Osteoporosis Canada’s new National Report Card reveals unmet needs of Canadians living with Osteoporosis

In fact, over 80% of all fractures in people over the age of 60 are osteoporosis-related

In fact, over 80% of all fractures in people over the age of 60 are osteoporosis-related.² But numbers don’t tell the full story. For the individuals who suffer wrist, spine, rib and hip fractures as a result of the disease, the stories are personal ones. Moreover, these stories illustrate the prevalence of this debilitating disease and dispel the misconception that it is just an “old woman’s” disease. Pain, disability, reduced mobility and long-term disability resulting from osteoporosis are all too frequent and can occur in individuals of varying age, both male and female. Additionally, hip fractures related to osteoporosis result in death in up to 30% of cases.^3-5 Some of the real life stories about people living with osteoporosis today are are included in Breaking Barriers, Not Bones, and they are compelling examples of the impact this chronic disease has on individual lives.

Established in 1982, Osteoporosis Canada (OC) was the first national organization for osteoporosis in the world and is now the only national charitable organization serving Canadians who have, or are at risk of, osteoporosis. Our vision is a Canada without osteoporotic fractures. Osteoporosis Canada is committed to its goal of helping individuals reduce their risk of osteoporosis and to ensuring that all Canadians have access to the best diagnosis and treatment. Our first national report looks at the two components that are critical to achieving this goal: access to bone mineral density (BMD) testing and access to medications. Breaking Barriers, Not Bones allows Canadians to see a measure of how well they are able to access these two elements through the publicly-funded health care system in their province. It also provides a benchmark to measure future progress.

Breaking Barriers, Not Bones, is also the first large-scale national Report Card of its kind to assess and grade Canadians’ access to BMD testing and to osteoporosis medications on provincial / territorial drug benefit plans across the country. In addition, the report examines provincial initiatives undertaken to help in the care of osteoporosis. Osteoporosis Canada’s Report Card Committee produced the report in an effort to highlight provincial activity related to osteoporosis care, evaluating information and data provided by provincial and territorial governments, and summarizing it to provide a cross-country picture of government initiatives.

Our research reveals that access to BMD testing across the country is far from adequate and that only a small percentage of Canadians is being referred for BMD testing. Access to drug treatment that can help prevent fractures varies across the country as well; in some provinces, individuals with osteoporosis are restricted from accessing effective treatment options. Action is required. With the aid of this first national report, Osteoporosis Canada is calling on the provincial and federal governments to help establish a national strategy, and parallel provincial / territorial strategies, to provide coordinated osteoporosis care and to reduce debilitating fractures and their impact on individual lives and the health care system. Breaking Barriers, Not Bones is our opportunity to partner with governments at the federal and provincial/territorial levels to develop and implement strategies leading to the improvement of bone health for all Canadians.

Key findings

• Analysis of the data on current rates of BMD testing across the country indicate that access is far from adequate – most provinces received a grade of C or lower, despite the existence of guidelines for identifying those who should be tested.  The grades ranged from two B’s (Alberta, Ontario); one C (British Columbia); six D’s (Quebec, New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland and Labrador, Northwest Territories); followed by two failing grades of F (Saskatchewan, Manitoba).

• An assessment of the availability of osteoporosis medications on provincial/territorial public drug plans yielded grades that ranged significantly from one A (Quebec); two B’s (Ontario and Yukon); six C’s (Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia, Newfoundland and Labrador); a C minus (British Columbia); to a failing grade of F (Prince Edward Island).

Grading

Access to Bone Mineral Density (BMD) Testing

The results show that provinces are not providing adequate access to BMD testing – most provinces received a grade of C or lower.The results are as follows:

BMD testing is an important diagnostic tool for osteoporosis, which assists individuals and health care providers to further support the management and treatment of osteoporosis. Additionally, once an individual has been accurately diagnosed and is receiving appropriate treatment, their likelihood of sustaining a future fracture is decreased.

Access to Osteoporosis Medication

The results for access to osteoporosis medication on provincial/territorial public drug plans were better than those for BMD access. Grades range from A to one failing grade of F.

Individuals must have access to a range of therapies to ensure that effective treatment options for them can be available.The results of our research demonstrate that while some provinces are doing very well, there are many others that are simply not providing this access to individuals living with osteoporosis in their jurisdiction.

Medical Necessity vs. Geography

Osteoporosis care must be guided by medical necessity, not geography. Ensuring that Canadians with osteoporosis have access to adequate care regardless of where they live must be a priority. Furthermore, the gap between what is appropriate access to publicly-funded BMD testing and medications and what is currently available must be addressed in order to provide appropriate care for individuals with osteoporosis. In the long-term, however, improving outcomes for those living with the disease and reducing the impact of osteoporosis within the health care system will require a more comprehensive approach.

We recommend that:

references

1. Hanley DA, Josse RG. Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. Can Med Assoc J. 1996;155:921-3.
2. Goeree R, O’Brien B, Pettitt D, Cuddy L, Ferraz M, Adachi J. An assessment of the burden of illness due to osteoporosis in Canada. J Soc Obstet Gynaecol Can. 1996;18(suppl July):15-24.
3. Cree M, Soskolne CL, Belseck E, Hornig J, McElhaney JE, Brant R, Suarez-Almazor M. Mortality and institutionalization following hip fracture. J Am Geriatr Soc. 2000;48:283-8.
4. Iacovino JR. Mortality outcomes after osteoporotic fractures in men and women. J Insur Med. 2001;33:316-20.
5. Cummings RG, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359:1761-7.