OncologyRampant Disease Osteoporosis: Under-diagnosed, Under-treated - Experts Call For Earlier Diagnosis And Therapy
"With a continuously ageing population the incidence of osteoporosis is steadily rising. This does not only pose problems to the individuals concerned but is also an enormous challenge for our societies" according to Professor Wolfhart Puhl, past president of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT). Prof. Puhl, of the Orthopç¤dikum Allgç¤u, Germany, who is in Vienna for the EFORT Congress, emphasized that the problem"s "dimension is frequently underestimated. Policy makers and funding agencies do not always consider this development sufficiently in their planning."
More than 8,000 participants from throughout the world are coming together for this major scientific event at the Austrian capital between 3 and 6 June, 2009. International experts are presenting current trends and essential developments relating to all areas of orthopaedics - from basic research to prevention, treatment and rehabilitation.
"Orthopaedists and orthopaedic surgeons play an especially important role in the diagnosis and treatment of osteoporosis," according to Prof. Puhl. "Frequently a bone fracture is the first sign of this disease, so we can make an important contribution in getting those affected on the right path to treatment."
Femoral neck fractures as deadly as breast cancer - only a quarter of those affected get adequate treatment.
The fact that orthopaedic specialists are concentrating on the theme of osteoporosis at their congress in Vienna is of relevance not just to medicine but to public health policy. After all, the problem of age-related diminishing bone density, with its resulting high risk of an inanely triggered bone fracture, is developing into a veritable epidemic in Europe. As experts at the EFORT congress point out, a 50-year-old European woman today faces the same statistical risk of dying from a femoral neck fracture as from breast cancer. In Germany alone about 8 million people suffer from osteoporosis, according to the EU Osteoporosis Report 2008. EU wide, experts assume about 48 million affected, and the frequency is increasing just on the basis of demographic developments alone.
Particularly problematic, notes Prof. Puhl at the EFORT Congress in Vienna, "only just about half of those with the illness will even be diagnosed correctly and not even a quarter of them will get proper treatment." The consequences are dramatic: in Germany alone there are 12,000 femoral neck fractures due to osteoporosis; EU wide the figure is over a million.
There is a need for improvement here, Prof. Puhl notes, not least of all in advanced training for physicians. This is one reason why the agenda of the Vienna congress has dedicated several symposia to the osteoporosis theme.
The widespread proliferation of osteoporosis is not only causing human suffering. It also has enormous economic costs. In Germany alone the impact of the illness on the public health budget amounts to around four million Euros. For the broader EU economy, reliable figures are not available. "It is an important task for health professionals to provide data in order to support decision makers in their planning", says Prof. Puhl. "Apart from Europe, the region covered by EFORT, the growing incidence of osteoporosis is also a global problem, calling for global efforts."
Early recognition particularly important - old age fractures need special management
For that reason alone, scrimping in the case of osteoporosis is penny wise and pound foolish, warns Prof. Puhl. On the contrary, there ought to be investment in specialized patient management, preferably throughout Europe. "Whether or not osteoporosis patients get better or worse care should not be dependent on where they live."
Even in the area of early recognition there is a massive deficit: in a number of European countries, the possibility of a bone density test is still rarely offered - above all because of unavailable cost reimbursement.
Bone fractures require quite different forms of treatment for osteoporosis patients than for bone fractures in young healthy people, Dr. Puhl emphasises. "The bones are porous; the patients suffer from many different illnesses. It"s important that the fracture gets treated as quickly as possible and that the patient is again on his feet as quickly as possible after surgery." Interdisciplinary care of the patients, to include geriatric specialists among others, is of particular importance in such cases, Prof. Puhl notes.
New approach: uncemented prosthesis for osteoporosis
Special characteristics of bone healing play a role in the treatment of osteoporosis fractures. "Naturally one cannot expect the same healing process in osteoporotic bones as in healthy ones. That"s important for the question of if and which implants can be applied in needy cases." There are new approaches in this area that will be discussed at the EFORT congress. Whereas the use of bone cement with elderly patients was standard in the past, research groups will present new data at the Congress showing that an endoprotheses can also be well anchored in osteoporotic bones without cement-fixing.
Biomechanics: better understanding as basis for new therapies:
Researchers are also providing news at the EFORT Congress on the subject of bone biomechanics. The experts use this concept to describe the continuous adaptation process that bone and connective tissue undertake in reacting to the demands of body weight or movement. "Today we can increasingly better understand the biomechanics of the smallest bone trabeculae. That could lead us on the path to new therapies that promote bone healing and bone growth" explained Prof. Puhl. Bone trabeculae are tiny beams of bone tissue from which the spongy interior of the bone is built upon.
One research approach involves understanding the molecular and cellular mechanisms of the healing process of damaged bone. With this additional knowledge new therapeutic possibilities and strategies should be developed to accelerate healing and functionally improve the stabilization of bones. Another approach being followed by a research group in Ulm: whoever moves stimulates the building of bone tissue. The scientists want to find out how precisely the movement stimulus is registered in the cells and transformed into a cell growth command. The long-term goal here is to be able to stimulate this command through medication, for example, instead of through movement.
"Osteoporosis will remain an important theme on the EFORT agenda because of its increasing significance," Prof Puhl emphasized. "For the next Congress in Madrid in 2010 we are planning, together with patient organizations, a debate with political decision makers on the European level. For the sensitizing of the public and policy makers about this disease will be a decisive factor in finally providing care corresponding to the current medical knowledge to those suffering from it."
EFORT