Many of us will have experienced the painful, life-changing effects of osteoporosis. The disease can seriously limit quality of life for sufferers and all 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. Much can be done to improve patient outcomes – by patients, policymakers, healthcare firms and medical aids. As well as improving patient prospects, better systems can also keep treatment costs down for both patients and insurers. 

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. In South Africa, nearly half of all people over 80 have osteoporosis. Ethnicity also plays a role. Among South African women over 50: 1 in 4 White, 1 in 8 Indian, 1 in 14 Coloured, and 1 in 22 Black individuals will have an osteoporosis fracture.

As society has aged, the prevalence of osteoporosis has increased. Today, only 16% of South Africans are over 50, but in the next 20-30 years that number will grow substantially. With aging and urbanisation come diet and lifestyle changes, which contribute to reduced bone mass. Once diagnosed, osteoporosis can be managed, and patients can still enjoy fulfilling lives.

Helping them achieve this, however, will mean delivering on many of their needs that are currently unmet within the South African healthcare system… 

Video Cred: Conley van der Westhuizen

Screening and diagnosis

Screening is often expensive and rarely top-of-mind for providers, but it’s necessary to diagnose osteoporosis. Systematic, routine screening ensures patients with osteoporosis are identified and treated before their first fracture. Delayed diagnosis, or no diagnosis, makes an already at-risk person even more susceptible to bone fracture, which can have serious consequences. 

Even as statistics repeatedly show the value of testing, screening tools remain underutilised. Over the past five years, South Africa has seen a decrease in the number of bone-density tests given.

Secondary prevention, such as pharmaceutical intervention, can also greatly reduce the risk of first, and additional, fractures. Health plans and care providers need to engage with patients of all genders and appropriate ages about the importance of bone-density scanning. Educating patients and providers will help ensure more patients can be treated before a first fracture.

Access to effective therapies 

The accepted, best approach to treating osteoporosis is about strengthening a patient’s bones. Diagnosed 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 become more expensive to South Africans. Out-of-pocket costs have grown, while reimbursements have declined. 

For policymakers and health-plan administrators, adopting a “best treatment first” approach would help to reduce hospital stays, and address the need for post-fracture care.

Most osteoporosis patients discover they have the condition after a fracture. If left untreated, another fracture is likely within 18 months. Implementing a fracture-liaison service is a good solution for a fracture patient, and a major cost-saver for payors.

A fracture-liaison service refers patients suspected of a fragility fracture to an appropriate provider for further testing. Up-front costs are higher, as more osteoporosis tests and scans are done. However, long-term costs – such as acute care and hospitalisation – are reduced.

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-car materials.

The consequences of osteoporosis can be devastating if left untreated – 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.

As South Africa continues to age and urbanise, our people will be more prone to osteoporosis than ever before. Policymakers can act to ensure patients know their bone density status, can access treatments, and receive quality care from well-supported caregivers. 

Osteoporosis treatment must come early, it must be the best available, and it must be well funded. DM/ML

For more information, contact the National Osteoporosis Foundation of South Africa (NOFSA) help line at 0861102265, e-mail [email protected], or visit www.osteoporosis.org.za