“Our skeleton is formed before we are born, supports us throughout our lives, and can remain long after we die. Regardless of age, gender, race or nationality, we all have one. Yet this essential organ is so often taken for granted”. World Osteoporosis Day Report 2015.
We don’t tend to think about our skeleton very much. But without a healthy skeleton, we can be in big trouble. Osteoporosis causes bones to become weak and fragile, so that they break easily, even as a result of a minor fall or a bump. Fractures caused by osteoporosis can be life-threatening and a major cause of pain and long-term disability. You only have to ask yourself if have you known someone who has broken their hip. If so, you know just how devastating osteoporosis can be. The good news is that osteoporosis can be diagnosed, prevented and treated.
This month, our friends at Osteoporosis New Zealand (ONZ) are supporting the International Osteoporosis Foundation’s (IOF) World Osteoporosis Day (WOD) Awareness Campaign. The focus of the Campaign is to raise awareness that certain specific groups of New Zealanders are at increased risk of suffering osteoporotic fractures, also known as fragility fractures. These include:
- People who have sustained a fracture as a result of a minor fall or injury
- People taking certain types of medicines to control other medical conditions
- People who are living with certain diseases
Anyone who has broken a bone after 50 years of age as a result of a fall or modest impact should ask their doctor whether osteoporosis might have caused that fracture. A number of medicines which play a critical role in managing other diseases can have a negative effect on bone health, including Androgen Deprivation Therapy (ADT) for the treatment of prostate cancer [Goserelin (Zoladex), Leuprolide (Eligard, Lucrin), Flutamide (Flutamin)]. Further, people living with certain other diseases should also think about their bone health as these can be associated with bone loss and fracture risk.
ADT, in the form of gonadotropin-releasing hormone agonists (GnRHs), limits the production of testosterone and estradiol, hormones which play an important role in maintaining bone health. Consequently, a rapid decline in bone mineral density (BMD) is observed during the first year of ADT treatment. Studies have shown that men treated with GnRHs experienced significantly higher rates of fractures compared to men who didn’t receive treatment. Longer duration of treatment also conferred greater fracture risk.
Clinical guidelines relating to the prevention and treatment of ADT-induced osteoporosis are available in many countries, including New Zealand. In 2011, trans-Tasman guidelines were published by the Urological Society of Australia and New Zealand, in collaboration with the ANZ Bone and Mineral Society and the Endocrine Society of Australia. The guidelines made recommendations on the assessment and management of bone and metabolic health in men with prostate cancer who are receiving ADT. These included:
- Baseline assessment of bone health at the initiation of ADT.
- General measures to prevent bone loss, including regular physical activity, as well as ensuring calcium and vitamin D sufficiency.
- Men with a previous fragility fracture should receive osteoporosis treatment unless contraindicated; for those who have not sustained a fragility fracture, treatment is advised for men at high fracture risk.
Significant progress has been made in New Zealand in recent years. In 2012, ONZ published BoneCare 2020, which called for a national effort to develop a systematic approach to hip fracture care and prevention. Implementation of this strategy is now well underway, with systems to prevent fragility fractures being implemented across the country and establishment of a NZ Hip Fracture Registry. In July, ACC announced a major investment aimed at reducing the number of falls and fractures older people suffer.
You can read more about this exciting Campaign at www.osteoporosis.org.nz and learn how to keep your bones healthy throughout life.