Did you know that you can actually get screened for osteoporosis at your community pharmacy?
IN YOUR OPINION, WHAT IS THE BIGGEST TREAT TO THE HEALTH OF MALAYSIANS THESE DAYS?
Nik Jah : The biggest threat to the healthy of Malaysia now are non-communicable diseases (NCDs) such as diabetes, hypertention and also osteoporosis. The rise in NCDs is predominantly due to unhealthy urban lifestyle such as work stress, being sedentery and unhealthy eating habits, as well as our population is now getting older.
WHAT IS OSTEOPOROSIS AND HOW MUCH DOES IT AFFECT MALAYSIANS?
Nik Jah : Osteoporosis is a disease characterised by low bone mass and deterioration of bone tissue which increases bone fragility and alsorisk of fracture. It is ususally asymptomatic and thus remains undetected until the person develops a fracture. During the late stages of osteoporosis, scoliosis, loss of height, neck strain, back pain and fractures may appear.
Due to an increase in the elderly population, osteoporosis has become a worldwide challenge and is expected to increase in the increase in population, urbanisation and ageing.
WHO ARE AT HIGHER RISK OF OSTEOPOROSIS?
Nik Jah : Women are at a higher risk of osteoporosis than men and other risk factors for osteoporosis and osteoporotic fractures include low body mass index (BMI), low calcium intake, reduced sunlight exposure and early menopause.
This can be further divided into modifiable and non-modifiable risk factors such as:
MODIFIABLE
1. Poor Nutrition
2. Thinness or small frame
3. Cigarette smoking
4. Excessive alcohol intake
5. Sedentary lifestyle
6. Lack of sun exposure
7. Falls
8. Poor eyesight
9. Drugs induced osteoporosis
NON-MODIFIABLE
1. Age (being older)
2. Being female
3. Early menopause
4. Ethnicity (being Chinese or Caucasian)
5. A family history of osteoporosis
6. Having a previous fracture
7. Personal medical history
HOW CAN OSTEOPOROSIS BE DIAGNOSED AND MANAGED?
Nik Jah : The diagnosis of osteoporosis is based on the measurement of Bone Mineral Density (BMD). According to the World Health Organisation (WHO), an individual is diagnosed with osteoporosis when the BMD lies 2.5 standard deviations or more below the average value for a young, healthy women as illustrated in the table below:
The ultimate goal in the treatment of the osteoporosis is the prevention of structure and high-risk patients should be identified, evaluated for osteoporosis risk factors, and treated to prevent further fractures.
Osteoporosis treatment for postmenopausal women can be considered if they had a previous low trauma hip, vertebral or wrist fracture, or have a T-Score of -2.5 and below. They should also be advised on non-pharmacological treatment to improve bone health such as exercise and a high calcium diet. Once diagnosed, osteoporosis needs to be managed to avoid the occurrence of fractures.
The management of osteoporosis can be divided into non-pharmacology and pharmacology treatment.
HOW CAN WE PREVENT OSTEOPOROSIS?
Nik Jah : Osteoporosis needs to be diagnosed early before fractures happen. Vigorous screening needs to be done in our population to detect high-risk patients and this can be done in done by community pharmacists. According to my research with University of Malaya done a few years ago, community pharmacists were willing to introduce these services to the public it they had enough knowladge and support from the government.
One of the proposed public health messages, and indeed a cornerstone of a pharmacist-initiated service in this area is the latency of osteoporosis and the need of prevention and every detection. These messages would be used to introduce service components such as FRAX for screening. FRAX provides freacture risk within 10 years. It is a validated tool for pharmacists’ risk assessment for osteoporosis, and thus is useful to educate patients about this condition. Community parmacists can also play a more significant clinical role in identifying drug-induced osteoporosis, such as in corticosteriod users. Our participants also supported the role of the community pharmacy in the management of diagnosed osteoporosis through counselling to optimise adherence to prescribed osteoporosis medicines and lifestyle changes.
HOW DO COMMUNITY PHARMACIES SCREEN FOR OSTEOPOROSIS?
Nik Jah : Osteoporosis screening can be done using fracture risk assessment tools (FRAX, Garvan Bone Fracture Risk Calculator and Q-Fracture Score); or using risk assesment questionnaire instruements.
The purpose of risk assessment questionnaire instruments is not to diagnose osteoporosis but to identify women who are more likely to have low BMD, and who should undergo BMD measurement using the DXA scan for a definite diagnosis of osteoporosis.
WHO SHOULD GO FOR OSTEOPOROSIS SCREENING AND WHY?
Nik Jah : Many osteoporosis guidelines recommend screening for osteoporosis in women aged more than 65 years and in men aged 70 years and older; as well as in younger women whose fracture risk is equal to or greater than that of a 65 year old white woman who has no additional risk factors.
In the absence of a new risk factors, screening should not occur more frequently than every two years. Postmenopausal women and men aged above 50 years with at least one major (such as fragility fracture after age 40, early menopause and hypogonadism) or two minor risk factor (such as smoking,excessive alcohol and caffeine intake, rheumatoid arthritis and low dietary calcium intake), should undergo screenning for osteoporosis.
“BE PROACTIVE ABOUT YOUR HEALTH. PREVENTION IS BETTER THAN CURE; SO PLEASE MAKE USE OF YOUR COMMUNITY PHARMACIST NEARBY TO DISCUSS ON YOUR HEALTH PLAN TODAY.”
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