One of the problems related to aging is osteoporotic fractures. Essentially, osteoporosis refers to a progressive disease of the skeletal system with characteristics of decreased bone density and micro-architectural weakening of the bone tissue (Black & Rosen, 2016). As the condition manifests, bone resorption firstly exceeds bone formation, causing a net reduction in bone density/mass. Subsequently, it results in increased fragility of the bone tissue, making the aged individual susceptible to fracture. As such, the condition’s major characteristic is fragility of the skeletal system and microarchitectural wearing. Currently, osteoporotic fractures remain a significant public health concern. As a matter of fact, osteoporotic fractures cause severe consequences on an individual’s quality of life, morbidity, disability, and mortality. Some of the important factors influencing the occurrence of osteoporosis include gender, race and ethnicity. In fact, differences exist with regard to the treatment outcomes and risk factors for osteoporosis as per race and ethnicity. As such, it is imperative to understand the influence of racial and ethnic factors on osteoporotic fractures towards reducing the weight of such fractures on affected individuals and the society at large. Considering that the present demographic trends result to an escalation in the number of people above 65 years, the occurrence of osteoporotic fractures seems to increase. This clearly emphasizes that osteoporotic fractures remain a serious public health concern.
Specific Population Affected
Typically, osteoporotic fractures occur among older individuals, typically over 65 years. Another predisposing factor is sex as it strongly determines the risk of fracture in line with race and ethnicity. More specifically, research shows that white women stand a higher risk of hip fractures as seen in almost twice the incidence rates as compared to their male counterparts. Especially in nations with high occurrence rates, the sex difference manifests conspicuously where the incidence of hip fractures is higher for white women (Black & Rosen, 2016). On the other hand, the risk for osteoporotic fractures among Asians and African Americans remains low. As a matter of fact, rates of hip fracture stand at 50% lesser in Asian and African American women as compared to white women. Regarding occurrence among men, race and ethnicity presents lower impact on incidence, even though white men depict marginally greater rates of hip fractures as compared to African American and Asian men.
Delegate your assignment to our experts and they will do the rest.
Although race and ethnicity play a role in the occurrence of osteoporosis, the major factors include gender and age. Scholars point out that the vast majority of osteoporotic fractures occurs among postmenopausal women. Focusing on the United States, the risk of hip fracture from the age of 50 years stands at 15.8% for women and 6.0% among men respectively. In a different dimension, the occurrence of osteoporosis depicts a discrepancy subject to whether fracture incidence or low BMD (a T score of −2.5) or less is used to define occurrence (Adler et al., 2016). For instance, it is estimated that up to 300,000 incidences of hip fractures takes place every year in the United States. All the same, statistics point out that almost 40 million women have low BMD. As such, it is predicted that a white woman above 50 years stands a risk of between 15 - 20% of suffering a hip fracture and a 50 percent risk of one form of osteoporotic fractures.
Cultural Implications
Osteoporotic fractures have a widespread impact, especially considering the long term cultural implications. Firstly, hip fractures often result in a reduced quality of life for the afflicted individual. This extents to the family as they have to live with a person in a dependent situation. Another implication is an elevated risk of death. Both spine and hip fractures have a close association with a greater risk of death (Ferdous et al., 2016). Worse still, these fractures serve as robust predictors of impending fractures. Individuals with this condition often suffer chronic pain and kyphosis which take a toll on their self-esteem. Long term disability resulting from osteoporosis seriously impacts an individual’s happiness and health. Statistically, it is predicted that a third of women and a fifth of men beyond the age of fifty globally stand to experience osteoporotic fractures. The fracture incidences present a critical challenge for the elderly individuals, social institutions, health care providers, and in the long run, for the families.
Since osteoporotic fractures dramatically upset an individual’s functional status, it forces them to become dependent for basic functions. Individuals who experience fractures go through significant pain, with most losing the capacity to walk, stand up, or even dress themselves. Since they fear falling and experiencing further fractures, a sense of helplessness and isolation begins to affect them (Black & Rosen, 2016). Worse still, such persons face a risk of complications including pneumonia, pressure sores, and urinary tract infections. Since the family may not manage to adequately care for them due to cultural or economic reasons, such patients often end up in nursing homes. In fact, almost one in five individuals suffering from hip fractures end up admitted in nursing homes.
Hip fractures inflict pain, disability, decreased mobility, and a higher degree of dependence. Hip fractures stand as one of the leading causes for older persons losing their independence. Studies show that subsequent to a hip fracture, up to 20% of individuals who previously lived in the community often have need for long term nursing care (Ferdous et al., 2016). It is almost heartbreaking for families where they have to be separated from their loved ones so as to allow for institutionalized care. Nearly one in five patients pass away within the first year subsequent to experiencing a hip fracture. Those who live on following a hip fracture often undergo a loss of physical functionality and independence. Although the consequence of hip fractures is severe in western countries, it may be more overwhelming in other regions of the world. As a matter of fact, in countries with less than equitable distribution of health care services, patients suffering from hip fractures possibly never obtain surgery, resulting to long-lasting disability or death.
