Cycling, hill-walking, aqua-aerobics, Pilates, line-dancing, swimming, horse-riding – and on top of all of that, 64-year-old Breda Costigan is a regular at her local gym.
When it comes to being active, this dynamic retired teacher from Co Tipperary is always on the go. But when she fell off her horse and broke her wrist she embarked on a challenging journey, first with osteopenia, which is thinning of the bone mass, and later osteoporosis, which is characterised by a loss of bone mass, and has been linked to a number of factors, including ageing and menopause.
Osteoporosis is a common condition in this country. About 300,000 people in Ireland live with osteoporosis, which affects half of all women and a fifth of all men in Ireland over the age of 50. Meanwhile, new research has found that 85 per cent of people over the age of 50 who participated in a national survey had a high risk of developing the disease.
The study took place during the Address and Assess roadshow run last summer by the Irish Osteoporosis Society in conjunction with healthcare professionals and support from biopharmaceutical firm Amgen.
As part of the roadshow, just under 1,000 people, the majority of whom were over the age of 50, were encouraged to conduct a self-assessment online to determine whether they were at risk of developing osteoporosis. The results showed that 79 per cent of those who took the test had high risk factors for the condition.
Often, the first indication of osteoporosis will be a bone fracture, which can be seriously debilitating.
Hospitalised
In 2014 more than 12,000 people were hospitalised for osteoporosis-related bone fractures. This figure is expected to rise to more than 31,000 by 2046. Each year the condition costs the State more than €650 million.
Despite all of this, Dr Frances Dockery– a specialist in bone health and falls prevention, warns there is a huge lack of awareness of osteoporosis in this country. "There have been several surveys in Ireland over the years, and it seems that people regard it as part of ageing and as something that could not affect them," says Dockery, a consultant physician at Beaumont Hospital.
Many people, she adds, have no idea that they have the condition until they break a bone. “If you have a family history of hip fractures or osteoporosis, have any chronic medical condition, or you are prone to falling, you should ask your GP about being checked out for your fracture risk and have a DXA [also known as Dexa] scan,” says Dockery.
Women who are postmenopause should also get checked, she says, adding that “a healthy lifestyle, regular weight-bearing exercises and avoiding smoking and alcohol are key to maintaining good bone health”.
Following her accident in 2011, Costigan had a cast put on her arm. A DXA scan showed moderate to severe osteopenia in both hips. However, with the recommended supplementation and physiotherapy, the wrist gradually healed.
All was well until November 2017 when she started experiencing pain in her left hip and began to limp.
Stress fracture
After an MRI scan showed up a stress fracture in the hip, Costigan had an operation to have plates and screws inserted. However that wasn’t the end of the story and May 2018 brought more bad news for Costigan. A second DXA scan showed she had now joined the hundreds of thousands of people in Ireland living with osteoporosis.
“It was recommended that I take a weekly tablet and calcium,” she says, adding that when finding horse-riding became extremely difficult she gave it up.
In November of that year she saw a consultant who recommended a hip replacement for her right hip. “I had the operation in May 2019 and everything has been going very well since,” she says.
However, Costigan strongly believes, there should be more awareness of the seriousness of osteopenia as a precursor to osteoporosis: "I think people should look for a Dexa scan once they hit their 50s. There is a lack of awareness out there about these conditions and I think we need to be more informed about the risks they pose." (Sunday, October 20th is World Osteoporosis Day)
Dockery is a strong advocate of the fracture liaison services (FLS) operating in some Irish hospitals.
The service assesses people over the age of 50 who have sustained a fragility fracture to determine their risk of further fractures. If appropriate, they are referred for a diagnostic scan (Daxa), a falls assessment and recommended appropriate treatment.
Treatment recommendations are made to the patient's GP. This process, says Dockery, has been proven to prevent further fractures. Dockery – who was involved in the establishment and operation of a national FLS database in England – is now part of an expert Irish working group campaigning for the national rollout of FLS to tackle the huge rise in fracture numbers expected as a result of our ever-increasing elderly population.
Fragility fractures
Ireland has the sixth-highest hip-fracture rate in the world and bed days for hip and other fracture types, says Dockery, increased by 43 per cent between 2008 and 2017. It is estimated that between 30,000 and 50,000 fragility fractures occur annually in Ireland, and, as our population continues to age, this figure is expected to rise. “Fractures exceed bed days used for cancer, heart disease and lung diseases,” Dockery says.
Despite this, she observes, only five of Ireland’s 16 trauma centres have some form of a FLS – but none, she emphasises, are sufficiently staffed to capture all fractures.
“This service needs to be rolled out to all centres and adequately staffed to enable a high-quality effective service, and then we will see a reduction in fracture numbers. The direct and indirect costs of treating osteoporotic fractures in Ireland is over €650 million annually whereas full implementation of FLS in 16 sites across Ireland would cost about €434k annually – and would save the health service €188 million each year.”
“We know that osteoporosis drug treatments can reduce the risk of fractures by as much as 70 per cent. Strength and balance exercise programmes can reduce falls by at least a third. A well-run fracture liaison service can reduce fracture rates by 30 per cent. Once a first fracture occurs, the chances of another are two to three times higher, so prompt identification and management following the first fracture presents a great opportunity to reduce the risk of a second fracture.
"FLS is the key to putting all of this together, by providing a systematic approach to capturing those who have already sustained a first fragility fracture, so their falls and osteoporosis risks can be addressed," Dockery says, adding that studies from Australia and the Netherlands have shown hospitals that introduced FLS showed lower rates of hip and other fractures compared to those that have no service, with the benefit starting about a year and a half from the service start.
