/ 20 October 2022

Fix structural failures in osteoporosis treatment

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Senior African man at physical therapy exercising with therapist. African Man using rubber band with doctor's help. Photo: Getty Images

Many of us will have experienced the painful, life-changing effects of osteoporosis. The disease can seriously limit the quality of life for sufferers and those around them.

It might start with a bone-loss diagnosis after a fracture. This might be the first of many – perhaps more than a dozen broken bones. Without adequate intervention, sufferers might be left unable to walk. As costs spiral due to regular bone breaks, they might find their finances denuded as they battle their medical aid for desperately needed treatment.

Fortunately, this is not inevitable. There is much that can be done to improve patient outcomes – by the patients themselves, but also by the policymakers, healthcare firms and medical aids.

Osteoporosis is a systemic disease of low bone mass and deteriorating bone tissue, which causes fragile bones, and greater susceptibility to fractures. It can progress to a point where even minor movements, like bending or coughing, can result in a bone fracture.

Globally, more than one-third of women and one-fifth of men over 50 will suffer an osteoporosis fracture. More than 8.9-million osteoporosis fractures are recorded annually.

Once diagnosed, however, people living with osteoporosis can make changes that can help them live better. Osteoporosis can be managed, and with exercise, support and medication – which can prevent up to 70% of fractures – patients can still enjoy fulfilling lives.

Structural failures

Despite the high incidence of the disease, there are several structural issues that limit our ability to manage it. There remains much that can be done by health policymakers, healthcare companies and medical aids to address these issues.

Osteoporosis screening and diagnosis remain inadequate. Patients do not have enough access to therapy and the healthcare sector could significantly improve access to caregiving.

Screening and diagnosis

Screening to determine a patient’s bone density – known as a DXA, or DEXA scan – is fundamental to diagnosing osteoporosis. Tragically, in South Africa, the number of osteoporosis patients who get these scans has been decreasing yearly since 2017.

There are several possible policy solutions. Health plans and care providers can engage ageing patients to ensure they’re aware of the importance of bone-density scanning and the need for regular scans.

Effective therapies

The accepted best approach to treating osteoporosis is strengthening a patient’s bones. Osteoporosis patients should begin treatment soon after diagnosis to reduce the chances of another fracture, which brings further complications and health risks.

Unfortunately, medication rates among South African patients have also been declining since 2017. Even via medical aid plans, medications have also become more expensive. Out-of-pocket costs have grown, while reimbursements have declined. Medical schemes are often reluctant to fund bone-loss medication and life-changing devices such as a back brace.

It’s vital that policymakers and health-plan administrators look at ways to empower care providers and patients to chart the best treatment for each patient’s needs. Adopting a “best treatment first” approach would help to reduce hospital stays and address the need for post-fracture care.

Caregiving support

Some patients will require caregiving – more than likely from informal providers like family and friends. Caregiving comes with a host of challenges – emotional, physical and financial – which can place a great deal of stress on the caregiver.

Policymakers, physicians and insurers should ensure that caregivers get proper support. They should also provide easily understandable medical instruction and patient-care materials.

The consequences of osteoporosis can be devastating if left unchecked – for patients, their families and for society. As we mark World Osteoporosis Day on October 20, it’s vital that we restructure our treatment regimes and our medical insurance approach.

Osteoporosis treatment must come early, it must be the best available, and it must be adequately funded.

For more information, contact the National Osteoporosis Foundation of South Africa helpline at 0861 102 265, e-mail [email protected], or visit www.osteoporosis.org.za

The views expressed are those of the author and do not necessarily reflect the official policy or position of the Mail & Guardian.