Forever Autumn Community of Practice falls ConferenceHistory of

Osteoporosis in Ireland

Professor Emeritus Moira O BrienFRCPI,FFSEM,FFSEM(UK),FTCD

Trinity CollegePresident of the Irish Osteoporosis Society

30-09-2015

Osteoporosis Osteoporosis has been around for Three Millennia and skeletons

have been found from the dark ages

Osteoporosis: Three Millennia

0 1000 AD 2000 AD1000 BC

400 BCHippocrates

of Kos

700 ADSaxon

tomb, Wells

1825 ADSir AstleyCooper

1850 ADOsteoporosis

1950

2003 2007

199019801970

1948Albright

1963SPA

1976HRT

1987DXA

1990–99 WHOCalcium,FluorideBisphosphonatesSerms, PTH

1940 1960

Cooper (2002)

Protelos Prolia

\ \

Treatments • HRT was the first medication used for osteoporosis, which still

has its place, but thankfully more treatments were developed

• Calcium, Vitamin D and appropriate weight bearing exercise for everybody

• In 1990 -1999 Bisphosphonates, Forsteo and SERMS• Protelos in 2003 and Prolia in 2007• Combined Therapy anabolic and antiresorptive• Preventative osteoporotic medication before treatment that will

cause bone loss

• More medications are in the pipeline• Check and beware of Polypharmacy

Sports Medicine• I have always been involved in Sport and in the early 70’s I started doing

research in Women in Sport, Menstruation and Exercise, effects of jet lag and baby swimming Physiological testing

• Research with Dr Dermot Fitzgerald in St. Marys on Vascular changes in athletes

• I was appointed Irish Olympic Medical Officer in1979 and this was my pathway into Osteoporosis

• I founded the Irish Sports Medicine Association in 1980, the Irish Menopause Society in 1993 and the Irish Osteoporosis Society in 1996

• In the early 80’s I met Prof Barbara Drinkwater in Gotenberg, who had done numerous studies on menstrual irregularities in Sport and their affect on Bone Mineral Density using DXA

Osteoporosis Birth in Ireland

• In the 60’s and 70’s Osteoporosis was diagnosed by Single or Dual Photon. The Menopause Clinic in the Rotunda had the first Photon in Ireland and later changed to DXA

• DXA was developed in 1984

• The Anatomy Dept in Trinity College had the first DXA in Ireland in1990, in which Bernard Dunne played a major role

Osteoporosis Service

• In 1990 Bernard Dunne and I set up the first DXA service in the Anatomy Department in TCD

• Clinical Trials and MSc research projects on Osteoporosis on Athletes and Anorexics

Professor Bernard Walsh

• Professor Bernard Walsh is a Director Mercer’s Institute for Research on Aging in St James Hospital and set up their Osteoporosis service.

• Clinical Professor Clinical Professor, Department of Medical Gerontology, Trinity College Dublin

• He is a Professor of Geriatric medicine and past president of the Irish

Gerontological Society

• He has played a major role in the advancements of bone health, both its diagnosis and treatment.

• He also was involved in a significant amount of research in this area

Bone Diseases

• David Powell and Malachi Mc Kenna were involved in the treatment of Bone Diseases and also research

• In the early 1990’s David Powell and Malachi Mc Kenna used the DXA machine in TCD to do clinical trials

• Kevin Cashman has played a major role in the research on Vitamin D

Birth of Fall Prevention in ROI • Michele O’Brien set up the first private Falls Prevention service

in 2001

• I asked her to help with the IOS for a couple of months while she was promoting her business, she has now worked for the Charity for 14 years and Fall Prevention is still one of her passions

• Professor Rose Anne Kenny has played a major role in the fall prevention and bone health area and was successful in obtaining significant funding for St James Hospital in 2003 to start up a Falls Prevention clinic

Irish Osteoporosis Network

• The Irish Osteoporosis Network (ION) was set up in 2002. It was an All Ireland Network of all groups interested or involved in Osteoporosis and Osteoporotic fractures

• It was Chaired by Professor David Marsh, Professor of Trauma and Orthopaedics, Queens University Belfast and President of the International Society for Fracture Repair

• The aim of the ION was to identify and prevent low trauma

fractures throughout Ireland, using a Multidisciplinary approach and to set up audits of hip fractures, ideally in all the major Orthopaedic units

All Ireland Action PlanIrish Osteoporosis Network 2003

• Cross-Border research proposals by Prof David March• Osteoporosis fracture registry• Integrated services using Orthogeriatric Liaison• Programme of raising awareness

• The IOS with the OMBI (Osteoporosis Medical Board of Ireland) and David March organized the meetings

• David and myself tried to set up a hip fracture database but funding was not available in the ROI, however David was able to secure funding for the UK

• Emer Ahern was an IOS board member and very kindly took the baton and has run with it

• Louise Brent and Conor Hurson have both played important roles

• Hip fracture registry has been successful due to all the volunteers who have contributed to this project

2004• In February 2004 there was a two-day conference entitled “An Integrated

Approach to the Prevention and Treatment of Osteoporotic Fractures” • The conference was organised in association with the IOS,IOF, the NOS

and the Irish Orthopaedic Association

• The conference attracted speakers and delegates from as far away as Australia, Israel and Italy, as well as Ireland and the UK

• The Duchess of Cornwell, who is a patron of the UK’s NOS was guest of

honour at a Charity lunch and launched the IOS Osteoporosis educational pack, aimed at 12 to 18 year olds

Workshop

• In April 2004, the IOF and IOS organised an osteoporosis workshop. It was held in Cork and had representatives from the Irish Department of Health and Osteoporosis Patient Societies from other EU countries.

