So, today on World Osteoporosis Day, I’m going to abruptly break the silence. This forgotten, under-estimated disease has surged, on the quiet, to become one of the most urgent global public health challenges of the modern era. And, if we don’t act, generation after generation will face unnecessary suffering that will flood into our recovering NHS.
As we take for granted a longer life, osteoporosis strikes at the heart of the vision we have for our older selves, threatening our freedom, quality of life and independence. Yet it’s called “the silent disease” because of under-diagnosis, a postcode lottery for NHS services, startlingly low awareness, and harmful myths that curved backs and height shrinkage are just normal parts of getting older.
The reality is a disease which weakens the bones of those who live with it, leaving them vulnerable to broken bones following the slightest injuries. Just a fall from standing height, a cough, or even a hug from grandchildren is enough to cause a painful, life-limiting fracture.
Half of women over 50 – that’s right, half – will suffer such fractures due to osteoporosis and one-in-five men. The condition sneaks up on people; for many, the first sign they have osteoporosis is their first fracture. And, every day, hundreds of broken bones are being fixed up and forgotten about without investigating or treating the creeping disease underneath. In fact, a quarter of women with osteoporosis suffer three or more fractures before getting a diagnosis.
One fracture is a powerful predictor of another, often more serious than the last. A red flag for progression of the condition is a fracture in the spine. Painful and severe in themselves, spinal fractures are alarm bells for a future hip fracture – the injury which does more than any to limit people’s lives and steal their independence.
Yet over 180,000 Scots today are walking around with undiagnosed spinal fractures – the alarm bells are ringing loud but aren’t getting heard. Tragically, in so many cases, this ‘sit up and listen’ injury is misdiagnosed as back pain, the loss of height is misinterpreted as ‘just mum getting older’, and the silent disease creeps onward.
By the time you’ve read this far, at least five people will have fractured somewhere in the UK. The disease will cause 44,000 fractures in Scotland alone this year. In our ageing society, the sheer number of these fractures is driving spiralling costs for the NHS. And hundreds of thousands of older people are spending their later years burdened with pain, disability and social isolation. Osteoporosis is stealthy, persistent and a master of disguise.
Fortunately, it’s also both beatable and largely preventable. With an early diagnosis and the right treatment, people with osteoporosis can live very well, thanks to safe, effective medication which is highly affordable for the NHS.
But the silence around the condition, the missed opportunities for diagnosis and the postcode lottery for quality treatment mean that 90,000 people every year in the UK are missing out on the medication they need to protect their bones.
When it comes to treatment, the Scottish NHS has lessons to teach England. Everyone in Scotland has access to a fracture liaison service (FLS), which is the gold standard for diagnosing osteoporosis without delay and moving those affected onto a treatment plan to prevent further broken bones.
This compares to just over half of people in England and two-thirds of people in Wales. The game-changing FLS model was actually pioneered in Glasgow and proved so effective that it was exported and copied across the world. It’s a bitter irony that so many people around the UK are missing out on the medication they need due to the postcode lottery for access to one.
Transparency is another weapon to break the silence around osteoporosis. And this is an area where Scottish people deserve a better deal. Despite the Scottish NHS’s strong performance on FLS coverage, we often hear from Scots who are falling through the cracks because of variations in the quality of those services.
Scottish health boards aren’t required to take part in the UK-wide FLS audit, which keeps a watchful eye on the quality of fracture services. This means Scots with osteoporosis can’t read public data on how their hospital is performing. And it means these services in Scotland can’t learn from their own performance and each other’s.
Given Scotland’s proud history on fracture prevention, this can’t be right and we’re asking Scottish ministers to let the sunshine in by making the data public.
As well as being treatable, osteoporosis is also largely preventable. Anybody at any age can practice the weight-bearing exercise and take the vitamin D supplements needed to prevent osteoporosis.
It’s never too early to start: our bones hit peak strength when we’re in our 30s and then start to decline. It’s never too late to start either, with many older people walking, running, dancing and lifting weights to protect their bones. Far from ‘dead’ or unchanging, our skeleton is alive and regenerates itself once every decade. Bones can be run down and they can be rebuilt. They’re the scaffolding that keeps our bodies strong, steady and straight, and just a few minutes’ exercise every day can build their defences.
Today on World Osteoporosis Day, we can all play our part in beating this snowballing threat to living well in later life. The main thing that keeps osteoporosis strong is the silence.
It thrives on apathy, stereotypes and myths. Today, of all days, let’s bust them: curved backs and shrunken bodies are not just part of getting older. The sooner we treat these as signs of a significant – but treatable and preventable disease – the sooner we can all look forward to our vision of growing older in good health.
Craig Jones is chief executive of the Royal Osteoporosis Society