11 OCTOBER 2023

Osteoporosis – a bone disease that develops when bone density and mass decreases with age – is often underdiagnosed and undertreated, resulting in an increased risk of fractures and disability.

The National Osteoporosis Foundation of South Africa (NOFSA) estimates that more than one-third of women over the age of 50 and nearly half of those over age 70 are affected by this condition.

Prevention-minded pharmaceutical company, Pharma Dynamics, is encouraging everyone over the age of 65 to go for a bone density test ahead of World Osteoporosis Day (20 October) to assess their risk.

Rene Schickerling, Female Healthcare Product Manager for Pharma Dynamics, says while efforts are being made to increase awareness of osteoporosis, the importance of bone health and the need for early detection to prevent fractures and related complications cannot be emphasised enough.

She says several factors contribute to its underdiagnosis, which include the lack of routine screening, limited access to healthcare and the fact that osteoporosis shows no obvious early warning signs or symptoms.

“Unlike some other health conditions, there is no routine screening for osteoporosis in the general population. Routine bone density testing, such as a dual-energy X-ray absorptiometry or DEXA/DXA scan is typically recommended for postmenopausal women and older adults with specific risk factors, but it’s not a standard part of regular check-ups for most people.

“Osteoporosis is often asymptomatic. Therefore, patients may not experience noticeable symptoms until they suffer a fracture, which is often the first sign of the condition. This means that many individuals with osteoporosis may not seek medical attention until they’ve already experienced a fracture. Some individuals may underestimate their risk of osteoporosis and believe that they are too young or too healthy to develop the condition, leading to a delayed diagnosis.

“In some areas of South Africa, access to healthcare and medical resources may be limited, making it challenging for individuals to receive the necessary screening and diagnosis for the condition,” says Schickerling.

Early diagnosis of osteoporosis can have a significant impact on a patient’s health outcomes by enabling timely intervention and management of the condition. An early diagnosis can benefit patients in the following ways:

1. Prevention of fractures: Early detection allows healthcare providers to identify individuals at risk of fractures before they occur. This enables the implementation of preventive measures and treatments, like bisphosphonates, alendronate and tibolone, to reduce the risk of fractures. Preventing fractures is crucial because fractures associated with osteoporosis can lead to pain, disability and a reduced quality of life.

2. Initiation of treatment: Early diagnosis provides the opportunity to start treatment interventions timeously. These include medication and lifestyle modifications, to slow the progression of osteoporosis and improve bone density.

3. Education and lifestyle changes: Early diagnosis allows for patient education about osteoporosis risk factors and the importance of a healthy lifestyle. Patients can make informed decisions about nutrition, exercise and fall prevention strategies to reduce their risk of fractures.

4. Monitoring: Regular monitoring of bone density and overall health can be initiated when osteoporosis is diagnosed early. This helps healthcare providers assess the effectiveness of treatment and make adjustments as needed.

5. Prevention of complications: Osteoporosis is associated with various complications beyond fractures, including spinal deformities and chronic pain. Early intervention can help prevent these complications or manage them more effectively if they have already occurred.

6. Improved quality of life: By addressing osteoporosis in its early stages, patients are more likely to maintain better bone health and overall physical function. This can result in an improved quality of life, as they are less likely to experience pain, disability, or limitations in daily activities.

7. Cost savings: Early diagnosis and intervention can also lead to cost savings in the healthcare system. Preventing fractures and related complications can reduce the need for hospitalisations, surgeries, and long-term care.

While osteoporosis is more common in women, it is important to note that men can also develop the condition. Men typically have a later onset of osteoporosis than women, and it is often associated with factors such as aging, hormonal imbalances (such as low testosterone levels), certain medical conditions, medications, and lifestyle choices.

Schickerling says both men and women can take steps to maintain good bone health throughout their lives, by including a balanced diet rich in calcium and vitamin D, regular weight-bearing exercise, and lifestyle choices that reduce bone loss risk factors, like not smoking and limiting alcohol intake).

“For individuals at higher risk, healthcare providers may recommend bone density testing and, if necessary, prescribe medications to prevent or treat osteoporosis.

“People at greater risk usually include those with a family history of osteoporosis, a low body mass index (BMI), low levels of gonadal hormones in especially post-menopausal women, thyroid problems, low calcium intake, long-term use of corticosteroids, as well as those that suffer from certain chronic diseases or inflammatory or malabsorption conditions like coeliac disease, inflammatory bowel disease (IBS), kidney or liver disease, cancer, systemic lupus erythematous or rheumatoid arthritis, among others. Factors like sedentary living, excessive alcohol intake and smoking also increase one’s risk,” she says.

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