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"Only 20% of patients with osteoporosis receive treatment"

The Greek researcher based in Holland is one of the most recognized authorities on osteoporosis and bone metabolism. We interviewed him in Toronto, Canada, at an international congress on his area of expertise

JORDI MONTANER | DECEMBER 30TH, 2010

What is osteoporosis?
First of all, I have to say that this is a chronic disease.

There are people who do not consider it a disease but rather a condition, like high cholesterol.
Let me tell you that the relationship between osteoporosis and vertebral and hip fractures is much clearer than the link between cholesterol and ischemic cardiomyopathy. I find it nonsense not to accept that osteoporosis is a chronic disease because it is a health problem with dramatic effects on survival and the quality of life of patients, and it is perfectly diagnosable and treatable with medicine.

How can someone know if he or she suffers from this disease?
Like hypertension, osteoporosis has no symptoms. However, the family doctor or gynecologist who follows the patient (we usually speak of women) can use clinical tests to identify a weakening of the bones, which become more porous, brittle and, therefore, can break a lot more easily. The density and quality of bone are reduced, a fact which implies a weakness of the skeleton and an aggravated risk of fracture in the spine, wrists, hips, pelvis and extremities. If untreated, the disease progresses until the bone literally dissolves.

What does it have to do with hormones?
Some people confuse osteoporosis with a "wearing down" of the bone. Bones are living tissue with two layers, a cortical and a trabecular layer, which wear down and are continually renewed, so that the bone as a unit is remodeled. We can speak of a metabolic process focused on calcium and vitamin D that is instigating by a diverse group of hormones: growth hormones (GH), T3 and T4 hormones, thyroid hormones, sex hormones such as estrogen, progesterone and testosterone, the so-called growth factors (IGF) similar to insulin, cortisol, parathyroid hormones (PTH) and calcitonin. Each of these hormones is involved in a certain stage of growth. Until the third decade of life, bones are being built. Later, they are gradually taken apart, a process due to hormonal changes like menopause.

Osteoporosis is not as well known as diabetes, hypertension or hypercholesterolemia, but it affects millions of people.
The World Health Organization estimates that more than 75 million people in Europe, Japan and North America suffer from it. We do not have data from other regions or countries. In 2000, 1.7 million forearm fractures, 1.6 million hip fractures and 1.4 million vertebral fractures were attributed to osteoporosis.

At the congress of the ASBMR, here in Toronto, it has been said that a sedentary lifestyle and obesity have led to fewer fractures worldwide.
The skeleton does not move much and has more "cushion." But that does not mean you have less osteoporosis, quite the opposite. Globally, the risk of osteoporotic fracture in women is 30% to 50%. In men, the risk drops to 15% to 30%.
Also, here in Toronto, we have heard that 3.8 million European Union citizens have experienced osteoporosis-related fractures, of which 8,900,000 were related to the hip. Continuing in Europe, one in three women and one in five men over age 50 will suffer a fracture during the remainder of their lives. In the United States, it is believed that there are about 34 million people with very low bone mineral density (osteoporosis).
New data from Australia is also very interesting: 2.2 million Australians have osteoporosis, and this figure is expected to reach 3 million by 2021. Every five minutes there is a hospital visit in Australia related to an osteoporotic fracture, accounting for 262 admissions per day.

In addition to a chronic disease, to what extent can we speak of a serious illness?
European data says that 24% of women that underwent a hip fracture and 33% of men die within one year after surgery. Among those who survive, approximately 40% are unable to walk and 80% of cases become dependents. As a result, around one third of the patients operated on lives in residential facilities.

But you said that osteoporosis can be treated.
We have established the efficacy of oral bisphosphonates and have argued for health authorities to ensure levels of calcium and adequate vitamin D in the diet or the use of supplements. The problem is that only 20% of patients with osteoporosis and in risk of fracture are being treated.
Moreover, here in Toronto we have presented data from an extension of the FREEDOM study that confirms the safety profile and efficacy of a new drug, denosumab, a monoclonal antibody developed by a biotechnology company (Amgen). The study has gathered data of nearly 8,000 patients and has achieved a 40% reduction in hip fractures and 68% drop in vertebral fractures. Most interestingly, in order to ensure its correct use, it is dispensed by subcutaneous injection every six months.

CHRONIC AND EXPENSIVE
Osteoporotic fractures impose a heavy financial burden on society as a whole. The total direct medical cost of osteoporosis in Europe has been estimated at more than 36 billion euros per year and is expected to multiply over the coming decades. Hip fractures generate higher economic costs compared with other fractures because these patients require long hospital stays that can last months. It is for this reason that experts have developed an algorithm for evaluating fracture risk, FRAXTM, which includes risk factors such as age, sex, weight, height and densitometric measures, and other clinical parameters such as previous fractures and family history. FRAXTM calculates the individual’s probability of suffering an osteoporotic fracture in 10 years as a percentage that can guide physicians in making decisions. More http://www.iofbonehealth.org.

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