The Coming Osteoporosis Epidemic: Trend Analysis; an Aging Society Is Almost Certain to Be Characterized by a Weakening Population as the Ravages of Thin-Bone Diseases Affect More People. A Health Futurist Analyzes the Trend's Coming Impacts on Families, the Economy, Public Policy, and Social and Technological Innovation

Article excerpt

Osteoporosis is characterized by low bone mass and deterioration of bone structure, which causes bone fragility and increased risk of fracture. The disease is already a major public-health problem, affecting an estimated 75 million people worldwide, and is expected to reach epidemic proportions as populations age.



While government actions are unpredictable, individual and market-driven initiatives should yield an environment by 2020 much superior in fracture prevention and quality of life than is now available.

By 2010, we will see more osteoporosis patients or their relatives reaching political office, in executive positions, among celebrities, and so on. This will raise public awareness of the disease and its consequences, thereby increasing fund-raising for voluntary agencies, creating legislation for the financing needed, and exerting pressure on insurance companies for short-term and long-term osteoporosis coverage.

Osteoporosis patients themselves will organize in interest groups, communicating through the Internet, and launch political-action projects. The increasing number of osteoporosis patients in the workforce and their fracture-related absenteeism rate should result in additional pressure by employers for fracture prevention programs at the workplace and elsewhere.

The following is a sector-by-sector trend analysis of the looming osteoporosis epidemic. Although this analysis focuses on U.S. impacts, the findings are broadly applicable worldwide.

The Demographics Of Bone Diseases

Osteoporosis is caused by osteopenia, which is below-average bone-mineral density and, like osteoporosis, puts patients at risk for fractures. In the United States, about 10 million people have osteoporosis, and 34 million have osteopenia. These numbers are projected to increase to 14 and 47 million respectively by 2020.

Approximately 35% of postmenopausal white females have osteoporosis of the hip, spine, or wrist. White women over the age of 50 years have a 40% lifetime risk of fracture, compared with 17% for men. It is estimated that 80%-90% of hip and spine fractures and 70%-80% of wrist fractures are attributable to osteoporosis or osteopenia.

Bone loss begins early in life. Often there are insufficient lifestyle counterbalances (such as appropriate diet and physical activity) to change its course. For women, bone loss accelerates after menopause, and the disease is often detected after the age of 50.

For women older than 50 years, there is an estimated 50% increased risk of fracture for every standard deviation drop in bone-mineral density (BMD) after adjustment for age. As a general rule, a 2%-5% increase in BMD produces a 40%-50% reduction in fractures.

The osteoporosis epidemic is likely to grow due to the aging of the population, which is expected to outpace anything we can do to combat the disease, such as through lifestyle and diet changes and increased availability of effective drugs. The principal scenarios for the future are prevention or delay of fractures, with innovative ways of financing the costs of care.


Societal Impacts of Osteoporosis

Demand for caregivers and home health aides will increase. The public and business owners will have a greater awareness of their role in preventing accidents. The need for home care will create larger households of relatives who might have otherwise been living apart. It could also accelerate the development of "new families"--people living together under one roof who are not blood relatives. In some cases, these new families will consist of one or several patients living in the home of a paid caregiver. This will be especially true as long as osteoporosis patients are not covered by long-term-care insurance.

Some rural-urban shift will take place as osteoporosis patients move to larger urban areas where, in addition to family members, there are facilities and programs not available in rural areas. …


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