Clinicians have called for a national osteoporosis strategy after new research showed up to 70 per cent of patients are not receiving appropriate treatment, and that osteoporotic fractures are one of the main reasons for acute public hospital admissions.
Osteoporosis is a condition that causes large holes to develop in bones, which can cause them to break easily. About 300,000 people in Ireland have osteoporosis, with only about 19 per cent of people diagnosed, according to the Irish Osteoporosis Society.
A team of clinicians and academics at University of Galway carried out an analysis of findings from a study of more than 5,000 men and women referred to Galway University Hospital’s osteoporosis service.
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They said the research, published to coincide with World Osteoporosis Day on Sunday, revealed the scale of overtreatment of people at low risk of osteoporosis and undertreatment of those most in need of medication.
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The results showed the majority of men (70 per cent) and women (54 per cent) who are at very high risk of fracture are not on treatment, while an even greater proportion of at-risk men (80 per cent) and at-risk women (70 per cent) are not taking appropriate treatment.
Ireland does not have an osteoporosis programme, although the bone disease is one of the most prevalent and disabling diseases in Ireland and accounts for almost 10 per cent of the healthcare budget.
The research team said a national osteoporosis programme would help address these anomalies, reduce waste in the health service, prevent harm from overdiagnosis and overprescribing, and improve appropriate prescribing for those most likely to benefit.
Prof John Carey, one of the lead researchers from the University of Galway, said overprescribing in low-risk people has led to a “false impression – an ecologic fallacy – that the treatment gap that we have for osteoporosis patients in Ireland is actually quite small.
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“When treatment indications are taken into account, the gap remains unacceptably large,” he said.
“A national osteoporosis programme would help address these anomalies, reduce waste and harm for the patient, and improve treatment for those most likely to benefit. This would make a significant improvement in the quality of care and value for money.”
The research found calcium and vitamin D is widely prescribed for people concerned about their bone health. This is despite “very strong evidence” that while additional supplementation has a benefit for the majority of people, it has a “significant cost and can cause harm” including increasing the risk of fracture.
Calcium and vitamin D prescribing exceeds osteoporosis medication prescribing, and costs about the same as osteoporosis medications, which have “very strong evidence” to support their use.
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Many low-risk men and women are prescribed osteoporosis medication who do not need it, the research found, while the majority of people who should be prescribed osteoporosis medication are not.
The research team estimated the true gap for patients not receiving appropriate treatment is in the region of 60-70 per cent.
Clinicians, computer scientists and engineers at the University of Galway use modern scanning technology to assess a person’s risk before a fracture occurs, as well as to assess their prognosis and monitor treatment.
“We regularly see patients in clinic who had a test they did not require, following which a poor-quality report and interpretation led to overtreatment and sometimes significant harm to the patient and all of the associated costs,” said Prof Carey.
He said that a national programme would “significantly reduce waste and provide better-quality care and value for money”, adding it was something the Government should be “striving for”.
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