Osteoporosis is a highly prevalent disorder in older postmenopausal women both nationally and internationally, and a potent major risk factor for subsequent fracture. Among older women of white race, it is estimated that approximately 1 in 2 women will experience an osteoporotic fracture in her lifetime. Nationwide efforts during the past two decades have led to evidence-based consensus guidelines for osteoporosis screening and treatment, with the goal of both primary and secondary fracture risk reduction. Models to assess fracture risk integrating a number of independent clinical risk factors have also been developed to support clinical therapeutic decisions, including web-based applications. Beyond pharmacologic therapy, the importance of falls prevention, patient and family education, and modification of lifestyle factors and/or the home environment have been increasingly recognized. Given the projected increase in the U.S. population aged 65 years and older during the next two decades, there is a critical need to develop interdisciplinary programs and research methodology that focus on comprehensive risk assessment, including markers of bone fragility, nutritional status and novel methods for assessing functional status and risk of falls, in the context of osteoporosis care.
This proposal will bring together expertise in endocrinology, geriatric medicine, nutrition, physical therapy and epidemiology/biostatistics and focus on the development of a large prospective cohort of older community-dwelling individuals across diverse health settings and communities (e.g. UCSF, Kaiser, SFGH, VAMC and other new Bay Area partners in geriatric care) and integrate existing data available in the electronic health record, newly collected data elements and novel interventions with the overall goal of maximizing the net clinical benefit of fracture prevention strategies in both white and non-white populations. The proposed initiative would facilitate innovative approaches to improving individual-level risk assessment, enhance our understanding of the factors driving disparities across various patient subgroups, and create a population-level resource to support new efforts in fracture risk reduction and quality improvement strategies.
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