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What is osteoporosis?

Osteoporosis is a disease that attacks bones with the spine being the most frequently affected, followed by the hip, wrist, and other sites. It alters bone structure, bones become more ‘porous’, bone mass is reduced, bones become more fragile and people affected are at increased risk of low-trauma fracture (NOS 2015, SIGN 2015). Low-trauma fracture refers to fractures involving minimal force such as a fall from a standing height or less.

How big a problem is it?

Osteoporosis is a common bone disease that affects over 3 million people in the UK (including 250,000 in Scotland) and accounts for around 300,000 fractures per year (Age UK 2015, IOF 2015, NOS 2015). Osteoporosis rates increase with age and in the context of a rapidly ageing population in the UK and elsewhere, the overall numbers will continue to rise. Indeed medical specialists refer to an impending ‘osteoporosis epidemic’ as around 50% of people aged 75 and over have osteoporosis. Globally osteoporosis is a large public health issue.  Although it is commonly viewed as a disease mainly affecting postmenopausal females, it can strike many others in the population. For example, recent robust evidence shows it affects older males in significant numbers giving rise to an increased risk of hip fracture and often poor health outcomes especially in males over 75 years. As this disease is often ‘silent’ in its presentation until fractures occur, it is frequently under diagnosed in the general population and as a result people may not gain access to treatment until it is well-advanced.  

So how does osteoporosis impact on people’s health?

Osteoporosis is associated with higher rates of poor health and increased risk of death (IOF 2015). A serious consequence of osteoporosis is the increased risk of low-trauma fracture with hip fractures linked to osteoporosis incurring most of the negative health outcomes and financial costs. Hip fractures disproportionately affect older people who may live alone hence the need for a strong focus on post hip fracture care in current healthcare systems. Osteoporosis of the spine can cause acute, severe and/or chronic back pain as well as curvature of the spine due to spinal compression fractures and potentially a loss of height. A range of other physical symptoms can be experienced. Fear of falling and causing further fracture can lead to people becoming increasingly isolated and reluctant to leave their homes and in turn this can have a negative impact on physical and mental health. Osteoporosis is a complex disease to manage medically. After diagnosis people normally remain under the care of experienced doctors and osteoporosis nurse-specialists. Physiotherapists, occupational therapists, pain specialists and dieticians also have important areas of expertise to contribute in the management of this disease.

At the public health level there is a great need to target strategies to improve bone health across the lifespan. Screening for osteoporosis and fracture risk is extremely important as with early diagnosis and prompt initiation of medical intervention (and with rapid advances in treatments being the result of exemplary interdisciplinary and specialist research) the disease can be more effectively managed.  Overall, the goal of treatment is to minimize the risk of fractures and the poor health outcomes that can result, especially in the case of hip fracture. We also know that early intervention can substantially improve quality of life for people with osteoporosis. Nursing and Allied Health Professionals all have important roles to play alongside medical colleagues, including in the identification of people at risk,  referral for diagnosis, Fracture Liaison Services, promoting physical activity, symptom management  and helping people to live well with the disease.

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