Financial/legal/ethical implications
From a general perspective, the huge numbers of osteoporotic fractures that occur in the United States every year result to over half a million hospitalizations, more than 800,000 encounters in emergency rooms, over 2 million physician visits, and the institutionalization of more than 150,000 patients into nursing homes (Ferdous et al., 2016). With the high numbers of osteoporotic fractures, providing the needed care comes at an expensive price. Studies demonstrate that yearly direct care expenses for osteoporotic fractures cover up to $18 billion every year. Furthermore, indirect costs such as lost productivity for caregivers and patients alike add more financial impact. With the prevailing trends, the costs may possibly double in the future years.
Osteoporotic fractures also impact negatively on the patient’s body image and self-esteem which often implicates psychological consequences. Individuals suffering from such fractures may require measures to ensure that their medical bills are covered by their insurance plan. They may apply for exceptions as they require physical therapy (Department of Health & Human Services, 2018). If a patient’s therapy provider or therapist delivers adequate documentation to demonstrate that the individual’s services are medically rational and required and specifies this on the individual’s claim, Medicare’s approval means that it will carry on to covering the payment. For individuals to determine whether or not to make claims beyond the therapy cap limits, the first step involves asking their therapist or therapy provider. It is for a fact that the therapist will be in possession of the most up-to-date information regarding the individual’s progress and can determine whether the needed occupational therapy services will require payments above the Medicare limits. All the same, it is the ethical obligation by physical therapists and other health care providers to indicate that such patients require medical cover beyond the annual caps.
Interventions to Improve the Problem
Since osteoporotic fractures occur due to decreased bone density and micro-architectural weakening of the bone tissue, physical activity may help to a great extent. Studies show that resistance exercises not only increase muscle mass, but also transiently enhance BMD. Further, longitudinal studies have revealed the beneficial impacts on skeletal microarchitecture related to some practices of regular physical activity. In fact, fractures resulting from falling may be reduced through engaging in regular balance exercises to prevent incidences of falling. Achieving them may require collaboration by the physical therapists and occupational therapists to ensure a well-balanced exercise program. As such, programs for exercise and balance may help in improving the problem. Resources exist to support such measures, including the Medicare insurance that pays for an individual’s medically essential occupational therapy services.
Another intervention involves pharmacologic therapies. Pharmacologic drugs for the management of osteoporosis in both antiresorptive and anabolic classes need to be provided to all individuals at risk of osteoporosis. The choice of these drugs is based on the fact that they have been demonstrated to increase BMD and decrease the risk of fractures (Ferdous et al., 2016). Furthermore, estrogen therapy for postmenopausal women effectively works through directly affecting bone integrity through inhibiting bone resorption while at the same time maintaining bone formation. Studies have shown that estrogen therapy considerably decreases the occurrence of non-vertebral, vertebral, and hip fractures among post-menopausal women. Another pharmacological approach involves the administration of Bisphosphonates to individuals at risk of osteoporosis (Adler et al., 2016). Bisphosphonates prevent bone remodeling, thus maintaining its integrity. Data from randomized trials point out that they are largely safe. All the same, caution should be observed in the administration and the use of bisphosphonates.
In the United States, various insurance plans exist to help extensively in making the medication needed by osteoporosis patients. Currently, through implementing the Health Insurance Exchange Program, majority of the states in the US have opted to use it towards increasing Medicaid coverage for older adults. The effect has been that providers of medical insurance engaging in selling insurance plans under the Affordable Care Act conditions have the obligation to decrease the rates of cost-sharing among low and mid-level wage recipients. The low wage earners comprise majority of the elderly hence the insurance plan will ensure their coverage. Further improvements will necessitate clearly defining the various exchange duties and responsibilities as an indispensable aspect towards determining the most appropriate category of administrative structure as well as deliberate attention on basic models (Department of Health & Human Services, 2018). Difficulties may arise with regard to the risk of improper selection and is a significant challenge. Therefore comprehensively dealing with health plans calls for an outreach that is multifaceted alongside a well-organized registration initiative that is crucial towards informing persons to sign up in large and extensive blend of insurance exchanges.
Conclusion
The occurrence of osteoporosis seems on the rise due to the increase in life expectancy. As a problem associated with aging, osteoporotic fractures comprise one of the significant public concerns afflicting the elderly. Le However, with apt measures towards mitigating the impact of aging through exercise and therapies, it becomes possible to improve the problem of osteoporotic fractures. The US allows for an exception process for individuals requiring physical therapy services. Under this exceptions process, individuals are allowed to go beyond the yearly payments cap if the therapy service provider verifies that sustained outpatient therapy services are medically indispensable. As such, it remains feasible to improve the outcomes of the elderly, more so, those affected by osteoporosis.
References
Adler, R. A., Camacho, P. M., Clines, G. A., & Greenspan, S. L. (2016). Managing osteoporosis in patients on long ‐ term bisphosphonate treatment: report of a task force of the American Society for Bone and Mineral Research. Journal of Bone and Mineral Research , 31(1), 16-35.
Black, D. M., & Rosen, C. J. (2016). Postmenopausal osteoporosis. New England Journal of Medicine , 374(3), 254-262.
Department of Health & Human Services. (2018). Medicare Limits on Therapy Services . Retrieved July 9, 2018 https://www.cms.gov/Medicare/Billing/TherapyServices/Downloads/Outpatient_Therapy_Caps_Exceptions_Process_Refinement.pdf
Ferdous, H., Afsana, F., Qureshi, N. K., & Rouf, R. S. B. (2016). Osteoporosis: A Review. BIRDEM Medical Journal , 5(1), 30-36.
