Shulamit Wieder

The International Osteoporosis Foundation’s (IOF’s) report, ‘Osteoporosis in the EU in 2008’, provides a glimpse into the progress and ongoing challenges of osteoporosis in the EU. Shulamit Wieder reviews the report and suggests how HCP’s can take the key messages and translate them into practice.

Introduction

In the EU, osteoporosis, a largely preventable disease, currently causes around two fractures a minute. In our aging population, over the next 50 years, this is expected to rise to at least two fractures every 30 seconds.

Osteoporosis is where a progressive decrease of bone density and quality leads to porous and fragile bones. This results in an increased risk of bone fracture. It is associated with a significant risk of mortality and accounts for increased morbidity; for example, the highest number of days spent in hospital for any illness in women aged over 45.

The International Osteoporosis Foundation (IOF) report

This report “Osteoporosis in the EU in 2008: ten years of progress and ongoing challenges”, published by the IOF, examines current trends of osteoporosis management across the EU; the incidences, costs of and care for fractures and funding provided for research and support programmes. It provides 8 recommendations based on those in the 1998 report. Acknowledgement of progress is given and areas where improvements are still needed are highlighted. The report also aims to provide a policy tool for HCP’s, amongst others, to help improve the quality and quantity of care for those at risk of or suffering from osteoporosis.

In the EU member states, for example in the UK, osteoporosis is often not considered a ‘national healthcare priority’. At the same time, statistics show the number of osteoporotic fractures is increasing, along with the associated medical care costs, which annually exceed 36billion Euros. The report found that preventing fractures, in addition to increasing the quality of life for a patient, would save governments significant amounts of money – millions of Euros each year.

Screening and therapies for treatment and prevention have been available and marked as important since 2001. However, medication which needs to be taken for a number of years to be effective, is highly expensive and is often paid for privately. Even where medication is paid for or reimbursed by the governments for example, there is a poor patient compliance.

Lifestyle prevention programmes

An alternative or a complement to medication, for preventing the first fracture, would be a lifestyle prevention and education programme. Despite this, in 2007, it was reported that over half of the EU member states, including the UK did not provide one, despite the obvious benefits - see table 1 for the modifiable risks that such a programme could address. Generally, national programmes which had been implemented since 2001, were found to have worked in promoting ‘awareness, prevention, healthy lifestyle, diet including calcium and vitamin D, and treatment’ of osteoporosis. If stakeholders would join to provide support and funding, positive changes could continue to evolve. These would include raising public awareness of positive lifestyle changes for improving bone health or improving training for HCP’s to help them recognize early signs of osteoporosis and enable them to provide effective lifestyle support.

Bone health throughout the life-cycle

The public needs to understand the importance of bone health at all stages of the lifecycle – from young children, through to old age. They need to be taught how to build up and maintain strong bones. The report found government funding of such educational programmes to be critically low. Peak bone mass is reached around the mid 20’s when the bones reach the end of their growth process. Key to a high peak bone mass is adequate dietary calcium and vitamin D and exercise right from childhood. Once peak bone mass has been reached, an adequate calcium and vitamin D intake is important to preserve and sustain bone mass as well as ensuring efficient recovery from fracture.

Supplementation in the elderly has been shown to have a positive effect on rate of fracture and rate of bone loss. The majority of the EU do have some national guidelines for calcium and vitamin D intakes (see table 2 for UK RNI’s) but just 10 have implemented a complementary national public health programme.

Role of Healthcare Professionals (HPCs)

The author would suggest that the report shows a need for HCPs to move into the frontline. If HCPs are going to be able to make a significant difference in the number of future osteoporosis fractures, they are going to need funding. This will allow a large scale educational programme which will both raise awareness of the risks for osteoporosis as well as enable HCPs to know how to recognize those at risk and provide adequate support to those who need it.

Until this is available, and even without major funding, HCPs can still play an important role on a smaller scale. This would include being alert for early signs of osteoporosis in their patients, advising those who they suspect are at risk to be have their bone density analysed. Where necessary, they can educate and encourage lifestyle preventions that will delay or prevent the first fracture. For example, school nurses could implement local initiatives in their community to help parents understand the importance of and how to ensure their children build up a strong peak bone mass. HCPs who work with the over 50’s can teach them how to support their bone health. HCPs should encourage a healthy intake of calcium and vitamin D products or supplements and should remember to bring up osteoporosis as an important consequence of modifiable factors (table 1) when they are discussing these factors for other purposes.

The report is available to download from the IOF website http://www.iofbonehealth.org/publications/eu-policy-report-of-2008.html (accessed 3/3/2008)