National Osteoporosis Foundation Chief Medical Officer Dr Andrea Singer tells HEQ about the burden and treatment of osteoporosis.
The National Osteoporosis Foundation (NOF), established in 1984, is the USA’s only national healthcare organisation focusing on osteoporosis and bone health. Through its National Bone Health Policy Institute, it aims to raise awareness of issues around bone health and drive advocacy at the policy level for patients affected by bone health and osteoporosis.
Dr Andrea Singer, Chief Medical Officer of the NOF, tells HEQ about osteoporosis risk, treatment, prevention, and innovation.
What are the key risk factors for osteoporosis?
There are a variety of factors – both modifiable and nonmodifiable – that put you at risk for developing osteoporosis. It is important to talk with your healthcare provider about your risk factors for osteoporosis and together you can develop a plan to protect your bones. A woman’s risk of breaking a hip due to osteoporosis is equal to her risk of breast, ovarian and uterine cancer combined; and a man aged 50 or older is more likely to break a bone due to osteoporosis than he is to get prostate cancer. Unmodifiable risk factors include:
- Being over the age of 50
- Being female
- Natural or premature menopause
- A family history of osteoporosis or fractures
- Low body weight/being small and thin
- Breaking a bone from a fall from a standing height
Things we have more control over when it comes to osteoporosis risk include:
- Not getting enough calcium and vitamin D
- Not eating enough fruits and vegetables
- Having an inactive lifestyle
- Drinking too much alcohol
- Drastic weight loss (for example, in patients with eating disorders)
What preventive or protective measures can be taken to lessen the risk of the disease?
There is no time like the present to establish and regularly practise good habits to protect your bones and help prevent future bone density loss. Now is the time to take action with some simple steps which can easily be incorporated into your daily lifestyle. Proper nutrition, including adequate amounts of calcium and vitamin D, as well as daily weight-bearing and muscle-strengthening exercises are essential. The National Osteoporosis Foundation has a breadth of resources about nutrition and physical activity on our website at www.nof.org. It is never too late to take care of your bones or treat osteoporosis.
Has the COVID-19 pandemic had a significant impact on osteoporosis research and treatment?
A global survey of healthcare providers by the NOF, the International Osteoporosis Foundation (IOF), and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) revealed unprecedented effects of the COVID-19 pandemic on worldwide healthcare delivery for osteoporosis. The survey report is based on online questionnaires completed from April to June 2020 by 209 healthcare providers in 53 countries.
In the US, the pandemic seemed to have a substantial impact on reimbursement, which may have had implications for the ability to sustain and offer various osteoporosis clinical services and tests such as bone density (DEXA) scans. Despite Medicare allowing greater flexibility for home administration of injectable medication, some 39% of survey respondents were either not sure about the new arrangement or would not consider using this option. The long-term impact on reduction in resources, and corresponding decrease in the assessment and treatment of patients with osteoporosis and related fractures is yet to be determined.
How can digital solutions help with the screening and treatment of osteoporosis?
The COVID-19 pandemic and mandated social distancing forced healthcare providers to quickly determine how to use technology to provide patient care. A NOF survey revealed that more than 60% of healthcare providers are offering telemedicine visits by phone or videoconference. Since March 2020, more than one third (36%) of patient respondents have participated in technology-driven appointments. Overall, the feedback has been very positive, with 77% indicating that their telemedicine appt was easy, convenient, safe, and a good quality visit. In-person office visits are preferred, but there is an opportunity post-COVID-19 to utilise telemedicine as a tool to reach patients for whom office visits are challenging. There will need to be processes and procedures in place to ensure that telehealth options do not increase disparities in healthcare, though.
Other technological and digital solutions for screening and diagnosis of osteoporosis are making it easier to reach a broader audience and to help raise awareness about bone health and osteoporosis risk factors. While DEXA remains the gold standard for osteoporosis diagnosis, there are many technological advances that are now available to healthcare providers to assist with diagnosis of osteoporosis.
How important is collaboration between services in addressing bone health? Could health and care providers benefit from a more centralised base of resources and data?
No single medical speciality ‘owns’ bone health, as cardiologists do with heart health and oncologists do with cancer. It is essential that there is collaboration between services in addressing bone health because there are often comorbid conditions impacting the bone and causing bone loss; and there are potentially multiple treatment needs for osteoporosis patients including physical therapy and nutrition services. Collaboration and communication between various healthcare providers will bring about much better outcomes for patients. The National Osteoporosis Foundation has been advocating for a post-fracture care pathway to address the needs of those who are most at risk: patients who have already suffered one osteoporotic fracture and require a systematic and thorough follow-up to prevent future fractures.
What are the primary goals of the NOF’s National Bone Health Policy Institute? What changes should be made at the policy level to improve the prevention, diagnosis and treatment of osteoporosis?
NOF’s National Bone Health Policy Institute brings together the expertise, resources, and perspective of the full spectrum of bone health stakeholders to advocate for health policy initiatives that promote bone health and reduce both the personal and financial costs of fragility fractures. Although the Policy Institute’s goals extend beyond the bone health concerns associated with advancing age, the NBHPI is primarily focused on protecting Medicare beneficiary access to osteoporosis treatment options and aligning the payment policies of the Centers for Medicare and Medicaid Services (CMS) with our shared goal of reducing the incidence of and improving the care for fragility fractures in the Medicare population. The Policy Institute recently released new state-based data on the Economic Burden of Osteoporotic Fractures. It also addressed disparities in fractures among ethnic and racial groups. Overall, osteoporosis and bone health need to be a higher priority on America’s health agenda due to the enormity of the population affected – 54 million Americans – and the burden of resulting fractures on the healthcare system.
Andrea J Singer, MD, FACP, CCD
Director, Women’s Primary Care
Director, Bone Densitometry and Fracture Liaison Service
Departments of Obstetrics and Gynecology and Medicine
MedStar Georgetown University Hospital
Chief Medical Officer, National Osteoporosis Foundation