Prevention of recurrent fracture oft ignored aspect of bone health

This call comes as the nation enters the post-COVID-19 phase. Osteoporotic patients can be managed by identifying their risk factors, altering their perceptions to place importance on appropriate management of fragility fractures, and implementing preventative measures to avoid future fractures, if one has already occurred. The COVID-19 pandemic has somewhat eclipsed osteoporotic care leading to reductions in bone mineral density assessment, interruptions to medication supply, and disruption to treatment. [Osteoporos Int 2021;32:611–617]

Indeed, following the pandemic, delayed referrals and irregular follow-ups or care were observed, which may have contributed to an increase in complaints such as fractures. This results in an increase in fracture rates, as well as a substantial rise in individual morbidity and societal burden. As the endemic phase begins, it is crucial for those with osteoporosis to avoid fractures. [Osteoporos Int 2021;32:611–617]

Speaking at the media event, Dato’ Dr Lee Joon Kiong, president of Fragility Fracture Network Malaysia and consultant orthopaedic surgeon said: “Malaysians must be aware of the bone health related post-pandemic issues that need to be addressed. Reduced physical activity drastically increases the risk of falls and fractures, and reduced vitamin D levels due to the lack of sun exposure has a negative impact on bone health. Increased social isolation may also result in cognitive impairment among older persons leading to lack of adherence to proper treatment or dietary care and engaging in activities that pose a greater risk for falling and fractures.”

An initial fracture increases the risk of subsequent fractures. Every year, millions of men and women suffer osteoporosis-related fractures, and nearly half of those who break their hip have had a previous fracture. Importantly, a prior fracture is associated with an 86 percent increased risk of any fracture and an elevated risk in the first 2 years following an initial fracture. [Available at https://www.osteoporosis.foundation/health-professionals/fragility-fractures/epidemiology Accessed on 13 October 2022] However, despite these individuals being at an increased risk of osteoporotic fracture, only 12 percent were on bone health optimizing medications and less than one-fifth underwent surgery within the recommended 48-hour window from hospital admission due to a lack of awareness about bone health management. [Available at https://apfracturealliance.org/current-future-challenges-of-hip-fracture-management-in-malaysia/ Accessed on 13 October 2022]

“Based on Malaysia’s growing ageing population along with the highest projected number of hip fractures in Asia, this is expected to cost the country over RM530 million for health-related services in 2050. Prioritizing bone health at the national level and implementing healthcare policy aimed at reducing the burden is a strategic and systematic approach that will help minimize the negative impact on the population and healthcare system,” said Professor Dr Chan Siew Pheng, president of the Malaysian Osteoporosis Society and consultant endocrinologist, who was also present at the event.

Osteoporosis backgrounder
Osteoporosis is referred to as a “silent disease” because it causes gradual weakening of the bones and is frequently not diagnosed until a fracture occurs. Fractures caused by osteoporosis are a major health concern among older adults and postmenopausal women, causing significant disability, diminishing the quality of life, and in extreme cases even resulting in death. [Available at https://www.bones.nih.gov/health-info/bone/osteoporosis/overview Accessed on 13 October 2022, Available at https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Rheumatology/CPG%20Mx%20of%20Osteoporosis%20Second%20Edition%20(2015).pdf Accessed on 13 October 2022] Locally, less than 25 percent of Malaysians who suffered a fracture were able to walk independently 6 months after being discharged from a medical facility, while the rest were immobile or required a walking aid. [Malays Orthop J 2020;14(3):16–21]

Osteoporosis Awareness Society of Kuala Lumpur and Selangor (OASKLS), Fragility Fracture Network Malaysia (FFNM), and Malaysian Osteoporosis Society (MOS) constitute the Bone Health Alliance Malaysia (BHAM). Amgen Malaysia is the corporate partner of support. The partnership is established to pave the way for bone health promotion in local communities, meaningful stakeholder engagement, and improved treatment and diagnosis with the aim of enhancing patient outcomes.

OASKL president, Choo Yem Kuen said: “A subsequent osteoporotic fracture would not occur if the first fracture had been promptly and adequately treated. Notably in the post-pandemic setting, Malaysians must adopt a positive behavioural change in bone health management by seeking treatment upon a fracture. Echoing the BHAM standpoint, as primary care physicians are the first point of contact for most people, we want to empower Malaysians to discuss bone health with their physician by sharing concerns and questions.”

 

Tips to prevent subsequent osteoporotic fractures:

·        A healthy and balanced diet with sufficient intake of calcium, protein, and vitamin D.

·        Regular exercise that improves balance, posture, coordination, and muscle strength.

·        Be proactive about preventing falls, inside and outside the home by fall-proofing the environment.

·        Assess osteoporosis risk through a DXA scan and come up with the appropriate bone health management.

·        Maintain continuity on bone care and treatment.

Ed: A fragility fracture may be defined as a pathological fracture that results from minimal trauma (eg. a fall from a standing height) or no identifiable trauma at all. The fracture is both a sign and a symptom of osteoporosis.