Why Ireland would Benefit from a National Screening for Osteoporosis

Osteoporosis is the commonest skeletal disease worldwide. Failure to attain or loss of skeletal mass and quality result in weak bones leading to fractures. Osteoporotic fractures are one of the leading causes of morbidity and mortality in older European adults, and one fragility fractures (FF) one of the most expensive. 1-3 A recent European report notes Ireland has one of the highest rates of fracture but will experience the greatest increase in numbers over the coming decade. While Ireland performed well on certain domains, we did not on national policy, guidelines or investment. 4 If we are to address the rapidly increasing burden of this illness and the associated costs for patients, their social network and our country, fundamental shifts in knowledge, policy and how our healthcare system is run are needed. In 2008 the H.S.E. estimated the direct cost for caring for Irish people with FF will be ¤2billion, a doubling from 2020. 5 As things currently stand we do not have the resources to manage what is already happening. Providing poor quality care has limited benefit, increases costs and harm to patients. We need a rapid escalation in resources and policy to support quality osteoporosis services for so Irish people.

These are the clinical events of this disease, the majority of which occur following a fall. Thus all patients should be assessed and considered for appropriate pharmacologic intervention and fall prevention, in addition to addressing any underlying causes or modifiable risk factors following these events. 2, 7 Unfortunately despite overwhelming evidence showing diagnosis and treatment are the most effective way to reduce subsequent fracture risk, 2, 6, 8 there is a considerable gap between the evidence and recommended management and what is actually taking place in practice. 8-10 For example data from the H.I.P.E. portal, the public hospital inpatient administration system shows fewer than 20% of those adults aged 50 years and older admitted with a major osteoporotic fracture over the past 15 years are diagnosed with osteoporosis. In Galway University Hospitals the treatment gap was similar, but following the establishment of a fracture liaison service this number increased to >80% for hip fracture patients between 2009 and 2018 (Proceedings from World Congress of Orthopedic Nurses 2018).