Osteoporosis, a progressive bone disease that increases fracture risk, is often referred to as a “silent disease” due to its asymptomatic nature until fractures occur. Despite this, the ethical considerations surrounding assessing and treating elderly patients in South Africa remain alarmingly under-addressed. As the National Osteoporosis Foundation of South Africa, we believe it is time to address the ethical dilemmas in denying appropriate care to this vulnerable population. Ignoring or under-treating these individuals is not just a healthcare oversight but a moral failing.
Ignoring High-Risk Patients
A growing number of elderly South Africans are at high risk of fractures due to osteoporosis, yet many of these individuals remain undiagnosed or untreated. This disregard raises significant ethical questions about the value we place on their quality of life. Left untreated, osteoporosis leads to fractures that can result in severe disability, loss of independence, and even death. Failing to assess or treat high-risk individuals signals a dangerous societal trend: dismissing the needs of the elderly simply because their conditions may not manifest with immediate, visible symptoms.
The Elitism of Osteoporosis Care
Osteoporosis is increasingly becoming an elitist disease, accessible only to those who can afford private healthcare or who are fortunate enough to have comprehensive medical aid plans. The fact that osteoporosis is not classified as a Prescribed Minimum Benefit (PMB) under the Medical Schemes Act further perpetuates this divide. This classification means that medical aids are not mandated to cover its treatment, leaving only the top-tier plans to offer necessary screenings, medications, or consultations with specialists.
This two-tier system of care leaves the vast majority of the elderly population—particularly those reliant on the public healthcare system—vulnerable. Many lack access to Dual-Energy X-ray Absorptiometry (DXA) scans, Fracture Liaison Services and essential drugs that could reduce fracture risk. The shortage of expertise and resources in public health settings further compounds this issue. As a result, osteoporosis is managed inequitably, reinforcing the notion that only those with financial means deserve proper care.
Failure to Communicate Risk and Benefit
Ethical medical care hinges on informed consent, which is impossible without transparent and thorough communication. Yet, many elderly patients with osteoporosis or at risk of it are not adequately informed about the benefits and risks of treatment options. Too often, the focus is placed on the complexities of drug side effects or cost, without equally weighing the devastating consequences of untreated osteoporosis—namely fractures, loss of mobility, and increased mortality.
Doctors have an ethical duty to ensure that their patients are fully informed and empowered to make decisions that align with their personal values and goals. When patients are left in the dark or are not fully informed of the benefits of early intervention, their autonomy in the decision-making process is compromised.
Respecting Patient Autonomy
Patient autonomy is a cornerstone of ethical healthcare practice. In the case of osteoporosis treatment, however, this principle is often overlooked. Elderly patients, many of whom already feel marginalised by the healthcare system, are not always given the opportunity to participate in therapeutic decision-making. Physicians and healthcare providers may assume that older patients, particularly those with other comorbidities, may not want or need osteoporosis treatment. This assumption strips them of their agency and denies them the right to choose what is best for their bodies and futures.
Every patient, regardless of age, should have the ability to make informed choices about their health. To deny an elderly patient the option of osteoporosis treatment because it is not deemed a priority by the system is both patronising and unethical. True patient-centred care respects the autonomy and individual needs of each person, ensuring that they have the tools to make decisions about their health with dignity.
Conclusion: A Call for Ethical Reform
As a society, we cannot continue to marginalise our elderly population by denying them the care and attention they deserve. Osteoporosis is not a disease of privilege, nor should it be treated as such. The ethical failures within the current system—from the lack of universal access to diagnostic tools and medications to the exclusion of osteoporosis as a PMB—demand urgent reform.
We at the National Osteoporosis Foundation of South Africa call on healthcare providers, policymakers, and the medical aid industry to reconsider their approach to osteoporosis. Our elderly deserve comprehensive care that acknowledges their value, ensures their autonomy, and offers them the best possible quality of life. Anything less is simply unethical.