As a public health professional, it is important to understand the key themes, gaps in care, and ongoing initiatives in osteoporosis prevention and treatment. Addressing disparities, improving treatment adherence, and expanding research on high-risk populations are essential steps in reducing the burden of osteoporosis and fractures. The highlighted key findings offer valuable insights to inform policy, drive clinical advancements, and guide public health efforts to optimize bone health outcomes.

 
 

Current research explores the underlying biological factors contributing to osteoporosis, including hormonal, metabolic, and genetic influences. Studies have linked biochemical markers related to bone and glucose metabolism with bone mineral density and fracture risk, particularly in individuals with type 1 and type 2 diabetes. Key findings include:

  • Increased fragility fracture risk in diabetic patients (Meier et al.)

  • Understudied fracture risk in diabetic populations, limiting early intervention strategies (Leungsuwan et al.)

  • Faster decline in hip bone mineral density among menopausal women with diabetes, increasing fracture risk (Khalil et al.)

The effects of diabetes on bone turnover and fragility are significant, and more attention should be paid to identifying prevention strategies and educating at-risk patients on managing bone mineral density loss due to diabetes.

Key Studies

  • Meier et al., Biochemical Markers of Bone Fragility in Patients with Diabetes

  • Leungsuwan & Chandran, Bone Fragility in Diabetes and its Management

  • Khalil et al., Menopausal Bone Changes and incident fractures in diabetic women: a cohort study

 
 

Creating opportunities to reach those impacted by disparities can provide better outcomes for diagnosis and treatment across diverse populations. Research indicates disparities in osteoporosis prevalence, screening, and care based on race, ethnicity, socioeconomic status, and educational attainment. Vulnerable populations, including individuals with lower education levels and non-White women, experience suboptimal osteoporosis management and post-fracture care. Notable findings include:

  • Higher standardized osteoporosis prevalence in individuals with lower education, economic instability, unemployed and non-citizens. (Tsai et al.)

  • Disparities in osteoporosis screening and treatment between White and non-White women (Ruiz-Esteves et al.)

  • Suboptimal osteoporosis management and post fracture care in Non-Hispanic Black, Asian and Hispanic populations. Increased post-fracture mortality in non-White women populations. (Noel et al.)

Key Studies

  • Tsia, Disparities in Osteoporosis by Race, Ethnicity, Work, Immigrant, and Economic Status

  • Ruiz-Esteves et al., Disparities in Osteoporosis Care Among Postmenopausal Women

  • Noel et al., Racial and Ethnic Disparities in Bone Health and Outcomes in the United States

Efforts to reduce osteoporosis-related fracture risk focus on early diagnosis, lifestyle modifications, and pharmacological treatments. Key advancements include:

  • Updated screening guidelines by the United States Preventive Services Task Force to prevent osteoporotic fracture in women over 65 years. (USPSTF)

  • Primary osteoporosis pharmacological treatment recommendations from the American College of Physicians (ACP) (Qaseem et al.)

  • Economic burden and clinical impact analysis of osteoporotic fractures by the National Osteoporosis Foundation (now the Bone Health and Osteoporosis Foundation) providing management of osteoporosis.

Key Studies

  • US Preventive Task Force, Screening for Osteoporosis to Prevent Fracture

  • Qaseem et al., Pharmacologic Treatment of Primary Osteoporosis

  • Medicare Costs of Osteoporosis Fractures Report

Falls and fractures are major contributors to morbidity, mortality, and healthcare costs among older adults. Research emphasizes the importance of identifying fall risk factors and implementing evidence-based fall prevention strategies. Screening tools and strategies to predict and reduce fall risk are critical to addressing this issue. Key findings include:

  • High fall incidence among older adults reported in 2020 (Kakara et al.)

    • Previous year falls – 14 million (27.6%) older adults

      • Women 28.9% vs Men 26.1%

    • In 2021, unintentional fall related deaths 78.0 per 100,000 older adults

  • Comparisons of fall screening tools for clinical prediction in the following year (Burns et al.)

  • Over $20 billion spent annually on acute fall-related treatment (Reider et al.)

Key Studies

  • Kakara et al., Nonfatal and Fatal Falls Among Adults Aged ≥ 65 Years

  • Burns et al., Validation and Comparison of Fall Screening Tools for Predicting Future Falls

  • Reider et al., Cost of U.S. Emergency Department and Inpatient Visits for Fall Injuries in Older Adults

Advancements in osteoporosis research include changes in diagnostic criteria, treatment options, and national health strategies. Innovative approaches to care involve multidisciplinary strategies and technological integration, such as electronic medical records. Key studies highlight:

  • The impact of new osteoporosis diagnostic criteria in the United States. (Wright et al.)

  • Identified ethnic disparities in addressing osteoporosis care disparities and suggested ways to minimize these differences. (Navarro et al.)

  • Skeletal health disparities among U.S. Asian and Pacific Islander populations as higher risk. (Looker et al.)

Key Studies

  • Wright et al., Impact of New NBHA Diagnostic Criteria on Osteoporosis Prevalence

  • Navarro et al., Minimizing Disparities in Osteoporosis Care of Minorities With an Electronic Medical Record Care Plan

  • Looker et al., Percentage of Adults Aged 65 and Over With Osteoporosis or Low Bone Mass

These findings also highlight persistent gaps I osteoporosis research, including limited data on subpopulations, emerging risk factors, and disparities in diagnosis and treatment. Despite advancements, significant gaps remain in osteoporosis research:

  • Limited Data on Subpopulations: Insufficient exploration of bone health outcomes among Asian, Pacific Islander, and Indigenous populations

  • Inconsistent Inclusion of Social Determinants of Health: Limited research integrating factors such as housing stability, access to nutrition, and community resources

  • Limited Longitudinal Data on Emerging Risk Factors: Need for studies on biochemical markers like triglycerides and advanced glycation end products

  • Insufficient Focus on Fall Prevention Programs: Lack of comprehensive evaluations of long-term effectiveness and scalability

  • Limited Research on Medication Adherence and Long-Term Outcomes: Gaps in understanding sustained impact of osteoporosis therapies

The BONEUP project is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $375,000.00 with 100 percent funded by CDC/HHS during year one. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.