Calls to prioritise $3 billion health problem

The rebranding to Healthy Bones Australia comes as concerning figures show that in 2020, 173,000 bones were broken in Australia.
 
An estimated 3.8% of Australia’s population has osteoporosis, and Healthy Bones Australia is calling for more focus on understanding the risk factors and optimum preventive approaches to reducing brittle bones and osteoporosis.
 
‘The renaming of our consumer organisation reflects our aim – to protect, support and build better bone health for all Australians,’ Healthy Bones Australia’s Medical Director Professor Peter Ebeling said.
 
‘Much more must be done to improve public awareness of the importance of maintaining healthy bones, and the diagnosis and treatment for those at risk, and living with osteoporosis.
 
‘Early diagnosis of osteoporosis is vital to reducing fracture rates, and their subsequent impacts and costs.’
 
It is estimated that osteoporotic fractures cost the Australian healthcare system more than $3 billion each year.
 
Dr Jane Elliott is a GP, women’s health specialist and Clinical Senior Lecturer at the University of Adelaide’s School of Paediatrics and Reproductive Health. She told newsGP the rebrand will help define GPs’ role.
 
‘As GPs we are aware that patients often confuse osteoporosis with osteoarthritis,’ Dr Elliott said.
 
‘The new name focuses on a positive preventive health aspect of healthy bones and reflects our patient aim of protecting bones by prevention, building healthy bones by early diagnosis and treatment, and supporting patients with osteoporosis with ongoing management.’
 
The rebrand coincides with a recent paper published in MJA Insight by osteoporosis experts, including Dr Elliott, presenting preliminary findings and recommendations from the recent Inaugural National Consumer and Community Forum.
 
Convened as part of the National Strategic Action Plan for Osteoporosis, the forum’s expert panel comprised GPs, specialist groups, policy makers, national health organisations, community groups and people living with osteoporosis, and examined ways to address health system barriers to improving Australian’s bone health.
 
Dr Elliott said there are many challenges facing the health system but the expert panel was able to table a set of key recommendations for establishing osteoporosis’ higher position as a national health priority.
 
‘Firstly, public awareness of osteoporosis and risk factors needs further availability of good evidence-based resources ­– the new Healthy Bones Australia website and the joint Osteoporosis Australia/RACGP guideline are very welcome and useful tools for GPs in clinical practice,’ she said.
 
‘The community can be targeted by awareness campaigns, and GPs’ role in their communities is always one of education and identification of lifestyle issues.’
 
Dr Elliott said more focus on bone health to prevent osteoporosis and earlier intervention by GPs is needed, including early investigation of bone health as part of a general health check.
 
‘This can be both opportunistically at consult after a fracture, or actively via clinical case findings and reminder computer software,’ she said.
 
‘Including osteoporosis risk factors and reminders for DXA [dual-energy X-ray absorptiometry], if appropriate, at the time of implementing a GP Management Plan for other chronic diseases, and in the Over 75 Health Assessment are other important ways to bring osteoporosis awareness to the patient and prioritise our awareness.’
 
Also among the recommendations is an increase in hospital fracture liaison services (FLS) to capture all patients post-fracture to examine their bone health, and to outline any treatment referral.
 
‘If a patient has been seen in a hospital for an osteoporotic fracture, then whether they are seen in an FLS or not, good communication from the hospital back to the GP is not always timely or optimised – this could be improved to guide follow up,’ Dr Elliott said.
 
‘Improved capture of post-fracture patients via hospital FLS is important, but not all patients are treated in hospital or indeed “captured” so it is up to GPs to follow up these patients in the community.’
 
Dr Jane Elliott says that more needs to be done to promote awareness of healthy bones.

Another ‘major barrier’ is GP access to ways of prioritising and managing multiple chronic diseases, and broadening treatment criteria, according to Dr Elliott.
 
‘This allows [GPs] time to educate and provide preventive care,’ she said.
 
‘Along with some restrictions on PBS prescribing, there are restrictions on Medicare benefits for DXA, which also could be broadened to improve diagnosis of osteoporosis.
 
‘It was recommended that osteoporosis treatment reimbursement criteria be reviewed and broadened. There are now several good treatment options for osteoporosis diagnosis after a fracture, but in the under-70 age group if it is a diagnosis on DXA without a fracture, options are limited.’
 
The recommendations are in line with the Asia Pacific Consortium on Osteoporosis (APCO) Framework, launched in January as a benchmark for delivering best osteoporosis care in the Asia-Pacific region.
 
The APCO framework comprises 16 minimum clinical standards for the screening, diagnosis and management of osteoporosis, as well as individual intervention selection and patient guidance for self-care.
 
It is estimated that by 2022, there will be 6.2 million Australians over the age of 50 with osteoporosis or osteopenia – a 31% increase from 2012. It is also predicted there will be one fracture every three minutes – 501 fractures per day and 3521 fracture per week.
 
Dr Elliott said that GPs ‘clearly serve’ as the primary healthcare group responsible for managing patients living with osteoporosis and bone health in general, with coordinating referrals to other specialists only reserved for more complicated cases.
 
‘GPs’ role in identifying patients with risk factors for osteoporosis, educating about lifestyle risks, diagnosing using DXA and preventing ideally the first fracture, but at least preventing the second fracture, is essential,’ she said.
 
‘The question is, how do GPs add this important role to busy clinics? As we know, more patients now have multiple chronic diseases and the difficulty can be how to prioritise and not miss those that are like osteoporosis, the “silent disease”, until a fracture occurs.’
 
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