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Osteoporosis—striking the right balance
Editorial
Science Photo Library
Osteoporosis—striking the right balance
See New Horizons Lancet 2011; 377: 1276
For the IOF report see http:// www.iofbonehealth.org/ about-iof/the-organization/ committee-of-scientificadvisors-csa/publicationsposition-and-consensusstatements.html
Bone loss due to osteoporosis is insidious and initially symptom-free. Diagnosis is therefore often after the first fracture. A new report from the International Osteoporosis Foundation, together with the European Federation of Pharmaceutical Industry Associations, suggests that the burden of fractures in France, Germany, Italy, Spain, Sweden, and the UK has been underestimated. They conclude that there were 2·5 million new fractures in 2010. However, what appears to be the strong involvement of the pharmaceutical industry in this report’s genesis should warn against any rash conclusions. In the report, the estimated total health burden of osteoporotic fractures is about 840 000 quality-adjusted life-years lost in 2010. The authors forecast a rise in the number of fractures to 3·2 million in 2025. And they say, despite the existence of management guidelines, that only a few patients receive preventive drugs. The authors also estimate that improving the implementation of existing guidelines (ie, prescribing more drugs) would greatly reduce the number of fractures by 2025—a
suggestion that could be true, but is impossible to interpret safely in view of the industry entanglements. It is worth noting that any rise in the use of preventive drugs would increase the total cost of treatment in most countries assessed. The proportional increase in the elderly population will mean that the health burden and costs attributable to osteoporotic fractures will only grow in the future; therefore the development of new drugs for the prevention and treatment of osteoporosis is welcome. But any risk related to preventive drugs will be magnified if they are prescribed too liberally (a problem for any type of widespread drug-based preventive strategy), so preventive measures will need to go beyond drugs. Drug-based prevention and treatment must be preceded by changes in lifestyle (smoking cessation, reduction of alcohol consumption, and increased physical activity) and nutrition. And, as with many noncommunicable diseases, the necessary lifestyle changes offer benefits beyond this one disease. ■ The Lancet
World Health Organization
“Respect your elders”
For WHO’s report see http:// www.euro.who.int/__data/ assets/pdf_file/0010/ 144676/e95110.pdf
2152
On June 16, WHO released its European report on preventing elder maltreatment. Identified as an increasing health burden in Europe, elder abuse is defined as physical, sexual, mental, or financial abuse (such as stolen money or fraud), or neglect of people aged 60 years or older. More than 4 million elderly people a year are subjected to abuse in the WHO European region, with 30% of all homicides in this age group being the result of maltreatment. 19·4% of all people older than 60 years in the region have been subjected to mental abuse in the past year, and 3·8% to financial, 2·7% to physical, and 0·7% to sexual mistreatment. The risk of abuse is greater in elderly people who live in the same house as the perpetrator, with most reported cases being at the hands of spouses or offspring. Victims with physical or intellectual disability are specifically at risk; elderly people with dementia have a four times increased risk of abuse compared with their peers without cognitive impairment. Risk factors for abusive behaviour in caregivers include financial or emotional dependence on their charge, depression, substance misuse, or so-called
carer burnout. Many report having experienced abuse themselves during childhood. Health professionals work at the front line of elder maltreatment, providing clinical care and support services. They have a unique position from which to educate victims and perpetrators about the dangers of abuse and means of positive behavioural change. But they cannot work alone. The strongest protective factors against elder abuse are robust personal relationships and community involvement of both elderly people and their carers. Governments must implement multidisciplinary efforts to reinforce nurturing family environments, to create positive societal attitudes towards elderly people, and to provide effective community support programmes to reduce stress among caregivers. With a third of the European population expected to be older than 60 years by 2050, change is urgently needed. By collating current evidence, the WHO report is a welcome first step. Now governments must take up the challenge to protect their ageing populations from abuse and neglect. ■ The Lancet www.thelancet.com Vol 377 June 25, 2011
