Who’s at risk of osteoporotic fractures?
This research was completed on 31 January 2008
Published on 6 October 2007
Half of all women and one fifth of all men over 50 will suffer a fracture because of osteoporosis.1 These breaks can have very serious consequences, yet many people don’t even realise they’re at risk. Researchers are hoping to improve our ability to predict who will suffer a fracture, so the right people can take preventative treatments.
What's the problem and who does it affect?
Osteoporosis is an insidious disease
Often dubbed ‘the silent epidemic’, osteoporosis can go unnoticed for many years. As sufferers get older, their bones gradually become weaker. But this slow progression causes no obvious symptoms at first. Many people don’t even realise they have a problem until their bones become so fragile they suffer a fracture – normally to the wrist, spine or hip.
Fractures can happen during everyday activities as straightforward as picking up a bag of shopping, or even just sneezing. One in two women and one in five men over fifty will suffer a fracture because of osteoporosis, with the proportion of people affected increasing with age.1 These fractures can have very serious consequences. For example, one in four people who suffer a hip fracture dies within the next year, and half of those remaining never regain full independence.2
Some treatments can help prevent bone loss and reduce the risk of suffering a fracture. They work best if they are given early in the disease process, before people start suffering fractures. It’s important that we ensure these treatments are targeted at people who need them most.
What is the project trying to achieve?
Making the prediction of fractures even more accurate
Doctors around the world use a technique called heel ultrasound to predict someone’s risk of suffering an osteoporotic fracture. This is particularly useful for hip fractures. The technique assesses the movement of ultrasound waves – sound waves that have frequencies above the threshold of human hearing – through the bone in a person’s heel.
We do not fully understand how variations in the makeup of bone influence the measurements that heel ultrasound provides. To help improve our understanding, researchers are exploring how differences in the density and structure of bone affect these measurements. (Osteoporotic bone is less dense than normal bone, and its structure slowly deteriorates.) The researchers are using replicas of bone created using a sophisticated manufacturing technique called rapid prototyping. The replicas are needed because studies using actual human bone have so far proved unsuccessful. The team hopes to use their increased knowledge to improve the ability of heel ultrasound to predict a person’s risk of suffering a fracture.
What are the researchers' credentials?
|Project Leader||Dr C M Langton FInstP, FIPEM, CEng|
|Location||Postgraduate Medical Institute and Department of Engineering, Hull University|
|Grant awarded||6 July 2007|
|Start date||1 August 2007|
|End date||31 January 2008|
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The project leader, Professor Christian Langton, developed the technique of heel ultrasound for the early detection of osteoporosis in the 1980s. This truly ground-breaking work has resulted in over 1,500 citations in scientific and medical literature. Heel ultrasound has proved extremely useful in the assessment of osteoporosis. Seven commercial devices currently use Professor Langton’s technique, with over 15,000 systems utilised worldwide.
Heel ultrasound is used in most major hospitals throughout the world. Despite the success of his earlier work, Professor Langton says he struggles to find funding for his ongoing studies. ‘Research such as ours, that involves the development of innovative clinical measurement techniques, is often overlooked by other funding bodies,’ he says. ‘The support of Action Medical Research is sincerely appreciated and incredibly important to us.’
In 2006, Professor Langton’s work on bone ultrasound was recognised by Universities UK as being one of the top 100 developments made in UK Universities over the past 50 years to have changed the world. He was recently awarded the degree of Doctor of Science at the University of Hull – making him the first to receive this award in over 10 years.
Who stands to benefit from this research and how?
Preventative treatment for people who need it most
Heel ultrasound is already reliable, cheap and safe. It is easy and quick to carry out, and suitable for use in hospitals, GPs surgeries and in the community. The ultimate aim of this project is to improve heel ultrasound, so it is even more accurate at predicting who will suffer a hip fracture in the future. This would help doctors to prescribe preventative treatment to the people who need it most.
With the population of older people increasing, and the number of people affected by osteoporosis steadily rising, more and more people may benefit from this research – a four-fold increase in the incidence of hip fractures is projected for the period from 1990 to 2050.3
Better use of preventative treatments will mean fewer people suffer fractures, so avoiding the associated hardship and even saving lives. It would also bring significant cost benefits - the annual cost of osteoporosis to the UK Department of Health has been estimated to be a staggering £1.73 billion.4 Indeed, according to the World Health Organisation, the lifetime risk of fracture in women at age 50 years is greater than the risk of breast cancer or cardiovascular disease.5
1. van Staa T P, Dennison E M, Leufkens H G M, Cooper C; 2001; Epidemiology of fractures in England and Wales; Bone, 29(6), 517-522. 2. Keen G S, Parker M J, Pryor G A; 1993; Mortality and morbidity after hip fractures; BMJ, 307, 1248-1250 3. Cooper C, Campion G and Melton L J, 3rd ;1992; Hip fractures in the elderly: a world-wide projection; Osteoporosis International 2:285 4. Torgerson D J, Iglesias C, Reid D M; 2001; The effective management of osteoporosis. In: the economics of fracture prevention, edited by Barlow D H, Francis R M and Miles A; pp 111-121 5. WHO Study Group (1994). Assessment of fracture risk and its application to screening for post menopausal osteoporosis. *43, 1-129. WHO Technical Report Series.