Chapter 11

Other Chronic Diseases and

Conditions

Chronic Diseases: What Are They, and Why Are They Important?

• Diseases that persist for a long time • Rarely cured completely • Chronic diseases (including heart disease

and cancer) cause more than half of deaths around the world.

• Almost all women will be affected by at least one chronic disease.

Chronic Diseases Are Common, and They Also Affect Women More Than Men • Chronic diseases are responsible for 70% of

deaths in the U.S. (men and women). • Women have greater rates of arthritis,

autoimmune diseases, Alzheimer’s disease, and: – Osteoporosis (4x more common) – Lupus (9x more common) – Hypothyroidism (50x more common) – Fibromyalgia (7x more common)

• Women are also more likely to be caretakers for other people with chronic diseases.

Racial/Ethnic and Socioeconomic Dimensions

• White and Asian women have osteoporosis more often than African American women.

• African American women are more likely than White women to die following a hip fracture.

• American Indians and Alaska Natives have the highest prevalence rates of diabetes.

• Blacks and Whites have somewhat equal rates of arthritis, but Blacks have a higher rate of activity limitations due to arthritis and a higher prevalence of severe pain.

Estimated Annual Costs

Conditions Costs Arthritis $128 billion

Diabetes $245 billion

Alzheimer’s disease and dementia

$226 billion

Bone fractures $19 billion

Economic Dimensions

Osteoporosis

• Literally “porous bone” • Caused by gradual loss of calcium that weakens

bone structure • Usually occurs without symptoms

Figure 11-2A: Healthy bone (left matrix)

Figure 11-2B: Osteoporotic bone (right matrix)

Osteoporosis

Osteoporosis in the vertebra can cause women to lose height and a curving of the spine.

Nonmodifiable Risk Factors for Osteoporosis

• Being female • Increased age/postmenopausal • Small frame and thin-boned • White or Asian • Family history of osteoporosis or fractures

Modifiable Risk Factors for Osteoporosis

• Diet low in calcium and vitamin D • Sedentary lifestyle • Cigarette smoking • Estrogen deficiency • Low weight and body mass index • Certain medications

– Glucocorticoids, anticonvulsants • Amenorrhea • Anorexia nervosa or bulimia

Screening and Diagnosis for Osteoporosis

Women who should be tested • All postmenopausal women younger than age 65 who

have one or more additional risk factors for osteoporosis besides menopause

• All women age 65 and older • Women 50 and older with fractures • Women with a condition or taking a medication

associated with low bone mass or bone loss • Women who are considering therapy for osteoporosis or

who want to monitor the effectiveness of certain osteoporosis treatments

Treatment and Prevention of Osteoporosis

• Adequate supply of calcium (ideally from food) • Vitamin D • Participate in weight-bearing and muscle-

strengthening exercises • Estrogen replacement therapy • Drugs: alendronate (Fosamax), risedronate

(Actonel), raloxifene (Evista), teriparatide (Forteo), nasal calcitonin spray

• Fall-prevention strategies

Arthritis • Arthritis—inflammation of the joints—affects

an estimated 50 million Americans (1 in 5 adults). – Osteoarthritis: degenerative joint disease – Rheumatoid: chronic inflammatory disease – Gout: excess uric acid in the body

Arthritis affects at least 1 in 6 adults in every state. Arthritis

Figure 11-4: Percentage of adults with arthritis, 2013

Data from Centers for Disease Control and Prevention. Arthritis prevalence estimates by state, Behavioral Risk Factor Surveillance System 2013. Available at http://www.cdc.gov/arthritis/data_statistics/state-data-current.htm

Healthy Joint versus Osteoarthritic Joint versus Rheumatoid Arthritis

Figure 11-3: Left to right, healthy joint, joint affected by osteoarthritis, and joint affected by rheumatoid arthritis.

Risk Factors for Arthritis