By Dr. Will Briggs

In a world with increasing comorbidities, musculoskeletal health is often an afterthought for clinicians. Osteoporosis, the most common bone disease, isn't usually a priority, but it should be.

The estimated global prevalence of osteoporosis is very high, at around 18.3%. Osteoporosis places a high burden on healthcare systems. In the US, direct and indirect Medicare costs for osteoporosis-related care are around $57Bn a year. Characterized by bone mineral density (BMD) loss and changes in bone microarchitecture, osteoporosis is usually symptomless until a fracture occurs. Once a fracture occurs, both morbidity and mortality risks are elevated; one study found the rate to be 33% in the 12 months following a hip fracture. Limited mobility, decreased independence, and interference with the ability to perform daily tasks all contribute to the adverse outcomes that patients and their caregivers must face following an osteoporotic fracture. For example, the care required after someone is discharged from hospital following a hip fracture accounts for the majority of the incident’s overall cost, at 69%. Once an initial fracture has occurred, subsequent fractures become more likely, ever-increasing the impact on the patient and the system. Patients who suffer vertebral and hip fractures are at especially high risk of mortality.

Despite progress in treatment options and understanding of the disease, osteoporosis care still has gaps. Due to the aging population and increasingly sedentary lifestyles, it is predicted that the already high incidence of osteoporosis will skyrocket in the coming years. One key improvement area is early detection; as we discussed above, osteoporosis is usually only diagnosed after a fracture has already occurred. If we, clinicians, are aware of a person’s risk and can intervene early to prevent bone deterioration, then it is possible to reduce the risk of a fracture and mitigate the associated problems.

Does osteoporosis screening need to be fixed?
Treatments and lifestyle interventions exist that can slow the progression of bone loss. However, healthcare providers and patients face the challenge of underdiagnosis of osteoporosis.

Current screening guidelines globally are heterogeneous. In the US, the US Preventative Services Task Force recommends screening women 65 years and older and Postmenopausal women younger than 65 years at increased risk of osteoporosis. The US doesn't recommend screening for men of any age or risk profile currently, although these guidelines are under review as the impact of osteoporosis in men has been recently highlighted by an international workforce, showing that there are areas for improvement.

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