Importance of prevention and early detection in osteoporosis – Prof O’Brien

The Irish Osteoporosis Society (IOS) 2023 Annual Medical Conference for Health Professionals was held virtually on Saturday, 21 October. The well-attended conference featured a varied range of presentations from expert speakers on topical issues relating to osteoporosis.

President of the Society, Prof Moira O’Brien, told the Medical Independent that she was delighted attendees could get updates in so many areas of bone health on the day, and raise their awareness of the importance of prevention, early detection, and evidence-based treatment of osteoporosis. “It really is a silent disease and I would ask all clinicians to be aware of the potential bone loss risk factors in their patients. Any patient with one or more risk factors should be referred for a DXA scan, as it is much cheaper and less painful to prevent fractures than to treat them, and vitamin D supplementation is very important, particularly in the over-50s.”

She also highlighted the importance of clinicians investigating the root causes of bone loss in patients, and not just assuming it is down to the menopause or chemotherapy, etc: “Very high stress levels, for example, can cause bone loss, along with poor absorption of vitamin D due to gluten sensitivity.”

Prof O’Brien recently turned 90 years of age, but has no plans to retire. She continues to practise medicine, combining it with her role in the IOS, as well as writing, professional consultancy and research work.

“I graduated medical school in 1956 and I have been involved in sports medicine since the 1960s, and at 90 I am still working as an osteoporosis consultant.”

During the lively questions and answers session at the meeting, Prof O’Brien noted that she had “99 per cent” compliance with her patients’ treatment plans, adding that continuous monitoring was a key part of ensuring treatment compliance and success. She advised annual DXA scanning in osteoporosis patients to monitor for any bone loss/improvement, as no one feels bone loss and significant bone loss can occur in one year.

During the meeting, Dr Tamer Darwazeh, St James’s Hospital, Dublin, gave an oral abstract presentation on medication-related osteonecrosis of the jaw (MRONJ). The delegates were reminded that MRONJ is a rare, but debilitating condition, which can have a significant effect on a patient’s quality-of-life. Dental treatment in osteoporosis patients needs to be very carefully planned and scheduled to take account of the specific osteoporosis medicines (eg, bisphosphonates and denosumab) the patient may be on and their individual risks in delaying/stopping their medication. Patients taking antiresorptive medication to help prevent osteoporotic fractures should be made aware that the risk of MRONJ is low, compared with the risk of osteoporotic fractures, which can result in significant complications.

There is no universally agreed treatment for MRONJ, and Dr Darwazeh discussed a protocol for the management of advanced MRONJ involving debridement of necrotic bone and reconstruction using bone and buccal fat grafting. Follow-up of 23 MRONJ patients who were treated with this approach suggests that this protocol is beneficial for improving quality-of-life for patients and limiting progress of this disease.

During the meeting, the IOS launched its MRONJ and ONJ guidelines for dental practitioners. The guidelines are a rolling document and thus will be updated as warranted.

The guidelines, as well as more information and resources on osteoporosis for both patients and healthcare practitioners, are available on the IOS website, www.irishosteoporosis.ie.

Two research winners were also announced during the conference: Dr Cliodhna Redmond, Tallaght University Hospital, Dublin, won Best Poster for her work entitled: ‘Older patients admitted with a fragility fracture – a review of discharge summary documentation in accordance with HIQA National Standards.’