A epidemiologia e o impacto sócio-económico das fracturas da extremidade proximal do fémur: uma reflexão sobre o padrão actual de tratamento da osteoporose grave

Abstract

Hip fractures (HF) following low-impact trauma are the most visible and dramatic consequences of osteoporosis (OP). It is estimated that within one year after HE 10 to 20% of the patients die, 50% become disabled and only 30% fully recover their previous functional levels. Therefore, its medical, societal and economic impact is huge and it is not fully delivered by the event itself, but rather by its consequences. This systematic review aims to collect available epidemiology data about HF and to revise the national data regarding the current OP treatment of patients after HE In Portugal, over 9500 HF occur every year and have been growing along with due associated refracture and mortality rates. Despite the high vulnerability of patients and their continuous loss of bone mineral density, only 4.5 to 14.4% of them receive any OP medication. This lack of treatment represents a public health issue which is rising along with the ageing of populations and thus should not be disregarded. According to the clinical guidelines there are several pharmacological options available to stabilize bone mineral losses. This includes zoledronic acid which is associated with a significant reduction in the rate of new clinical fractures and improved survival after HE Therefore, it is expected that by increasing the number of patients treated for OP after suffering a HF will translate in a significant benefit in terms of health outcomes and due public expenditure. This article illustrates how negative the current scenario is, not only from a clinical perspective, but also from an epidemiological one. This represents an unrestrained public health problem which should concern all health professionals and sectors related with OP fractures.