Orthopaedics
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Imagine breaking a rib from coughing, fracturing your spine while lifting groceries, or shattering your wrist from a minor stumble.
For millions of South Africans living with osteoporosis, this is reality – yet two-thirds do not know they have the condition until a bone breaks.
"Osteoporosis is called the 'silent disease' because patients may not have symptoms until they fracture," explains Dr Phumzile Mahlangu, Emergency and Family Physician at Mediclinic Legae. "By the time we see them in the emergency department, preventable damage has already occurred."
This sobering reality prompted Mediclinic Legae to host a comprehensive symposium on osteoporosis and bone fragility on 5 October, bringing together GP’s and specialists from multiple disciplines to address what the World Health Organization calls a global public health problem affecting approximately 200 million people worldwide.
This topic was recently highlighted among local medical experts at Mediclinic who shared critical warning signs that could prevent life-changing fractures at the CPD Symposium themed "Osteoporosis and Bone Fragility across the Lifespan" on 5 October 2025.
The Numbers That Should Worry You
In South Africa, one in three women and one in five men over 50 will experience an osteoporotic fracture in their lifetime. The statistics become even more alarming when you consider that after just one vertebral fracture, your risk of another fracture increases five-fold. A second fracture? That risk jumps to twelve times higher.
"What many people don't realise is that osteoporosis causes 1.5 million fractures every year globally," says Dr Zakhele Khoza, Orthopaedic and Spine Surgeon at Mediclinic Legae. "In our practice, we see that two-thirds of vertebral fractures go undiagnosed because people dismiss the pain as arthritis or normal aging."
Perhaps most concerning is the mortality rate. Up to 20% of patients die within the first year after a hip fracture, with two-year mortality rates equivalent to hip fractures at 20%.
When Your Bones Are Crying for Help
So how do you know if you need to see a doctor? The experts at the symposium identified several critical warning signs that should prompt immediate medical attention:
- Sudden or progressive back pain that does not improve with rest could indicate a vertebral compression fracture.
- Loss of height is another red flag. If you have lost more than 3-4 centimetres in height, or if you notice a developing stoop or hunched posture (kyphosis), your spine may already be affected by compression fractures.
- Fractures from minor incidents are perhaps the most obvious warning sign. Breaking a wrist from a simple fall, cracking a rib from coughing, or any fracture occurring from what should be a minor impact requires immediate evaluation.
- Previous fractures after age 50 significantly increase your risk and should trigger a comprehensive bone health assessment.
Who Should Be Screened?
According to the specialists at Mediclinic Legae, you should request a bone density test (DEXA scan) if you:
- Are a woman aged 65 or older, or a man aged 70 or older
- Are a younger postmenopausal woman with risk factors
- Have broken a bone after age 50
- Have taken corticosteroid medications for more than three months
- Have a parent who fractured their hip
- Have experienced height loss or posture changes
- Have been treated for cancer, particularly breast or prostate cancer
Dr Louisa Dlamini, Clinical and Radiation Oncologist, emphasised during the symposium that cancer patients face particular risks. "Certain cancers are likely to cause more bone damage than others, with multiple myeloma affecting bone in 80% of cases," she explained. "Additionally, cancer treatments – including chemotherapy, hormonal therapy, and radiation – can accelerate bone loss and increase fracture risk significantly."
The Hidden Toll: Mental Health Matters
One of the most overlooked aspects of osteoporosis is its profound impact on mental health. Dr Prudence Molete, Specialist Psychiatrist, highlighted during the symposium how the diagnosis and consequences of osteoporosis often bring fear of falling, loss of independence, and social isolation.
"Patients may stop participating in activities they love, avoid social gatherings, and experience depression or anxiety about their fragility," Dr Molete explained. "This fear can become a self-fulfilling prophecy – reduced activity leads to further muscle weakness and bone loss, which increases fall risk even more."
This psychological dimension underscores why osteoporosis requires more than just medical treatment – it demands a holistic, multidisciplinary approach.
The Multidisciplinary Advantage
Mediclinic Legae's approach to osteoporosis management exemplifies this comprehensive care model. The hospital brings together orthopaedic surgeons, emergency physicians, oncologists, psychiatrists, physiotherapists, and legal experts to address every aspect of bone health.
"Rehabilitation is the cornerstone of treatment," explains Pheto Moumakoe-Modingwana, Physiotherapist and Deputy Chairperson of the South African Society of Physiotherapy's Private Sector Group. "Through weight-bearing exercises, balance training, and resistance training two to three times per week, we can increase muscle mass, decrease fall risk, and restore independence. Even patients with established osteoporosis can improve their strength and confidence through appropriate rehabilitation."
The symposium also addressed an often-uncomfortable topic: medical negligence in osteoporosis care. Advocate Maud Letzler, Head of Legal at Genoa Underwriting Managers, emphasised that healthcare providers have a duty to recognise red flags, document them clearly, and ensure patients understand the urgency of follow-up care.
What You Can Do Today
The good news is that bone health is not entirely predetermined. The specialists at Mediclinic Legae recommend these immediate steps:
- Get adequate calcium and vitamin D – aim for 1,000-1,500mg of calcium daily (depending on your age) and 800-1,000 IU of vitamin D. Calcium-rich foods include dairy products, broccoli, sardines, pilchards, and even baked beans.
- Engage in regular weight-bearing exercise – walking, stair climbing, and light resistance training can strengthen bones and reduce fall risk.
- Stop smoking and limit alcohol – chronic alcohol consumption decreases bone strength and doubles hip fracture risk when more than eight drinks are consumed per week.
- Make your home safer – remove tripping hazards, improve lighting, install grab bars in bathrooms, and ensure you wear appropriate footwear.
- Review your medications with your doctor – some drugs contribute to bone loss and may need adjustment.
A Call to Action
As World Osteoporosis Day (25 October) approaches, the message from Mediclinic Legae's multidisciplinary team is clear: do not wait for a fracture to think about your bone health.
"A conversation with your doctor and a simple screening test could be the difference between maintaining your independence and facing a life-altering injury," concludes Dr Khoza. "The silent disease doesn't have to break you – but only if we identify it early and treat it comprehensively."
For more information about bone health services or to schedule a screening, contact Mediclinic Legae or speak with your family physician about your personal risk factors.