Objective Status

  • 2 Baseline only
  • 2 Developmental
  • 0 Research

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About the Workgroup

Approach and Rationale

Osteoporosis is a disease marked by significant bone loss and reduced bone strength leading to increased risk of fractures. It affects people of all races/ethnicities and both sexes. In the United States, an estimated 10 million people age 50 years and older have osteoporosis. Most of these people are women, but about 2 million are men. Just over 43 million more people — including 16 million men — have low bone mass, putting them at increased risk for osteoporosis.1 

Core objectives selected by the OP Workgroup aim to reduce osteoporosis and hip fracture numbers by tracking bone mineral density as a measure of the major risk factor for fractures. They’re also designed to reduce hip fractures, the most serious type of osteoporosis-related fracture. Developmental and research objectives highlight high-priority public health issues that lack data or evidence. The OP Workgroup selected developmental objectives that focus on improving osteoporosis screening and treatment following a fracture. As more data become available, these developmental objectives may become core objectives.

Osteoporosis objectives' targets are aligned with federal strategies and priorities, including the U.S. Preventive Services Task Force (USPSTF) recommendations. All Healthy People 2030 core objectives meet several criteria — for example, they have baseline data, a direct impact on health, and an evidence base. In developing its objectives, the OP Workgroup considered that osteoporosis prevalence data are determined by measurements collected in the population. There’s also significant burden associated with quality of life in those with osteoporosis and related fractures, high cost of treatment, and recent changes in trends of the disease.

Understanding Osteoporosis

There are many factors that contribute to osteoporosis and fractures. Nutrition and physical activity are important modifiable risk factors. Family history and personal history of fractures are also risk factors for osteoporosis.2

Emerging Issues in Osteoporosis

There are USPSTF screening recommendations for osteoporosis and effective medications that have been approved by the U.S. Food and Drug Administration. Yet data suggest osteoporosis drug use has significantly decreased3 and hip fracture numbers are no longer declining.4 These changes may be because of questions about the safety of osteoporosis drugs. There are reports of rare but serious adverse events such as atypical femoral fractures and osteonecrosis (cell death) of the jaw. There is also little data on long-term, uninterrupted drug usage and other unanswered questions such as who benefits the most from long-term treatment. It’s possible that these concerns have made providers less likely to prescribe these drugs to people who need them — and made patients less likely to take them when they are prescribed.

Citations

1.

Wright N.C., et al. (Nov. 2014). The Recent Prevalence of Osteoporosis and Low Bone Mass in the United States Based on Bone Mineral Density at the Femoral Neck or Lumbar Spine. Journal of Bone and Mineral Research, 29(11), 2520-2526. DOI: 10.1002/jbmr.2269

2.

Department of Health and Human Services. (2004). Bone Health and Osteoporosis: A Report of the Surgeon General [PDF file]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK45513/pdf/Bookshelf_NBK45513.pdf

3.

Wysowski, D.K. & Greene, P. (Dec. 2013). Trends in Osteoporosis Treatment with Oral and Intravenous Bisphosphonates in the United States, 2002-2012. Bone, 57(2), 423-428. DOI: 10.1016/j.bone.2013.09.008

4.

Lewiecki, E.M. et al. (March 2018). Hip Fracture Trends in the United States, 2002 to 2015. Osteoporosis International, 29(3), 717-722. DOI: 10.1007/s00198-017-4345-0