Expand Bone Densitometry Service, educate public re good bone health

Expand the Bone Densitomerty Service. At present the patients are either follow ups sent from their GP, those identified by the Fracture Liaison Nurse as forfilling the criteria for a DEXA scan, some identified by hospital consultants as needing their BMD measured because of their medical problem/s and those new ones sent in by GPs querying the BMD measurement for various reasons. Liaise with the local branch of the National Osteoporosis Society to help educate the population re good bone health.

Why the contribution is important

I attended the National Osteoporosis Society (NOS) conference in November 2016. At the beginning Sir Bruce Keogh, NHS Medical Director addressed the conference. He stated that there are more older people thatn younger in the UK. That of the 3 million people with osteoporosis, 300,000 will have fractures. But the sentence that caught my attention "Osteoporosis will drain the NHS if it is not addressed properly". As we know the Isle of Man has an aging population.

The last figure I know of for a hip fracture is £15,000 (I believc I am out of date though & that was for the UK). But it doesn't stop there. The loss of independence is a major factor after a hip fracture. The figures given out at the NOS conference indicate that in the UK 59% of patients return home and 22% are discharged into residential care. Those at home may well need social care to enable them to cope. Those in residentail care will either need to be supported by the Government or, if the patient owns their own home that will need to be sold to fund their care until that runs out and the Government has to step in to pay for their care.

Vertebral fractures cause disability to patients. Pain. More visits to their GP. Some patients become depressed. More visits to their GP. Altered body shape - as the vertebae collapse from osteoporosis, kyphosis develops. This leads to an increased risk of chest infections as the lungs are compressed within a smaller are. Increased hospital stays. The abdomen is compressed. Increased risk of bowel obstruction. With increase in hospital stays. With vertebral fractures there is an increased risk (four fold) that another vertebrae will fracture within a year. A recent study has shown Lateral Vertebral Assessments (not currently

by SandraK on May 13, 2017 at 11:47PM

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  • Posted by SandraK May 14, 2017 at 01:19

    A recent study has shown Lateral Vertebral Assessments (not currently carried out by the BD department) are "cost neutral" (Dr Nicola Peel).
    Educating the public. Genes; if it is in the family there is a good chance of developing osteoporosis so people need to know that they should ask for a DEXA scan to check their bone density. With early intervention, if necessary, osteoporosis may not develop. Good bone health basics; Calcium + vitamin D3 + weight bearing activity. Moderate alcohol. From the NOS conference it was stated that moderate alcohol (for bone health that is up to 14 units per week for females and 21 units per week for males) is beneficial as it has a positive interaction with pertinent hormones. Smoking cessation. Minimal fizzy drinks. I would like to get the message out that osteoporosis isn't "one of those things" that comes with older age and that steps can be taken to help reverse it. If a patient has osteoporosis they may be prescribed Bisphosphonates which stop bone turnover so that with a prescription (or from diet) for Calcium & vitamin D3 and weight bearing exercise building new bone, the patient can increase their Bone Mineral Density. The problem with that is that there is a known large drop off of patients taking the Bisphosphonates. They do not suit everyone but patients seem to stop taking them without asking their GP if there are alternatives. The Fracture Liaison Nurse does follow ups for those of her referrals who are diagnosed with osteoporosis and prescribed Bisphosphonates but it would be of benefit if there was follow up for those GP/Consultant patients diagnosed and prescribed Bisphosphonates. Taking it further, to save future problems the message re good bone health needs to be passed on to parents for their children's benefit. 3 1/2 hours of running and jumping every day. Good diet to include adequate calcium & vitamin D. 15 minutes of sunshine outside the hours of 11 a.m to 3p.m before putting on the sunscreen. Minimal fizzy drinks which interfere with the digestive process. Peak bone mass occurs in the early twenties.
    A lecture a few years ago by Dr Khan, the endocrinologist, recommended that everyone take vitamin D3 during the autumn & winter months as the sun on the IoM (when we see it) is at too low an angle from October through to the end of April to make vitamin D3. I read last year of a recommendation that everyone take it year round. Residential home residents needs to take it as they tend to have low levels and may have an increased risk of falls. The NOS conference presented a paper where the levels of over-the-counter vitamin D3 had been measured. The contents varied from below that stated to up to 200% more. Ironically I have recently been told my blood test shows I have low vitamin D3. I'm going to chat to my GP about a prescription rather than risk over-the-counter hit 'n' miss vitamin D3! I work as a radiographer and I am the DEXA Lead.
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