Researchers say the aging of the U.S. population, led by a growing number of baby boomers entering retirement age, will cause epidemics of osteoporosis and osteoarthritis that strain the health care system. Americans will suffer dramatically more hip fractures, and need millions of knee and hip replacement surgeries.
Hip Fractures in the “Extreme Elderly”
The number of Americans over 80 was more than 11 million in 2008, and the “extreme elderly” are expected to comprise more than 25 percent of the U.S. population by 2050. Nearly two-thirds of hip fractures occur in this population, according to a study presented last week in Berlin, Germany at the Annual Congress of The European League Against Rheumatism
“We know that hip fracture in the extreme elderly is a serious problem due to the associated consequences of hospitalization, disability and mortality,” said lead author Amrita Sehgal from the University of California, Berkeley. “This data is cause for concern as the impact highlighted will only increase along with this population segment. The question now is how we manage the extreme elderly more effectively to limit the impact that osteoporotic fractures have going forward.”
The study called for more aggressive measures to prevent, diagnosis and treat osteoporosis. Osteoporosis is caused by a decline in mineral bone density, which makes bones weaker over time and more likely to fracture. The disease is responsible for 1.5 million fractures in the U.S. annually at a cost of $14 billion. About half of all women and a quarter of all men over the age of 50 will break a bone due to osteoporosis, according to the National Institutes of Health.
Surge in Hip and Knee Replacement Surgeries
The aging of the U.S. population is also causing a surge in hip and knee replacement surgeries. Joint replacement surgery is generally conducted on the elderly to relieve pain from osteoarthritis, a painful and disabling condition caused by a loss of cartilage and the degradation of joints. 27 million Americans suffer from osteoarthritis.
Over a million hip and knee replacement surgeries are currently performed annually – a number expected to surpass four million by 2030. This dramatic increase will place an undue burden on critical care services, according to a study published in the journal Anesthesiology.
“The number is large enough that critical care physicians need to be very familiar with this patient population,” said Stravros Memtsoudis, MD, PhD, director of Critical Care Services at the Hospital for Special Surgery (HSS) in New York. “Hospitals need to understand that it is going to be a significant part of their patient population and allocate resources accordingly.”
The study analyzed the outcomes of more than 500,000 patients who underwent total hip or knee replacement surgery and found that three percent required critical care services before they were discharged from the hospital. Patients most likely to require critical care were 69 and older, and were obese, had advanced diabetes or had chronic obstructive pulmonary disease. The use of general, rather than regional, anesthesia also increased the need for critical care.
Researchers found that the most common complications requiring critical care were cardiac difficulties such as heart attacks and pulmonary issues, including shortness of breath and acute respiratory distress syndrome. The latter requires prolonged time on a ventilator and carries a high risk of death. Joint replacement surgery carries a special risk for pulmonary distress.
“When a prosthesis is implanted, bone marrow, fat debris and cement particles can enter the blood stream of the patient,” said Memtsoudis. “The first organ to see that load of embolic material is the lung. When the load of debris is large or the lung itself is compromised by preexisting disease, the resulting inflammation in the lung can cause pulmonary compromise.”
Patients who required critical care had higher mortality rates, longer hospital stays, higher costs and were less likely to be discharged home. The study urged hospitals and critical care units to increase monitoring of high-risk patients undergoing hip and knee replacement surgery. This strategy was implemented at HSS two years ago – through a team of six critical care physicians dedicated to the needs of orthopedic patients.
“We identify patients who are at high risk for complications and we monitor them in our recovery room for at least one night,” said Memtsoudis. “If you have someone in an environment where you can observe patients closely, you can pick up abnormalities very quickly and intervene, thus hopefully avoiding more serious consequences.”