheless present, such as bone densitometry scores can establish the disease as a clinical expression fracture: the average age of onset of wrist fracture is 55 years, that of vertebral fracture 67 years that of hip fracture 81 years.

In addition, the first fracture increases the risk of developing the following. However, it does not always lead to appropriate medical care. Punctuated by the passing years, the cascade of fractures will then implement.

From a medical point of view, the fractures have a significant impact on morbidity, mortality and the autonomy of patients. In 1984, have already made the fracture responsible for 8,000 deaths annually. When it does not lead to death in the following year, it is a source of serious sequelae and often requires institutionalization in the elderly.

Signs that attract attention
Vertebral fractures can be the cause of back pain, often localized. Acute or severe pain guide to the diagnosis, but may also become chronic pain, relieved by bed rest, unlike aggravated by stress, exercise, coughing or sneezing.

These fractures can lead to loss of height, sometimes important: when it is greater than 3 cm from the particulars of the identity card, it should be enough to suggest the diagnosis. Other signs such as kyphosis should also attract attention.

However, the diagnosis of vertebral fracture is difficult, since it can occur without trauma or symptoms. According to epidemiological studies, two-thirds occur in a completely asymptomatic. In fact, only 25% of vertebral fractures are diagnosed. About a quarter of mundane causes back pain or a temporary decrease in functional capacity.

In these clinical difficulties are compounded by problems related to the recognition of radiographic vertebral fracture. An American study conducted in 423 women with one to four vertebral fractures, shows that 93 of them undiagnosed, when replaying snapshots by an expert radiologist, 22% mismatch. A second study in patients with radiologically visible vertebral fracture reveals that 50% of them are not diagnosed by the radiologist and 80% go unnoticed in the medical record.

Finally, only 20% are treated, while the available therapies have proven to halve the risk of new fractures.

This gap in coverage is probably not likely to facilitate compliance: in a context of low interest in pathology are concerned, poorly motivated and insufficiently aware of the risk, patients continue to live as osteoporosis inevitable age-related.

Knowing the risk factors
Various factors predispose to osteoporosis: family and personal history of fracture, female gender, age, leanness, height loss, early menopause (natural or surgical), specific treatments such as long-term corticosteroid , sedentary lifestyle, a vitamin and calcium deficiency, the alcohol-smoking.

Densitometry (DXA or X-ray) provides a quantitative approach to bone demineralization, based on measurements made at some fracture predilection sites (lumbar spine, hip, wrist).

This review and identifies various stages, depending on the standard deviations (SD) from the mean bone mineral density in young adults:

- Normal bone: T-score greater than or equal to -1 SD;

- Osteopenia: T-score between -1 and -2.5 SD DS;

- Osteoporosis: T-score below -2.5 SD (pre-stage fracture);

- Established osteoporosis: T-score below -2.5 SD associated with at least one fracture.