Osteoporosis: are we giving the wrong health messages?

Osteoporosis is one of those chronic medical conditions that are so prevalent, particularly in those over 60, that it is almost ignored. About 20 years ago, we were warned that, like diabetes, it would reach epidemic proportions.

Now, about one in two women over 50 and one in four men over 50 will have an osteoporotic fracture – the medical term for a broken bone caused by osteoporosis. Yet experts remain concerned that it is under-diagnosed, therefore under-treated and – again like type 2 diabetes – it is preventable.

So, where did we go wrong? Perhaps, it’s not a good idea to tell the public a silent symptomless disease (osteoporosis is often diagnosed only after someone breaks a bone from a simple fall) is an epidemic.

The strict definition of epidemic is “the widespread occurrence of an infectious disease in a community at a particular time”. And osteoporosis is neither infectious nor an acute disease. Instead, it is the slow wearing down of bone over years, caused by both genetic and lifestyle factors (see panel).

Together with arthritis, it is the most prevalent chronic condition in the over- 50s.

Wrong message

Prof John Carey, consultant physician and associate professor of medicine at

NUI Galway

, argues we have got the health messages wrong about osteoporosis.

“One of the biggest problems is that doctors, nurses, physiotherapists and health administrators don’t have a good understanding of the true impact of osteoporotic fractures.”

The Irish Osteoporosis Society recently suggested that about 200,000 people in Ireland have osteoporosis and many of them are unaware that they have the condition.

The society also states that 20 per cent of people over 60 who fracture a hip will die within six to 12 months due to secondary complications of osteoporosis.

Half of people over 60 who fracture a hip will no longer be able to dress, wash or walk unassisted and only 30 per cent will regain their independence.

Carey says that €1 billion is spent on the treatment and management of patients who break their bones, almost one-third of which is spent on hospital management of these patients.

“The cost of care for hip fractures is greater than the combined cost of treatment for heart disease, strokes and breast cancer yet we are the only country in Europe that doesn’t have a bone health strategy,” he says.

Another problem is that the wrong people are getting tested for osteoporosis, says Carey, who hosted an international conference on musculo-skeletal health and the diagnosis and treatment of osteoporosis at NUI Galway in early June.

“A lot of young people are worried about their bones and getting DXA scans which isn’t appropriate. They might discover that they have a lower bone density than normal but they don’t have osteoporosis and don’t need medical treatment or food supplements. They just need to have a healthy diet and weight-bearing exercise.”

However, according to Carey, many of the over-65s are breaking their bones due to osteoporosis, not having DXA scans and therefore not being diagnosed and treated for the condition.

“Most older people who have a fracture are not getting tested for osteoporosis and not having the standard treatment that can reduce their risk of a further fracture by 50 per cent,” he says.

He suggests everyone over 65 – and those on steroids/hormonal treatment for breast or prostate cancer – should be scanned for osteoporosis.

“Anyone under 65 who has broken a bone when you wouldn’t expect to break a bone, should also have a DXA scan. If they have good bone density, they don’t need treatment and if they don’t, the treatment will reduce their risk of another bone breaking by 50 per cent.”

Loss of height

Another symptom of osteoporosis is a loss of height which is commonly seen in older women who have had a vertebral or spinal fracture.

“Only one-third of these fractures cause pain or symptoms so it can go unnoticed until a loss of height is seen.

"Older women can also become more stooped and their tummies can stick out a bit more as a result of spinal fractures; these are all signs of osteoporosis," says Dr Ronan Kavanagh, consultant rheumatologist at the Galway clinic.

Reversing the risk factors where possible (obviously, you can’t reverse the genetic risk factors) is the first step in treatment.

Those diagnosed with osteoporosis will be advised to stop drinking alcohol and quit smoking to help their bone health.

Taking plenty of weight-bearing exercise also strengthens the muscles and the bones. Calcium and vitamin D are also essential for bone health.

Experts agree that post-menopausal women and men over 50 should be eating 1200mg of calcium a day. This is about the equivalent of two 250 ml glasses of milk, a matchbox size piece of hard cheese or a standard portion of yogurt. Calcium supplements may be needed for those who don’t take dairy products.