Better Diagnosis, Treatment Needed For Brittle Bone Disease: Report

Only a small proportion of Canadians with fractures from brittle bones get treatment to prevent future breaks that can lead to disability and even death, says Osteoporosis Canada, which unveiled new guidelines Tuesday for managing the disease.

The guidelines are meant to improve the diagnosis and treatment of fragility fractures caused by osteoporosis, which affects almost two million Canadians. One in four women and at least one in eight men over age 50 have the disease.

“We know that in Canada, and indeed globally, most people after a major fracture event are just not getting appropriately looked after,” said Dr. William Leslie, chair of Osteoporosis Canada’s scientific advisory committee and a co-author of the guidelines.

“This is called the care gap and we see that less than 20 per cent of women and less than 10 per cent of men are appropriately tested and treated after a fragility fracture,” Leslie said from Winnipeg. “That is just not acceptable.”

Osteoporosis is a condition that causes bones to become thin and porous. The disease is most common in postmenopausal women, but can also develop in men and, in rare cases, even in children. Smoking, lack of weight-bearing exercise, taking certain medications and being underweight are among the causes of brittle bones.

Fractures of the hips, vertebrae, arm, ribs and pelvis can occur from falls or minor bumps. In severe cases of osteoporosis, a person can sustain a fracture without an injury even occurring — for instance, breaking a rib by coughing or sneezing.

Leslie said fractures like a broken hip can be extremely painful, so people seek medical attention. But breaks in some bones can cause little discomfort and may go undetected. That’s often the case for people with spinal fractures — their first inkling that something is wrong is a loss of height as the spine compresses.

Salima Ladak-Kachra of Toronto was just 25 when she discovered the ongoing back pain she’d been experiencing was the result of osteoporosis.

After she took a fall on a ceramic floor, X-rays showed she had broken her vertebrae in four places — but they also revealed the tell-tale signs of previous fractures that were still healing.

“I was actually having fractures and not knowing it,” said Ladak-Kachra, adding that because of her young age, doctors hadn’t considered osteoporosis as a cause of her earlier back pain.

But Ladak-Kachra had several risk factors: she was underweight for her height, didn’t eat calcium-rich dairy products, got no weight-bearing exercise and both her parents had the bone-thinning disease.

Now 40, the married mother of two has put on weight, eats a healthy diet and exercises. But she has lost more than an inch in height due to a compressed spine and still suffers chronic back pain that makes tasks such as doing the laundry or making beds difficult.

“Osteoporosis is not just an elder person’s disease,” said Ladak-Kachra, who has run an osteoporosis clinic for the last 12 years. “It’s a multifactorial disease that can happen to anyone.”

Leslie said both spine and hip fractures can take an enormous toll on patients, their families and society.

“Hip fractures can be so debilitating that individuals are no longer able to look after themselves. So quite a few, who are typically older, need to enter nursing homes.”

A broken hip is also associated with a significantly elevated risk of death in the first year after the injury — often due to diseases such as pneumonia that develop from being bedridden, he said.

Judy Stenmark, CEO of the International Osteoporosis Foundation, said fallout from the disease costs billions of dollars a year worldwide. The IOF will release a global report on the disease Thursday in Toronto.

“In terms of impact and severity and cost to society, it’s right up there with cancers and diabetes, but it’s the poor man’s disease,” Stenmark said from Geneva.

Doctors need to be more aware of the need to test for osteoporosis, especially if they see a patient who is losing height or developing stooped posture, she said, and radiologists need to report evidence of previous spinal or other fractures that show up on X-rays.

“The problem is once you have one fracture, you have another and another and another,” said Stenmark, noting that a person with a fragility fracture of the spine has a four-fold chance of experiencing another within a year and then a hip fracture the year after that.

“So it’s not that you have one spinal fracture … The cascade keeps rolling along if there’s no intervention.”

Leslie said treatments, both lifestyle-related and pharmaceutical, are available to halt and help reverse loss of bone density.

Included in the Canadian guidelines is a recommendation for people to take vitamin D supplements: 400 to 1,000 IUs per day for those aged less than 50, and 800 to 2,000 IUs daily for those 50 and older. Intake of calcium, from both diet and supplements, should be 1,200 milligrams per day.

Leslie said Osteoporosis Canada wants to raise awareness of the disease and to improve diagnosis and treatment.

“We’re trying to draw attention to this, so (that means) education of the public, patients, health-care professionals and governments,” he said.

“The priority is … to associate a broken bone with osteoporosis, and consider a bone attack the same way somebody associates a heart attack with heart disease and the need for care.”

The new guidelines, updated from 2002, are published in this week’s issue of the Canadian Medical Association Journal.

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