Prevention of Osteoporotic Fractures: Possibilities, the Role of Exercise, and Limitations

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Abstract
The Compression of Morbidity paradigm seeks to reduce lifetime illness and morbidity by compressing the dominant morbidity, that of the senior years, between an increasing age of onset of morbidity and a more slowly increasing average age at death. Fractures, often associated with osteoporosis, cause a substantial part of this morbidity. For morbidity resulting from fractures to be reduced, the age-specific incidence of fractures needs to decline, since treatment of fractures after they occur is not likely to prove a major benefit. Thus, the risk factors for fractures need to be identified and appropriate preventive interventions undertaken. The medical model seeks to diagnose, then to treat those with disease. In considering prevention, many apply the medical model. The disease is “osteoporosis”, we must identify people with this disease and then treat them. The public health model, in contrast, seeks to prevent “disease” in all susceptibles. The disease is “morbidity resulting from fractures”. The fatal flaws in the medical screening approach will be discussed, together with a lament that this conference was not entitled: “Recent Progress in the Prevention of Morbidity Associated with Fractures”. Osteoporosis is only one of many factors associated with increased morbidity resulting from fractures. A fracture management model for reduction in this morbidity will be presented. Osteoporosis finds its genesis in many well-identified risk factors. including age, sex, estrogen levels, and exercise levels, together with positive (e.g. calcium, estrogen) and negative (corticosteroids) effects of medications. Falls, the other main branch of the model, find their genesis in such risk factors as slippery floors, medication side effects, and co-morbid conditions, often with their own antecedent risk factors. Together, over twenty preventable risk factors contribute to the major morbidity associated with fractures.