• The workshop, entitled “Delivering patient expectations and managing European health priorities.

• We explored issues such as achieving a better understanding of the needs

of European osteoporosis patients; how medicine and innovation can meet the needs of the patients and determine the conditions which would ensure the patients take on more responsibility for their healthcare spending choices.

2005 to 2010• IOS Annual Medical Conference

• Increase of DXA clinics

• Increase of Fall prevention clinics

• Representation in the EU and World congress

• Increase of education of public

2011 to 2014

• Rise in hip fractures

• Rise in loss of independence in our senior citizens

Present situation in Ireland• The number of hip fractures is increasing

• There is a wide variation in access to diagnostic and specialist services and in prescribing patterns

• Sadly the standard of DXA scanning and reporting ranges from excellent to appalling.

• There is a range of therapeutic interventions now available but there are concerns regarding inappropriate prescribing

• There is limited proactive treatment for high risk individuals to prevent bone loss and a general lack of knowledge of prevention, causative factors and treatments of osteoporosis among the general public

• Sadly due to the significant decline in the IOS funding over the last three years, progression has been very slow. Hopefully this will change and billions can be saved, senior citizens in Ireland will be able to stay independent in their own homes, the number of fractured hips and falls will decline and we will have much healthier citizens

Currently in ROI • Michele O’Brien and I represent the IOS on the European Osteoporosis panel since

1997

• Mr Derek Bennett and I have got Osteoporosis on the curriculum for the training programme for Orthopaedic and Trauma surgeons in the EU

• The Hip Fracture database is going from strength to strength

• A Fracture liaison service is the most effective way to prevent further fractures and every hospital should have one

• I would like to thank all the Fall prevention staff, DXA unit staff, members and staff of the IOS, and all those who have supported the IOS over the years and the uphill battle in the promotion of Bone health.

We need everyone here to promote bone health, the importance of Fall Prevention and much earlier diagnosis and most importantly the importance of WORKING TOGETHER

Ireland 2015• Ireland still has not adopted the Prevention of Osteoporosis as a Major

Governmental Health Policy

• The European Commission report Osteoporosis in the European Community (1998) provided a comprehensive guide to the prevention of osteoporosis. According to this report the best prevention is to establish a healthy lifestyle at a very young age and to continue throughout life

• The most effective preventative measures are those that are taken during childhood and adolescence, when 60% of bone is laid down, to form peak bone mass. Maintaining bone strength in later life is vital for reducing risk of fractures. It is important to realise that in many cases osteoporosis can be prevented and it is important that all health care professionals are aware of this

• This is why Physical Education should be mandatory and part of the leaving certificate in schools: Osteoporosis, Obesity, Diabetes, Heart disease, Mental health and Respiratory disorders

Carrying the torch • Dr Donncha O’ Gradaigh – Education and

advancement of Osteoporosis care• Professor Declan Lyons – Osteo and Falls clinic• Dr Emer Ahern – Hip Fracture database• Louise Brent – Hip Fracture database• Doctor Tara Coughlan - Hip Fracture database• Mr Derek Bennett - Orthopaedic Surgeon• Daragh Rodgers - Bone Health in the park

And everyone else involved, too many to mention

Dr John Carey • Dr John Carey and his wife Dr Miriam Delaney returned from

America and have been very involved in attempting to improve the standard of care for Osteoporosis patients.

• John has run the International Clinical Densitometry Courses and Body Composition Course in Galway

• For your calendar: International Clinical Densitometry Meeting and Course will be held in Galway in 2016 – Kerry@gowest.ie

The Future• Educate all Health Care Professionals

• Educate all patients about prevention, assessment, diagnosis and treatment

• Medical groups have the opportunity to implement a systems-based approach as well

• More specialized bone health developed specializing in disease management programs and appropriate care

• Implementing strategies that millions were spent developing, for improving overall bone health and preventing falls

Irish Osteoporosis Society• The Irish Osteoporosis Society (IOS) established in 1996

• It is a registered Irish Charity dedicated to preventing Osteoporosis, giving support and advice to those at risk and the few that are diagnosed - 280,000 are undiagnosed

• Also a resource for Health Professionals

• IOS Annual Medical Conference, strictly for Health Professionals, this year it is in TCD on Saturday 31st October, 9am to 5pm. Contact the IOS or Kerry@gowest.ie

• Mark Pollock is opening this conference!

THANK YOU