Osteoporosis

Osteoporosis is defined by the World Health Organization as a disease “characterized by low bone mass and micro-architectural deterioration of bone tissue, leading to bone fragility and a consequent increase in risk of fracture.” Osteoporosis is a significant, worldwide public health problem that is becoming increasingly common. It is estimated that globally, 1 of every 2 women and 1 of every 4 men older than 50 years will have an osteoporosis-related fracture. In the United States, 1.5 million fractures related to osteoporosis occur annually, with the estimated cost of caring for these patients approaching $18 billion. This number is expected to triple by the year 2040. In older patients, a broken hip can increase mortality fourfold. Those with hip fractures have a 20% risk of entering a nursing home within a year of their fracture, and it is estimated that almost 50% of women with hip fractures do not fully regain previous function. Many patients with hip fractures experience a decline in function, along with increased feelings of isolation, depression, and fear of falling. In an individual with osteoporosis, the potential for falling becomes even more important.

Ophthalmic considerations It is important to note what medications are being taken by a patient with osteoporosis. The class of drugs known as bisphosphonates, which are often prescribed for postmenopausal women to inhibit bone resorption, can affect eye health. These drugs are associated with inflammatory disease of the eye, including conjunctivitis, uveitis, and episcleritis. Scleritis, which can be vision threatening, has also been reported. On the other hand, a study of veterans determined that the rates of uveitis and/or scleritis following dispensing of a bisphosphonate drug were low and did not differ significantly from those of the control group.

• French DD, Margo CE. Postmarketing surveillance rates of uveitis and scleritis with bisphosphonates among a national veteran cohort. Retina. 2008;28(6):889–893.

Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.