Doctors say osteoporosis remains undetected threat

The organization representing the best medical talent in the world for prevention, diagnosis, treatment and management of osteoporosis says the disease is still not being detected early enough to protect women from fractures.

And a Canadian doctor says men too, suffer from the disease—often without realizing it. He is mid-way through a multi-year study looking at osteoporosis risk.

The statistics about women, at least, are clear—one in every two postmenopausal women is likely to develop osteoporosis.

A first-ever survey of 11 countries, including Canada, found this threat exists in spite of vast progress in research and education over the last decade. The survey was conducted by the International Osteoporosis Foundation.

Osteoporosis causes bones to become porous and brittle and more susceptible to breaking. The spine, wrist, hip and pelvis are at greatest risk. Women are more susceptible because of the drop in estrogen levels after menopause. The hormone helps protect bones.

And the medical evidence is clear: once fractures occur, quality of life suffers significantly.

“A lot of people die wiin a year of hip fractures and the complications,” says Dr. Wojciech Olszynski, a professor of medicine at the University of Saskatchewan and director of the Saskatoon Osteoporosis Centre. Dr. Olszynski is active in the Osteoporosis Society of Canada and attended the meeting in Chicago.

The international survey questioned more than a thousand physicians and almost 600 postmenopausal women about their attitudes and attempts to prevent or manage the disease.

Of the women surveyed:

• A surprising 85 per cent of the women replied that they did not believe themselves personally at risk of developing the disease.
• Even amongst the respondents who have the disease, a third said they were not currently taking medication to prevent fractures.

Of the doctors surveyed:

• 96 per cent said that osteoporosis is a serious condition that merits discussion with postmenopausal patients. As many also said that prevention of the first fracture was their management goal.

• Yet the doctors said they would screen or medicate only after evidence of a fracture. 80 per cent of the physicians said that one of the strongest indicators of a need for medication is the presence of a fracture in the spine.

“This report challenges women, their healthcare providers and government health authorities to make the identification of bone loss a top priority”, said the head of the IOF in a release about the study.

The report says the payoff for this is:

1. Better health and quality of life
2. Fewer hospitalizations and therefore reduced long-term costs associated with osteoporosis.

Dr. Olszynski says men, too, are at risk. He bases his statements on results from a study currently underway in Canada.

“We have a few more years to go, but so far, we are surprised to see that 25 to 27 per cent of all men and women over age 50 have some deformities in the spine. We are talking every fourth person. There’s no question that osteoporosis of the spine is coming in much higher numbers than we had expected.”

“And for men, it’s a significantly higher number than expected or estimated before. We cannot find any other reason for fragility of the bone and susceptibility to fractures, so the only definitive diagnosis is osteoporosis.”

Dr. Olszynski says many of these spinal deformities are fractures that patients don’t remember.

“With the men in the study, we found significant numbers of deformities. They are working on the farm, for example, they have a back pain, they consider this almost part of their life. They say—oh, I lifted something, I had back pain for two, three weeks, then everything was better, so I didn’t bother going to the doctor.”

Dr. Olszynski says that prevention is a big challenge, especially in his province.

“We have one bone density measurement machine for the whole province, which is a joke. You’re waiting more than a year, sometimes 18 months for tests to be done.”

He says while Alberta, for example, may have 30 machines and a waiting time of days only for tests, “I can tell you that the standard of care for osteoporosis across the country is below any acceptable level. In Canada, we are at the level of a third world country in this regard.”

Dr. Olszynski says he knows that scarce health dollars are a part of the reason. And also, because of the radical advancements in osteoporosis research, technology and treatment over the last decade, there is a huge educational gap and catch-up phase for doctors.

But he says health care professionals and politicians have to make osteoporosis a health priority.

“What we do now is wait for the patient to develop fractures and then treat the consequences. So if you take the $1.4 billion spent on osteoporosis each year in Canada, about 75 to 80 per cent of the money goes for treatment of the consequences, not identifying those at risk before something happens.”

“We don’t do prevention. We wait for the problem to happen, and then we treat the consequences of the established disease.”

He says osteoporosis is currently identified as the second most common cause of death for women, after cardiovascular disease. But he says his long experience tells him this is an over simplification in statistics keeping.

“At the end, many people are diagnosed as dying of a heart condition. But this is often the consequence of years of many chronic diseases. Close to 25 per cent of these cases are people dying from complications related to hip fractures from advanced osteoporosis. So cardiovascular disease as a cause of death is much overestimated.”

Dr. Olszynski says the simple tools already exist for identifying patients at risk. He says he and his colleagues want to put the emphasis on doing that and preventing the disease with lifestyle changes and medication for at-risk patients.

“More people are living much longer—and we are responsible for giving them a good quality of life for those longer years.”

He says in the summer, he will begin to use another simple diagnostic tool for early detection.

“I will be testing a small, portable ultrasound unit which you can put in a small suitcase. This is a breakthrough in risk assessment.”