Proposed fracture liaison service can help prevent life-threatening complications

Osteoporosis has been proven to affect people regardless of gender or population group.

A proposed fracture liaison service (FLS) at Mediclinic Bloemfontein will not only treat, but also help to prevent, the potentially life-threatening fractures that can result from the condition.

One in three women and one in five men over the age of 50 will suffer an osteoporotic fracture in their lifetime. “Osteoporosis is more dangerous than breast and prostate cancer and more people get osteoporotic fractures than myocardial infarctions [heart attacks],” says Dr Wimpie de Lange, an endocrinologist at Mediclinic Bloemfontein. “It’s a deadly condition and a worldwide problem.”

Yet osteoporosis – a disease that decreases bone density, making bones more susceptible to fracture – has been a relatively neglected condition in South Africa. This is mainly because of the historical thinking around it, rooted in studies conducted in the 1950s suggesting osteoporosis was a disease that only affected white people.

“However, in the past five to eight years, we’ve seen that while it mostly does affect the white population, when it comes to hip fractures, the risk of the Indian population is almost the same as for the white population,” explains Dr de Lange. “For the coloured or mixed-race population, the risk for hip fracture is a bit lower, and the lowest risk is in the black population. Yet, it’s not zero. Everybody in South Africa therefore does carry a risk for the development of osteoporosis and its complications.”

The severity of complications depends on the type of fracture the patient suffers. While painful, a wrist fracture has no associated increased mortality risk, osteoporosis is a systemic disease that affects the whole skeleton, Dr de Lange explains. “So, if you break a wrist, it’s indicative of the disease that’s going on everywhere, predicting that you may soon have a vertebral or hip fracture.”

Recent research also reveals that if you’ve recently had a hip fracture, you’re at a higher risk for developing a fracture on the other side. “That’s because the second hip is just as sick as the first one,” he says. The risk of a second fracture is at its height within the two years following the first, but still remains significant within the next five years.

This is concerning because hip fractures can potentially be life threatening. “The in-hospital mortality rate of hip fractures in women is 25%, and 35% for men,” explains Dr de Lange. “If you look at that percentage of those who do survive, a third will die within the next year because of the hip fracture.” While the stats are lower for those with vertebral fractures, they’re also associated with an increased mortality rate.

Why are hip fractures particularly dangerous? It often comes down to age, says Dr de Lange. “You see the wrist fracture early on, around the age of 50, but the hip fractures usually present after 65 to 70. So, you’re sitting with an older patient who probably has other co-morbidities such as hypertension or diabetes, which can have a major impact on them when they suffer a fracture.”

Preventing these potentially life-threatening injuries is the impetus behind Dr de Lange and his colleagues’ dedication to establishing an FLS at Mediclinic Bloemfontein through the National Osteoporosis Society (NOFSA). This would be the third FLS in the country – with others open at Tygerberg Hospital and another private hospital, both in the Western Cape.

“The idea is to train our casualty doctors as well as our surrounding GPs to refresh their knowledge of osteoporosis and its associated complications,” explains Dr de Lange. “The second is treating patients who present to casualty but aren’t admitted. If you’ve broken your wrist or ankle and leave with a cast, and the doctors in casualty think it was an osteoporotic fracture, they’ll notify your GP, who can handle it further. If you are admitted, a specialist physician will be notified to evaluate and treat you.”

“The idea is to treat the patient while they’re still in hospital. It’s about providing holistic, patient-centred care and access to active bone treatment, improving the patient’s quality of life, and preventing the next fracture – and possible death.”

While medication is an important part of the package, prevention of fractures starts with a healthy lifestyle. “Risk factors like smoking, excessive alcohol consumption, taking too much pain medication and following the wrong diet all have a negative impact on your bone heath,” says Dr de Lange. “A family history of hip or vertebral fractures is the highest risk factor for developing osteoporosis, so if this applies to you, do everything you can now to get the healthiest bones you can. Prevention is much cheaper than cure and contributes to survival.”

That’s why adopting a healthy lifestyle, including exercising when you’re still young, is so important. “Doing a lot of weight-bearing exercise increases your peak bone mass so that later in life, your drop-off point is much higher than somebody who didn’t exercise when they were young,” says Dr de Lange. “Exercise when you’re older won’t do a lot for your bone mass, but it improves your muscle strength and balance, which can prevent falling. We usually say that falling from a standing height and breaking something is suggestive of osteoporosis.”

“Once you’ve adjusted your lifestyle and diet, we investigate your medication options to treat osteoporosis and prevent the next fracture. “Currently we have access to very good medication that works, so there isn’t an excuse not to use it,” says Dr de Lange. Medical aids are already relooking the benefits and adjusting their policies in this regard,” he adds.