Recent years have seen a dramatic new focus on an old disease – osteoporosis (a condition characterized by reduced bone strength and susceptibility to bone fracture). Formerly osteoporosis was seen as an inevitable part of aging, and consequently little effort was expended in its early detection or treatment. This situation has altered radically. There have been great advances in our knowledge of the risk factors of osteoporosis and fracture. Accurate, non-invasive techniques are available for measuring bone mass and strength, and these have been validated in many populations including Manitoba. New treatments are available for the treatment of osteoporosis which, in large randomized controlled trials, have been proven safe and effective. In short, there has been a complete philosophical transformation of our approach to osteoporosis.
Not surprisingly, increased attention to osteoporosis as a treatable disease has resulted in substantial increases in utilization of associated medical resources. It is known that currently only a small fraction of patients with osteoporosis or who have sustained a major osteoporotic fracture are being treated. The scope of the problem is enormous. At age 50, a healthy woman has almost a 50% risk of sustaining an osteoporotic fracture during the remainder of her lifetime, and 15% will sustain a hip fracture with significant excess risk of death, institutionalization and loss of independence. Although traditionally considered a disease of females, males can also sustain osteoporotic fractures and at a given age are estimated to have approximately one-half the rate of females. Each year almost 1,000 Manitobans sustain a hip fracture, virtually all of which are related to osteoporosis. Many more will develop non-hip osteoporotic fractures. The financial implications, life-years lost and morbidity from these fractures is enormous. Unfortunately, few of these people currently receive adequate testing or treatment to prevent the next fracture.
Bone density testing is currently operated as a single program in Manitoba. This program reports through the Chair of the Department of Radiology, Winnipeg Regional Health Authority, who in turn reports to Manitoba Health.
Responsibilities of the bone density program:
(A) Clinical protocols for bone density measurements.
(B) Needs assessment for bone density services in Manitoba.
(C) Assessment of current and emerging bone density technologies.
(D) Monitor the bone density program.
Specific criteria have been identified which allow targeted testing to be performed. These are as follows:
Other indications may be considered if appropriate clinical justification is provided.