What is the prognosis for osteoporosis-related fractures?

Updated: Jan 20, 2021
  • Author: Rachel Elizabeth Whitaker Elam, MD, MSc; Chief Editor: Herbert S Diamond, MD  more...
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Many individuals experience morbidity associated with pain, disability, and diminished quality of life caused by osteoporosis-related fractures. According to a 2004 Surgeon General's report, osteoporosis and other bone diseases are responsible for about 1.5 million fractures per year. Osteoporosis-related fractures result in annual direct care expenditures of $12.2 billion to $17.9 billion. [82] In 2005, over 2 million osteoporosis-related fractures occurred in the United States. [83]  A report in 2019 by the National Osteoporosis Foundation noted that an estimated 2 million Americans on Medicare suffered 2.3 million osteoporosis-related bone fractures in 2015.

Osteoporosis is the leading cause of fractures in the elderly. Women aged 50 years have about a 50% lifetime fracture rate as a result of osteoporosis. Osteoporosis is associated with 80% of all fractures in people aged 50 years or older. Approximately 33% of women who live to age 90 years will suffer a hip fracture, which is associated with functional decline, nursing home placement, and death. [84]

Researchers analyzed data from a subgroup of the Study of Osteoporotic Fractures, a prospective cohort study that began recruiting in 1986. The study had 1528 participants, all of whom were women, with a mean (SD) age of 84.1 (3.4) years. During follow-up, 125 (8.0%) women experienced a hip fracture and 287 (18.8%) died before experiencing this event. Five-year mortality probability was 24.9% (95% CI, 21.8-28.1) among women with osteoporosis and 19.4% (95% CI, 16.6-22.3) among women without osteoporosis but at high fracture risk. In both groups, mortality probability similarly increased with more comorbidities and poorer prognosis. In contrast, 5-year hip fracture probability was 13.0% (95% CI, 10.7-15.5) among women with osteoporosis and 4.0% (95% CI, 2.8-5.6) among women without osteoporosis but at high fracture risk. The difference was most pronounced among women with more comorbidities or worse prognosis. For example, among women with 3 or more comorbid conditions, hip fracture probability was 18.1% (95% CI, 12.3-24.9) among women with osteoporosis vs 2.5% (95% CI, 1.3-4.2) among women without osteoporosis but at high fracture risk. [85]

If full recovery is not achieved, osteoporotic fractures may lead to chronic pain, disability, and, in some cases, death. This is particularly true of vertebral and hip fractures.

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