Will the EU take care of our bones?

In the next legislative term, EU policymakers will be called upon to tackle the risk factors of osteoporosis, a skeletal disorder which has never earned enough attention and is expected to take epidemic proportions in the decades to come, writes Andrea Giustina.

Professor Andrea Giustina is the chair of Endocrinology at San Raffaele Vita-Salute University in Milan and president-elect of the European Society of Endocrinology (ESE).

In a time of a rapidly ageing EU population and continuously tighter healthcare budgets, osteoporosis is becoming an ever more imminent problem of our society. If the EU and its individual member states do not take more measures to tackle the problem at hand, the incidence of osteoporosis is expected to take epidemic proportions.

Osteoporosis is a systemic skeletal disorder characterized by decreased bone mass associated with increased fracture risk. Lifting, bending, bumping into furniture and even sneezing can cause a bone to break in people affected by osteoporosis.

Of particular concern are spinal and hip fractures. Spinal fractures can result in serious consequences, including loss of height, intense back pain and deformity. A hip fracture often requires surgery and may result in a loss of independence or death.

Unfortunately, these fractures are hard to prevent as the loss of bone occurs silently and progressively. Often there are no symptoms until the first fracture occurs.

There are methods to detect osteoporosis by means of a bone density scan, but due to minor or the complete absence of symptoms or indicators like loss of height or a stooped posture, the majority of people with osteoporosis only see a doctor when it’s already too late. Up to 70% of all spine fractures are for example not detected or are diagnosed late.

Methods to proactively screen for vertebral fractures such as morphometry do exist. They should be widely used to identify patients at high risk of subsequent fractures in order to allow their access to adequate anti-osteoporosis treatment. This would optimise the use of scarce resources.

In addition to improving the diagnosis and treatment of people with osteoporosis, the focus should be on prevention by tackling some of the main risk factors of osteoporosis such as alcohol abuse, smoking, Vitamin D deficiency and low calcium intake.

To tackle the aforementioned risk factors a coordinated effort at the EU and national level is needed. Especially the EU could play a central role through the exchange of best practices and the development of European law and policies encouraging a healthier lifestyle, hereby setting an example for the individual member states.

In the area of alcohol and smoking, numerous efforts, although not always successful, have been made at the EU level mainly focusing on hepatic and respiratory diseases. Unfortunately, less attention has been given to the importance of vitamin D and calcium intake.

It is high time European-wide measures were implemented to ensure sufficient intake by every EU citizen of both substances. In addition to the health benefits, there are economic incentives for the EU to become more active in this area.

The EU could play a key role in promoting and coordinating sufficient uptake of Vitamin D and calcium across the EU and beyond.

Together with the industry and the NGO health community, a balanced approach could be developed to ensure a broadly supported process with a high qualitative outcome.

It is unclear why the EU institutions did not give osteoporosis sufficient attention in their political agenda.

It is hard to believe that a potential explanation may be that osteoporosis and other health topics unsuccessfully compete with Trump’s new deal, Brexit and immigration, although the voices of the possible disposal of DG SANTE as a whole may raise some doubts in this regard.

Also, one can hypothesise that since osteoporosis is primarily linked to menopause and ageing it can be considered a “physiological” event: but this is not true since not all women and elderly loose bone to the same extent and only some reach the serious thresholds of osteoporosis.

I also refuse to accept the idea that institutions are not paying enough attention to osteoporosis because it is mainly affecting women.

First of all because is not true, since also many men are affected but most importantly because it is unbelievable that still in the year 2018 such a discriminating view of health may exist.

For sure, a cultural gap is present and hard to overcome and in the end, someone may blame for this the disease itself which remain asymptomatic for many years and for diagnosis and follow-up is in need of instrumental examinations!

While we try to raise awareness of this dramatic and widespread health problem, the number of osteoporotic fractures is on the rise. Every 8 seconds, osteoporosis causes a bone fracture in an EU citizen, more or less the same time it takes for someone to read the following two sentences.

The new European Commission and the European Parliament to be elected next year face the important task of reviving the EU’s efforts in health, and more particularly osteoporosis, as one of the bigger health challenges for the decades to come.

In addition to attributing EU research funds to develop improved diagnosis and treatment methods, the EU has to implement a broad array of public health measures to tackle its risk factors and encourage the education of healthcare professionals and the implementation of screening programmes at the national level.

I wish the EU institutions, and the European Commission in particular, the necessary wisdom in the coming years to set the EU agenda, in a manner that does justice to the importance of osteoporosis and other health topics that are unfortunately being largely neglected.