October Academics and clinicians call for a national osteoporosis care programme

University of Galway leads international research to reveal scale of patient and economic burden of silent health crisis 
 

Alarming statistics show up to half a million people in Ireland live with osteoporosis

An international research team has revealed that between 300,000 and 500,000 men and women in Ireland are living with osteoporosis.

The findings are being released by University of Galway to coincide with World Osteoporosis Day on Friday October 20^th. 

Osteoporosis causes bones to become brittle resulting in skeletal failure. Half of all women, and 1 in 4 men, aged 50 years and older will suffer an osteoporotic fracture before they die. 

A postmenopausal woman’s annual risk of fracture is greater than her combined risk of stroke, heart attack, invasive breast cancer and death from heart disease.

Although the burden of illness related to osteoporosis - morbidity, mortality and economic costs - is similar to cardiovascular disease and cancer, the importance of osteoporosis is often not understood, and therefore care is neglected.

Researchers from the schools of Engineering, Computer Science and Medicine at the University of Galway carried out their analysis in collaboration with Tsinghua University in China, Oxford University in England, and Galway, Manorhamilton and Sligo University Hospitals.

The research used data from the health service in Ireland spanning 20 years to reveal: 

• More than 50,000 osteoporotic fractures occur each year in Ireland.
• 1 in 3 men and 1 in 5 women die within 1 year following a hip fracture.
• The number of osteoporosis-related deaths in Ireland is similar to, or greater than, the number of deaths related to Covid-19.
• Fewer than one fifth of people admitted to public hospitals with an osteoporotic fracture are discharged with a diagnosis of, or treatment for, osteoporosis.
• More than 1 million people in Ireland have low bone mineral density putting them at greater risk of fracture.
• Although men have a lower risk of fracture, they account for almost 1 in 3 public hospital admissions for osteoporotic fractures in Ireland.
• Less than 50% of older people who suffer an osteoporotic hip fracture will return to their baseline level of function.
• Fractures are one of the leading causes of long-term admissions to nursing homes.

The research team noted that public hospital bed days for fragility fractures among adults aged over 50 have risen almost 50% since 2008 and are at a higher level than those for ischemic heart disease, solid cancers, or diabetes mellitus - conditions where national programmes exist.

Clinicians, computer scientists and engineers at University of Galway are using Dual-energy X-ray Absorptiometry (DXA) technology to measure bone density and develop new screening and testing strategies for early identification of osteoporosis. 

Funded by the Health Research Board, the Dual-energy X-ray Absorptiometry Management Application Project (DXA MAP) uses state of the art machines to develop a personalised, patient-centred tool for osteoporosis screening and fracture prediction.

The international research team said novel osteoporosis-screening could reduce the number of unnecessary requests for a DXA test and increase referrals for those in need.

Early data suggests the financial cost of poor quality DXA scans in Ireland may be greater than the cost of providing high quality DXA which adheres to national and international standards, in particular avoiding testing and treating those at low risk and improving diagnosis and management of those with prior fractures.

Professor John Carey is Professor in Medicine at University of Galway and Consultant Physician in Medicine and Rheumatology and Clinical lead in DXA, Osteoporosis and Fracture Liaison Services, Galway University Hospitals.

“The key to prevention is the early detection of those most at risk. But what we require is a better use of current resources to benefit those at greatest risk, preventing more fractures, and eventually lead to substantial cost savings,” Professor Carey said. 

“DXA is the clinical test used to diagnose osteoporosis before a fracture occurs, as well as to estimate fracture risk and to monitor the effects of treatment. Access to quality DXA is a global problem, and Ireland is no different. 

“Although Ireland has one of the highest rates of osteoporotic fracture and will have the one of the greatest increases in cost and incidence over the coming decade, it does not have a national programme or consider osteoporosis a national priority. It is very clear to those of us who lead treatment and research of the disease that we should. A national programme could greatly focus efforts to enhance current care and further improvements can be made without additional funding.”

The research team validated the Osteoporosis Self-assessment Tool Index (OSTi) - one of the oldest and simplest methods for the identification of those at risk of osteoporosis - for the Irish population. They then compared it with new modelling, using artificial intelligence, which outperformed OSTi. 

Dr Attracta Brennan, School of Computer Science in University of Galway, said: “AI and big data are deeply intertwined - together, they offer powerful tools for risk prediction, modelling disease progression and prognosis, and supporting intervention recommendations. 

“AI can improve DXA detection of osteoporosis classification in older men and women. Underpinned by AI, our DXA-MAP tool assesses the user’s probability of having osteoporosis in less than 30 seconds using age, gender, height and weight. AI and big data can be used to reduce unnecessary testing, improve patient care, reduce the burden of osteoporotic fractures and improve efficiency and reduce waste.” 

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