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Osteoporosis has an image problem. Despite affecting 3.5 million people in the UK, it’s known as the “silent disease”, because of under-diagnosis, under-treatment and low public awareness. As many people die of fracture-related causes as from lung cancer and diabetes. Yet osteoporosis was raised in Parliament only 31 times between 2015 and last year, a tenth as frequently as these other conditions. To the public, osteoporosis is a mystery: only a quarter of adults can tell you what the word means.
For people who live with it, the disease can be life-changing. The fragility of their bones means minor injuries, like a fall, can cause bones to break. A cough, a sneeze, even a hug from grandchildren can trigger a painful spinal fracture. Without support, life can be changed overnight. One year after suffering a hip fracture, 60 per cent of people need help with eating, dressing and washing. About one in four hip fracture patients die within a year.
With the silence comes missed opportunities. Two-thirds of those with spinal fractures, up to 2.2 million people, are undiagnosed. GP care is patchy. Some hospitals have the fracture liaison services needed to spare people the agony of repeat fractures, while others fall short. Preventable problems are routinely left to get worse, causing life-changing pain and disability.
Our ageing population means the cost of treating fractures and osteoporosis –£4.5 billion a year at present – is rising fast. This is a preventable and ever-increasing burden on the NHS. And there are signs we’re slipping backwards, with some fad diets lowering bone density and triggering osteoporosis in people in their thirties.
How did we allow a public health challenge of this scale to go under the radar? Partly because of how we view old age. We see shrinking, getting a curved spine and broken hips as routine parts of getting older. This is fatalistic and wrong. The truth is that osteoporosis and fractures are preventable, but to spare ourselves the pain of the disease, we need to reframe the way we think about our bodies.
Everyone has bone health, but very few of us talk about it. Across cultures and continents, the human skeleton is the archetypal symbol of death. But our bones are alive, not dead. They’re dynamic, changing, self-healing parts of the body. Depending on how we live, we can strengthen our bones, or we can weaken them. Yet few of us consider exercising to look after our bones, as we’d do for muscles.
There is huge untapped potential for early intervention in bone health. This is a seismic opportunity to reduce the burden on the NHS and help people live better lives. Bone health should be made core business in GP surgeries, like blood pressure and cholesterol checks, especially for people on medication like steroids.
We shouldn’t wait. As the pandemic recedes, the NHS faces a potential tsunami of health problems that have built up during lockdown. Advice to stay at home and, in the case of the most vulnerable, to shield, means many people have missed their usual exercise. Those without gardens have been deprived of vitamin D, another key ingredient for strong bones. As people resume their normal lives, the Royal Osteoporosis Society is warning of a crisis of falls and fractures, with another spike in demand for the NHS.
Now’s the time to make a change. We can break the silence on osteoporosis and give hope and optimism to millions of people living with it. This week, as a Labour MP and Conservative peer, we’re jointly starting the new All Party Parliamentary Group on Osteoporosis and Bone Health as a cross-party initiative. Our aim will be to disrupt the traditional image that has pigeon-holed this disease for too long. We’re not satisfied that so many people are missing out on the early diagnosis, treatment and support they deserve. And, thinking big, we want to inspire preventative conversations about bone health across the generations.
We know the health system that emerges from the pandemic will need to be smarter and better at helping people prevent illness, rather than simply treating the consequences. Having a forum in Parliament about the silent disease, with the volume turned right up, is a great place to start.
Let’s end the fatalism, keep people living well in older age and protect the NHS.
For information and support on osteoporosis visit theros.org.uk
‘Early diagnosis would have saved my mother years of pain’
By Lord Guy Black
My mum, Monica, was irrepressible. She was always full of the joys of spring and her smile would light up a room. She loved people, and was always there for her friends She adored music, started learning Italian in her seventh decade, and had the greenest fingers.
This optimistic outlook was perhaps the start of her undoing. For as she got older, she treated oncoming frailty with the same cheeriness and stoicism: it was just “one of those things”. It had happened to her mother (who was housebound by the end of her life in terrible pain), and now it was her turn.
In her mid-60s, she started getting bad back pain. She was losing height, and started stooping. She talked to her doctor, who said it was the inevitable onset of old age. In truth these were all red flags for osteoporosis. Had she been diagnosed then, it would have transformed her remaining 15 years, saved her great pain and allowed her to stay independent for so much longer.
Five or so years after these symptoms started appearing, Mum fell as she was feeding her favourite robin in the garden. She broke her wrist badly and was taken to hospital. It was there they finally gave her a DEXA scan, which diagnoses the condition, and discovered that she had advanced osteoporosis. She began treatment under immensely caring experts at St Thomas’s, but the damage had been done. A few years later, she cracked a bone in her shoulder getting out of the shower. Quite apart from the pain, it meant she had to give up driving.
Osteoporosis was not finished with her yet. In summer 2008, she was gripped one morning by the most excruciating pain affecting every joint in her body. It was diagnosed as polymyalgia rheumatica, an inflammatory condition sometimes associated with osteoporosis. Its only treatment is long-term use of steroids, which she had to undergo because of the pain. The problem, of course, was that these steroids make osteoporosis worse, and shred your immune system. She started succumbing to regular chest infections, then a heart attack, before she died in February 2009.
If only she had known a little more about the condition – which none of us had heard of before her diagnosis – she could have insisted on a scan earlier on, and been spared a decade of pain. For me, the battle to raise awareness of osteoporosis is a very personal one – and I will wage it with vigour, energy and confidence.