Question

Osteoporosis is an age-related condition characterized by loss of bone mineral density (BMD) and is a risk factor for fractures in older women. A research project on women looking at fracture rates and bone mineral density showed that women with the lowest bone mineral density were associated with a higher fracture rate than those with higher bone mineral densities. Women targeted with bone mineral density rates of less than 2.5 standard deviations (SD) were evaluated and this was found to be effective in reducing fractures in those treated (compared with a control group of persons in the same range but not treated). A consortium of family practice, ob-gyn, and geriatric clinics and senior health centers decide to start a city-wide prevention campaign, therefore, to prevent falls and fractures in women. Implemented over five-years, this intervention screened and reached virtually all women with a bone mineral density of less than 2.5 SD. Follow-up evaluation, however, indicated no significant reduction in the overall fractures of women in the community during this period. They consulted a local public health professional who provided them with data and the figure below.

(5a) First define Rose’s Theorem. Drawing upon Rose’s Theorem, offer one hypothesis that might explain the failure of this intervention to reduce the overall prevalence and incidence of bone fractures in the community.

(5b) Describe an alternative intervention, and explain how this intervention would be more effective at reducing overall number of fractures. Define Rose’s prevention paradox and state how your intervention is an application of Rose’s “prevention paradox.”

Answer 1

5a)Ans; The Roses Theorem states that" a large number of people exposed to a low risk may generate more cases than small number of people who are exposed to a high risk".

Osteoporosis commen in women compared to man. They selected total women population for study instead of that they may choose postmenopausal women  are high risk and these people may be in less number compared to over all women population.

5b)Ans; Rose's prevention paradox describes the " where the majority of cases of a disease come from a population at low risk of that disease, and only a minority of cases come from the high risk population. This is because of the number of people at high risk in small."

I describes an alternative intervention for this first identify postmenopausal women in community. Start treating underlying cause for low bone density in postmenopausal (low estrogen level) it may help in reducing the fracture rate in community.