At age 58, Denise Gibbons lost her balance and fell. At the hospital, doctors ordered an X-ray, MRI and ultrasound and determined she had a broken hip. It didn’t occur to Gibbons that osteoporosis was to blame for her fracture.
“Because I was under 60 and had broken a bone, it was suggested that I have a bone density scan to see if I had osteoporosis,” she recalls. Until her hospital visit, the subject of osteoporosis had never come up with her doctor or anyone else for that matter. When given the diagnosis, she was concerned but admits, “I didn’t really know what osteoporosis was.”
Why the care gap around fractures truly matters
Gibbons’ experience underscores the need for increased awareness of osteoporosis, a bone disease that develops and progresses quietly without symptoms until a fracture or break happens. The disease affects one in four women and one in eight men in Canada over the age of 50.
Despite its prevalence, it remains under the radar which contributes to a serious care gap in identifying osteoporosis as the underlying cause of fragility fractures (defined as any fall from a standing height or less that results in a fracture). In about 80 per cent of those type of cases, patients are treated for their injury and go home without any follow-up to investigate whether osteoporosis was to blame.
“We need a massive public awareness campaign,” says Dr. Aliya Khan, director of McMaster University’s Calcium Disorders Clinic in Oakville, Ont. and director of the fellowship in metabolic bone disease.“We need to increase awareness of the fact that these fragility fractures are a sign you have a skeletal disease making your bones thinner and less capable of bearing weight, and that there’s intervention available to strengthen the skeleton.”
“It’s an education that hasn’t taken place. We really need to focus on it much like heart and stroke,” she adds. “I think we have a lot to learn from our colleagues in cardiology and neurology. I think they’ve done a really good job to catch a patient that we haven’t done.”
The critical need of public awareness around osteoporosis
Many Canadians know how to do CPR, know the signs of a heart attack and public spaces have invested in defibrillators – all positive outcomes in part because of the awareness and education efforts around heart attacks, contends Dr. Khan. She’d like to see our collective understanding of osteoporosis increase so that patients and healthcare providers realize that a fragility fracture, especially in post-menopausal women, is not normal. And that further steps are necessary once a fracture occurs.
The stakes are high. Within two years, someone with a fracture will likely experience another. Next time, it could be a hip fracture, which has a poor prognosis for many Canadians with life-threatening consequences. Data from Osteoporosis Canada indicates that 28 per cent of women and 37 per cent of men who suffer a hip fracture will die within a year.
Dr. Khan also is concerned about the impact of untreated and undiagnosed osteoporosis on our healthcare system. Oversight is a costly prospect. For example, a bone density test is $120, while a hip fracture costs the system anywhere from $20,000 to $40,000 to treat. “Billions of dollars are being spent around osteoporosis because we don’t have adequate ways of addressing the care gap,” she says. “We can prevent many of these fractures. And instead of treating them and people who have a very high risk of fracture, we should be preventing them.”
Both patients and healthcare providers have a shared responsibility to look into fragility fractures and their cause. Patients who have suffered fractures should talk to their doctor about osteoporosis and request blood and bone density tests.
But even patients aware of their risk of having the bone disease often fail to take action. Patients are in denial, Dr. Khan believes, “and that doesn’t help anybody.” A public education program around breaking a bone from standing height would help people understand “fractures are warning signs. People are health conscious now. They want to know how to improve their health. And if they are given the facts, then they will take action.”
Patients and physicians can work together to assess osteoporosis risk
At the physician level, there’s also a push for furthering awareness of osteoporosis, especially among primary care doctors – often the most frequent point of contact for patients. Dr. Khan hopes that family physicians take a leadership role and suggest testing patients who have had recent fractures. Some physicians already advise patients on how to evaluate a fracture, including on which tests to do, the therapies they should receive and precautions they should take.
It was Gary John Carter’s family doctor who suspected he had osteoporosis after he slipped off a ladder at age 55 and X-rays revealed that he had multiple vertebrae fractures. She suggested he get a bone density test because those kinds of injuries were not normal especially at his age. At that point, Carter knew nothing about osteoporosis.
“I didn’t even think about it,” he says. “I was surprised when I was told that I had it.” He now goes for regular checkups with an osteoporosis specialist and often finds himself the only man in a waiting room full of older women. He doesn’t mind. He’s taking steps to ensure his bones are strong, and that osteoporosis doesn’t stop him from enjoying his life in the lakeside town of Grand Bend, Ont.
It’s clear that awareness pays off with patients and healthcare providers. “I think osteoporosis has been neglected and the education is not there to the same degree [as heart and stroke and cancer], but we need to get it there,” states Dr. Khan. “Because if you look at healthcare costs alone – never mind the impact on mortality and morbidity – the impact is greater from osteoporosis in terms of billions of dollars being spent in healthcare resources than it is from heart disease and stroke and breast cancer combined. There’s an opportunity here to really turn things around.”
Presented through a sponsorship from Amgen Canada Inc.