The many costs of osteoporosis

Osteoporosis is the most common bone disease and affects more than 200 million people worldwide. Bones become fragile and break easily, following a simple fall or an activity such as dressing or sneezing. A diagnosis of osteoporosis can be made from a bone-density scan known as a DXA (dual-energy X-ray absorptiometry), or in people who suffer a fragility fracture.

A DXA scan should be considered for all women aged 65 years and older, men aged 70 years and older, and younger men and women with fragility fractures or with other risk factors such as family history, certain illnesses and medications.

Fracture is the medical term for a broken bone. While osteoporosis can occur at any age, frail elderly people are at greatest risk. One in two women and one in five men aged 50 years and older will suffer an osteoporotic fracture in their lifetime.

A postmenopausal woman’s annual risk of fracture is greater than her combined risk of cardiovascular disease – stroke or heart attack – and invasive breast cancer. Fractures can result in pain, disability and loss of independence.

The cost of care for these patients is high, as many require hospitalisation and surgery. International figures show one in five people die within a year of fracturing a hip.

At the recent annual meeting of the Irish Osteoporosis Society, in Athlone, it was pointed out that about 200,000 Irish people have osteoporosis, and many of them are unaware they have the condition.

A 2013 paper outlined that 18,000 osteoporotic fractures occur annually in Ireland, with an estimated total cost of care of €653 million. National hospital data shows more than 11,000 patients are admitted to Irish hospitals each year with fractures, and 28 per cent of those are men. In the past decade this number has risen, as have the length of stay and cost of care for these patients.

Several speakers discussed hip fractures, as Ireland has one of the highest rates of hip fracture in the world. About 10 per cent are admitted to Galway University Hospitals annually, of whom one in three men and one in five women die within a year.

The national hip fracture database and the global “Capture the fracture” programme (capturethefracture.org) were discussed. These were established to help address the needs of these patients and to improve their care. Irish healthcare facilities can use these to compare their services to other centres around the world.

Unfortunately many patients who sustain fractures are never diagnosed with, or treated, for their underlying disease: osteoporosis. Reasons for this include lack of knowledge, resources and a national policy. Guidelines are available, and an updated one is in progress.

Prof Kassim Javaid from Oxford spoke about fracture liaison programmes in England and outlined four critical steps in the process of care for patients with osteoporotic fractures:

Find them

Assess them

Decide how to treat them

Follow up to make sure the patient remains in treatment

The cost of running these fracture liaison programmes is less than 1 per cent of the cost of caring for hip fracture patients, and about 25 per cent of fractures could be prevented using medical information and therapies that are currently available.

Several speakers discussed Irish initiatives, research and fracture liaison services. The lack of resources and staff was highlighted as a critical problem for Irish services.

Treatment is effective, and reduces the risk of further fracture and death. Multidisciplinary care is essential for all fracture patients. Teams of physicians, surgeons, GPs, physiotherapists, nurses, occupational therapists, dieticians and others are required to achieve the best outcomes for our patients.

Ensuring patients have enough calcium in their diet, adequate vitamin D and regular weight-bearing exercise are essential.

Supplemental calcium and vitamin D may be required if patients are deficient. Fall prevention is a key part of any fracture prevention strategy. A growing list of medications have been shown to reduce the risk of fracture. These are generally very safe, cheap and effective. Patients should discuss osteoporosis with their doctor.

World Osteoporosis Day is on Monday, October 20th. For further information

see the Irish Osteoporosis Society, irishosteoporosis.ie or telephone 1890-252751, and the International Osteoporosis Foundation: worldosteoporosisday.org

Dr John J Carey is a consultant physician in rheumatology and medicine at Galway University Hospitals and a lecturer in medicine at National University of Ireland, Galway