She emphasised the widespread, global nature of osteoporosis, highlighting that 80% of individuals living with an osteoporotic fracture are never diagnosed or treated for osteoporosis.
Projected statistics indicate a significant increase in hip fractures, especially in ageing populations, with fractures in men expected to rise by 310% and in women by 240% from 1990 to 2050.
In South Africa, there is limited epidemiological data on osteoporosis. However, current estimates suggest that around 2.5 million individuals >50-years are affected.
Studies show that vertebral bone density and fracture rates in South Africans from African and European descent are comparable, emphasising the need for country-specific diagnostic tools like the FRAX tool, designed to enhance fracture risk assessment in South Africa.
Risk factors for osteoporosis include both modifiable (eg smoking, excessive alcohol, low BMI, poor nutrition, lack of exercise) and non-modifiable factors (eg genetics, family history, certain medications, and medical conditions like rheumatoid arthritis and diabetes). For women, bone mass loss can accelerate post-menopause, increasing fracture risk.
Osteoporotic fractures, particularly vertebral and hip fractures, lead to substantial morbidity. Only one in three vertebral fractures are diagnosed, with many cases going untreated.
These fractures not only result in physical limitations but also decrease quality of life, with conditions like kyphosis and chronic pain leading to complications such as breathing and digestive issues, and increased dependency and depression.
DXA scans, though often used to assess osteoporosis risk, are not diagnostic tools but rather risk indicators for osteoporotic fractures. These painless scans take about 20–30 minutes, providing a T-score based on bone density compared to peak bone mass, typically achieved between ages 25 and 30.
The diagnosis of osteoporosis, especially in older adults, has significant emotional and physical repercussions. Patients often feel frail, which can lead to anxiety, fear of movement, and even depression, impacting their quality of life and increasing their dependency on family or caregivers. This change also affects family members, who may face financial and emotional burdens as they support the patient’s daily needs and safety.
Lifestyle modifications are crucial for osteoporosis prevention and management. A calcium- and vitamin D-rich diet, limited alcohol, and no smoking are fundamental.
Weight-bearing exercises like walking or low-impact activities such as yoga and Tai Chi help maintain bone and muscle health, reducing the risk of fractures. However, high-impact activities and certain exercises should be avoided in severe osteoporosis cases, and individual exercise plans should be developed with healthcare providers.
Vitamin D, mostly obtained from sunlight, is vital for calcium absorption. Given common deficiencies due to limited sun exposure, fortified foods and, if necessary, supplements are recommended.
Managing medication, especially polypharmacy in older adults, reduces fall risk, as certain drugs can increase dizziness or coordination loss. Routine vision checks and home modifications also support fall prevention. Pharmacologically, options include antiresorptive and bone-forming agents, though some newer treatments are yet to be widely available.
In summary, early screening, comprehensive lifestyle guidance, and a proactive approach to fall prevention are key to managing osteoporosis and improving patients' quality of life.
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