One fracture, two fracture, three fracture……enough!
Image: Salvatore Vuono / FreeDigitalPhotos.net
By Irwin Lim, Rheumatologist
On the rainy weekend, I attended a provocative lecture by a world expert in osteoporosis, Professor Markus Seibel. He spoke about the clear need for coordinated interventions in osteoporosis.
Why bother?
“In Australia, 67,000 osteoporotic fractures occurred in 2001. By 2007, this figure had increased to 87,100 fractures and by now has probably passed the 90,000 mark. Osteoporosis costs the Australian tax payer over $7 billion per year. For the individual patient, osteoporotic fractures cause pain, disability, social isolation, depression and premature death.” This quote appears in the latest issue of Osteoblast, an Osteoporosis Australia publication.
We bother to highlight this because Osteoporosis is a BAD disease with BIG consequences.
There are many risk factors for osteoporosis, and doctors need to be vigilant for these. Unfortunately, this “silent” disease is too often forgotten.
The greatest risk for having another osteoporotic fracture is having already had one. Prevention strategies are therefore best targeted at this high risk group.
In this group, the disease is no longer silent.
Sadly, most patients presenting to hospitals with an osteoporotic fracture (also referred to as a minimal trauma fracture) are getting a surgical fix or a cast, but not assessed and therefore, not treated for osteoporosis. Between 20-50% of all patients who have suffered one of these osteoporotic fractures will have subsequent fractures.
This of course causes pain, suffering, disability and loss of independence. It also costs hospitals, and therefore governments, a lot of bedtime and money.
Professor Seibel and a team of clinicians and researchers at Concord Hospital, Sydney, recently published the 4-year follow-up results of a coordinated fracture liaison service on re-fracture rates in patients with previous minimal trauma fractures.
A simple coordinated team approach to actively identify these patients followed by diagnostic tests, and simple, standard treatment resulted in a reduction of 80% of recurrent fractures after an initial osteoporotic fracture! Health economic analyses also indicate that this sort of fracture liaison service is highly cost effective to society.
This effective prevention of a bad disease does not depend on high tech measures. It just depends on the health system caring enough to set up a simple fracture prevention service.
To date, most hospitals in Sydney do not have such fracture liaison services. I am not aware of any such services set up in the community setting.
Don’t you think it’s worth preventing the next fracture in the group of people at highest risk of developing recurrent fractures? BJC Health does.
Dr Irwin Lim is a rheumatologist and a director of BJC Health.
BJC Health provides a connected care multidisciplinary team philosophy to deliver positive lifestyle outcomes through a holistic approach to those with degenerative & inflammatory arthritis, tendon injury and lifestyle diseases. Our clinics are located in Parramatta, Chatswood and Brookvale. Contact us.
This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.
Stop Press: Stopping recurrent fractures after suffering a fracture from weak bones (osteoporosis) is a priority. We are going to run a Refracture Prevention Program at our Parramatta rooms to try & stop bones breaking.
I’m a 42 year old runner and rheumatoid arthritis patient. Following a stress fracture I asked for a bone density test and discovered I had osteopenia. Had I not pushed for the test and begun taking Fosomax, I have no doubt that there would have been a lot of fractures in my future. I’m so glad I caught this early and have a chance at stopping the bone loss!
Wendy, before you renew that Fosamax prescription, please read “We Never Imagined People Would Think of Osteopenia as a Disease” at http://ethicalnag.org/2010/02/06/osteopenia/ Osteopenia is essentially a case of “disease-mongering”, in which pharmaceutical companies attempt to redefine a diagnosis in order to sell more drugs. The non-disease osteopenia is NOT in fact associated with increased fracture risk, despite what Merck and other drug companies attempt to tell us.
Even more alarming, Dr. Susan Ott of the University of Washington worries that taking osteoporosis medications like Fosamax longterm — five years or more — might actually make bones brittle. In a 2004 issue of the journal, Annals of Internal Medicine, Dr. Ott wrote:
“Many people believe that these drugs are ‘bone builders,’ but the evidence shows they are actually bone hardeners.”
Other researchers have also suggested that many years of using Merck’s Fosamax (or other drugs like Procter & Gamble’s Actonel in a class called ‘bisphosphonates’) could eventually cause even MORE bone fractures. University of Toronto researcher Dr. Angela Cheung agrees, reporting in the May 2004 issue of the Canadian Medical Association Journal:
“We do NOT recommend using drug therapy for the primary prevention of osteoporosis, especially in young post-menopausal women. More than 45% of post-menopausal women have so-called ‘osteopenia’. The fracture risk for these women is very low.”
Carolyn, I would agree with you that osteopenia alone does not justify treatment. Instead, it’s the absolute risk of fracture that is the important factor to justify treatment. My post was not about treating osteopenia is you reread it. Its about treating the group with the highest risks, the people who have already suffered minimal trauma or osteoporotic fracture (in this group, bone mineral density measurements while useful, are only a part of the risk assessment).
My rheumatologist has me bone density scans every 1-2 years. Due to having RA and also being on steroids, , often for the past 25 years, I now have osteoporosis. Of course, screening is important for all, but especially those of us with even greater risk factors of developing it. Also, it makes sense to increase public education efforts, to include the disease and identifying and reducing one’s risk factors.
I also screen my patients with Rheumatoid Arthritis every few years. The frequency does depend on the amount & duration of steroid use as well as the baseline bone density. Typically, those patients with low bone density will be screened more often. For osteopenic patients who remain on long-term steroids, I am inclined to treat with bisphosphonate therapy to try and prevent steroid-induced bone loss.
Dr Lim, would you suggest that anyone on long term steroid treatment should speak to their treating physician regarding prophylactic therapy? Of course I guess the interpretation of “long term” steroid use and significant dosages are open to interpretation.