Improved management of patients with osteoporosis.

1 for greater awareness and improved management of patients suffering from osteoporosis or osteopenia and those with fragility fractures, particularly the elderly. We contend that this disease is not optimally managed locally and is often still regarded as an inevitable part of the ageing process, not amenable to treatment. The facts that 20% of hip fracture victims die within one year of the event and that less than 50% are capable of leading an independent life are often ignored. Moreover, the fact that fracture risk can be halved when lifestyle measures and appropriate bone-active drugs are employed also seems to go unrecognised. The National Osteoporosis Foundation of South Africa (NOFSA) published a guideline on the diagnosis and management of osteoporosis in 2010 that is available in print and also freely available on our website, either as a full guideline or an executive summary. 2 Unfortunately, osteoporosis medication is still not freely available to sufferers from this common disease, which affects one out of every four postmenopausal women and 20% of elderly men. The essential drugs list (EDL) published in June 2012 3 suggests that only patients with a bone mineral density (BMD) T-score of-2.5 standard deviation plus a fracture should be considered for treatment with bone-active medication. This is analogous to recommending that you should first have a stroke before your hypertension is eligible for treatment, or have a myocardial infarction before your dyslipidaemia is deserving of a statin! Clearly these EDL recommendations are embarrassingly out of touch with reality. There also appear to be regional differences in the availability of bone-active drugs in the public sector which is particularly problematic in the Western Cape, where NOFSA is frequently approached by patients and doctors unable to obtain justifiable osteoporosis treatment from a clinic or hospital. Moreover, unlike other provinces where access to modern intravenous bisphosphonates, strontium ranelate and even teriparatide can be obtained with or even without motivation, patients in the Western Cape are 'fortunate' when daily generic alendronate is made available – the efficacy and safety of which has been questioned. 4-8 Access to osteoporosis medication is not only problematic in the public sector, however, and private patients, often the elderly and less wealthy, have similar problems. It is illogical that the test to diagnose the disease (dual-energy X-ray absorptiometry measurement of BMD) and the treatment of its complications (e.g. hip replacement) are readily reimbursed, yet its effective prevention …