Osteoporosis is a silent disease in which bones become more fragile and therefore prone to fractures. But what you shouldn’t be silent about, is your choice of how to treat this disease through the heath care options available.

Currently, there are new medications and effective treatments available. But your concern may focus on costs, procedures and systems geared to providing affordable preventative approaches and favourable treatments; which of these will provide you with the most benefit. Models of care for improving outcomes for people with, or at risk of developing osteoporosis, include: fracture liaison, bone density screening, education, and exercise programmes.

The presence of osteoporosis often goes unnoticed and until bones fracture, most frequently in the hip, spine or wrist. This is more serious than is at first apparent. Among older people this can present major problems that can result in nursing home placement or even death. As a result, it is recommended that all women over the age of 65 and men over the age of 70 be screened regularly for low bone density.

Improvements in detection and treatments

However, it is good to know that both recognition and treatment of osteoporosis have increased noticeably in the past 10 years, including the emergence of new drugs, bolder marketing of medications, increased public awareness, and better screening technology.
Major therapeutic advances in osteoporosis treatment have been made as scientists gain greater understanding of bone morphology and the underlying mechanisms that cause osteoporosis.

Despite these advances, the problem of under-recognition and diagnosis of osteoporosis still remains. As a result, treatment and solutions remain less than they should be. This means that controlling costs can be problematic. As the number of aging adults on medical aid expands, costs will increase as the serious ramifications of unpredicted fractures are brought to light.

Most specifically, there should be well-developed management strategies for handling PMO (postmenopausal osteoporosis), including: identifying women at risk for fracture; implementing dietary and lifestyle changes to reduce risk factors; and initiating pharmacological therapy.

A systems-based approach

Four distinct “systems-based” activities can collectively contribute to improving bone health:

  • Identifying and developing intervention strategies for various risk levels of the population.
  • Educating and raising awareness among clinicians and the public about bone disease.
  • Ensuring that individuals receive appropriate preventive, diagnostic, and treatment services based upon their level of risk.
  • Monitoring and evaluating bone health outcomes within populations and the community.

Individual organisations and the “systems-based” approach

Individual clinicians – For clinicians to promote a systems-based approach to bone health, they will need to educate both themselves and their patients with regard to prevention, assessment, diagnosis, and treatment.

Medical groups – Organisations can play a role by: dedicating staff to certain important tasks; using bench-marking data or academic detailing to promote quality improvement; or implementing evidence-based care paths and computerised reminder systems that will provide timely and appropriate care; developing specialised osteoporosis clinics or disease management programmes.

Hospitals and rehabilitation facilities – These facilities should go beyond their traditional role of simply treating bone-related problems or symptoms, by developing strategies for improving overall bone health and preventing future falls.

Skilled nursing homes – These amenities are well capable of: instituting measures to prevent falls and fractures; ensuring residents receive appropriate amounts of calcium and vitamin D; and including activities in daily regimens that are geared to strengthening bones.

Health plans and insurers – These companies are in a position to contribute to the management of bone health by: assessing and monitoring the performance of healthcare providers; promoting quality improvement programmes; and implementing pay-for-performance initiatives.

The public health system – Plays a vital role in promoting a systems-based approach to bone health, including:

  • Promoting awareness among consumers and clinicians of bone health and disease.
  • Improve interface between health care organisations, community-based organisations, and the public health system.
  • Training healthcare professionals to promote bone health and recognise and treat bone disease.
  • Developing strategies to promote bone health and appropriate treatment.

NOFSA (National Osteoporosis Foundation South Africa)

NOFSA is the only non-profit, voluntary health organisation dedicated to promoting lifelong bone health. We focus on reducing the widespread prevalence of osteoporosis while working to find a cure for the disease, and by supporting research and developing programmes of education and advocacy.

Find out more about our work at: www.osteoporosis.org.za