Detection of the bone-thinning disease may be getting easier thanks to simple scanning methods but the situation is getting worse. Niamh Hooper reports
Two in 10 Irish people who fracture their hip will be dead within a year due to complications, according to Prof Moira O'Brien, head of the Department of Anatomy in Trinity College Dublin.
And five in 10 will not be able to look after themselves from then on - with at least 25 per cent being forced to resort to being cared for in a nursing home. The latest statistics relate to a silent disease - more commonly known as osteoporosis.
Essentially osteoporosis is the thinning of bone which leads to an increased risk of bone fractures, pain and deformity. No longer a condition associated with menopausal women or, as the French so eloquently put it, women of a certain age, osteoporosis is now claiming more men and children among its victims.
Broken down on a gender basis, one is three women will get it and one in five men. The figure for men is in stark contrast to say five years ago when it was estimated one in 20 men would get it.
Granted, detection using the simple Dexa scan has increased the chance of diagnosing the disease but that aside, founder and chairwoman of the Irish Osteoporosis Society, Prof O'Brien, says the situation is getting worse.
"We are especially concerned with low-level fractures in men and women under the age of 50 that go untreated," she says. "If someone breaks their hip, unless investigated and treated they are guaranteed to fracture the other one within six months. Most fractures are not being diagnosed as osteoporosis and are not being treated. It's really scary."
A low-level fracture can be anything from when you cough and break a rib to falling over or tripping and breaking a wrist.
In 2002 in a Dublin hospital, of the 230 people seen with low-trauma fractures, half had fractured their hips. Of that 50 per cent, only 17 per cent were screened and only 12 per cent were given medication. In January of this year in one of the major regional hospitals, of the 34 people with low-level fractures seen, not one of them was treated for osteoporosis.
"If the people who have fractures are not treated they will be back within six months with more broken bones and will take up hospital beds for anything from three weeks to three months," she says.
The cost of treating one person with a hip fracture is up to €26,000. However, as bleak as the picture she is painting is, the good news is that the disease is curable and preventable.
Diagnosis is the key. As the former doctor to the Olympic team, Prof O'Brien changed her focus in 1990 from sport to osteoporosis when she found the athletes were getting stress fractures.
By over-exercising on too little food they were inhibiting the body from forming the hormones essential to prevent bone loss of bone.
Since the introduction in 1993 of Trinity College's Dexa scan - which is safe, quick and uses only 1/16th of the radiation of a chest X-ray - she has scanned more than 10,600 people. Among them a growing number of children. She has seen 12-year-old girls with fractured spines from anorexia.
The main cause of osteoporosis is a lack of hormones; oestrogen in women and testosterone in men. Early menopause, lack of exercise, over-exercise or irregular periods are common culprits in women while in men it is often triggered by excessive stress, either physical or psychological, and the use of steroids.
According to rheumatologist in Connolly Hospital in Blanchardstown, Dr Eithne Murphy, steroids pose a great risk to bone density. "Steroids are definitely the worst medication for bones. While they're good for other conditions, when it comes to bones they're bad news.
"Throughout life you break down bone and replace it but if you are on steroids you break the bone down much faster than you can replace and the net effect is you're going to lose bone density," she says.
Steroids are commonly prescribed for respiratory problems such as asthma.
If on steroids, people need to be sure they get Vitamin D and calcium, urges Dr Murphy who will be co-chairing a national conference on osteoporosis in Dublin with geriatrician from Beaumont Hospital, Dr Alan Moore, in the coming months.
In keeping with the International Osteoporosis Foundation making 2005 the year of healthy exercise, Prof O'Brien emphasises that exercise is the best stimulus for healthy bone growth.
"Whether it's walking, skipping or running up and down on the spot, people need to do weight-bearing exercise for 30 minutes a day.
"If you prefer to do it in three bouts of 10 minutes that's perfectly fine but you just need to do it."