Science Photo Library
Osteoporosis—striking the right balance
See New Horizons Lancet 2011; 377: 1276
For the IOF report see http:// www.iofbonehealth.org/ about-iof/the-organization/ committee-of-scientificadvisors-csa/publicationsposition-and-consensusstatements.html
Bone loss due to osteoporosis is insidious and initially symptom-free. Diagnosis is therefore often after the first fracture. A new report from the International Osteoporosis Foundation, together with the European Federation of Pharmaceutical Industry Associations, suggests that the burden of fractures in France, Germany, Italy, Spain, Sweden, and the UK has been underestimated. They conclude that there were 2·5 million new fractures in 2010. However, what appears to be the strong involvement of the pharmaceutical industry in this report’s genesis should warn against any rash conclusions. In the report, the estimated total health burden of osteoporotic fractures is about 840 000 quality-adjusted life-years lost in 2010. The authors forecast a rise in the number of fractures to 3·2 million in 2025. And they say, despite the existence of management guidelines, that only a few patients receive preventive drugs. The authors also estimate that improving the implementation of existing guidelines (ie, prescribing more drugs) would greatly reduce the number of fractures by 2025—a
suggestion that could be true, but is impossible to interpret safely in view of the industry entanglements. It is worth noting that any rise in the use of preventive drugs would increase the total cost of treatment in most countries assessed. The proportional increase in the elderly population will mean that the health burden and costs attributable to osteoporotic fractures will only grow in the future; therefore the development of new drugs for the prevention and treatment of osteoporosis is welcome. But any risk related to preventive drugs will be magnified if they are prescribed too liberally (a problem for any type of widespread drug-based preventive strategy), so preventive measures will need to go beyond drugs. Drug-based prevention and treatment must be preceded by changes in lifestyle (smoking cessation, reduction of alcohol consumption, and increased physical activity) and nutrition. And, as with many noncommunicable diseases, the necessary lifestyle changes offer benefits beyond this one disease. ■ The Lancet
World Health Organization
“Respect your elders”
For WHO’s report see http:// www.euro.who.int/__data/ assets/pdf_file/0010/ 144676/e95110.pdf
2152
On June 16, WHO released its European report on preventing elder maltreatment. Identified as an increasing health burden in Europe, elder abuse is defined as physical, sexual, mental, or financial abuse (such as stolen money or fraud), or neglect of people aged 60 years or older. More than 4 million elderly people a year are subjected to abuse in the WHO European region, with 30% of all homicides in this age group being the result of maltreatment. 19·4% of all people older than 60 years in the region have been subjected to mental abuse in the past year, and 3·8% to financial, 2·7% to physical, and 0·7% to sexual mistreatment. The risk of abuse is greater in elderly people who live in the same house as the perpetrator, with most reported cases being at the hands of spouses or offspring. Victims with physical or intellectual disability are specifically at risk; elderly people with dementia have a four times increased risk of abuse compared with their peers without cognitive impairment. Risk factors for abusive behaviour in caregivers include financial or emotional dependence on their charge, depression, substance misuse, or so-called
carer burnout. Many report having experienced abuse themselves during childhood. Health professionals work at the front line of elder maltreatment, providing clinical care and support services. They have a unique position from which to educate victims and perpetrators about the dangers of abuse and means of positive behavioural change. But they cannot work alone. The strongest protective factors against elder abuse are robust personal relationships and community involvement of both elderly people and their carers. Governments must implement multidisciplinary efforts to reinforce nurturing family environments, to create positive societal attitudes towards elderly people, and to provide effective community support programmes to reduce stress among caregivers. With a third of the European population expected to be older than 60 years by 2050, change is urgently needed. By collating current evidence, the WHO report is a welcome first step. Now governments must take up the challenge to protect their ageing populations from abuse and neglect. ■ The Lancet www.thelancet.com Vol 377 June 25, 2011