By Joseph Kabia
Three in every 10 Kenyans are living with Osteoporosis, a systemic skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue, new data shows.
A cross sectional household survey conducted in Kiambu County, involving 254 postmenopausal women between October 2017 and February 2018, revealed that 26.4 percent were living with osteoporosis while 36.2 percent were osteopenia. The data shows that women have a higher incidence of osteoporosis fractures than men.
The lifetime risk for osteoporotic fracture at 50 years is 53.2 percent in women and 21 percent in men. According to the Kenya Osteoporosis Prevention and Age Concern (OPAC), an advocacy group, there is not enough data and resources to support research and care for those living with the debilitating disease.
Prof. Lawrence Gakuo, a leading Orthopedic specialist observed that the clinical significance of osteoporosis is the occurrence of fragility fractures with their attendant morbidity and mortality, while the common osteoporotic fractures of the skeleton occurring in the spine, hip, forearm, proximal humerus and ankle.
“At the age of 50 years, the remaining lifetime risk of an osteoporotic fracture exceeds 50 per cent especially fractures of the hip and spine are very significant causes of morbidity and long-term consequences on quality of life.” From a clinical point of view, osteoporosis has been defined in terms of low Bone Mineral Density (BMD), focusing the attention on the estimation of BMD.
“The ability of BMD to predict the fracture is comparable to the use of blood pressure to predict stroke, and significantly better than cholesterol to predict myocardial infarction,” notes Prof. Gakuo. He contends BMD is an important component of risk of fractures and it is typically assessed by dual-energy x-ray absorptiometry DEXA and operationally based on T-Scores.
While BMD is a key component of fracture risk, other factors such as age, prior fragility fracture and family history of osteoporosis contribute to fracture risk. A variety of non-skeletal factors such as liability to fall and the force of impact also contribute.
The specialist cites age as the most important risk factor, adding previous fracture, use of corticosteroids, a family history of osteoporotic fractures, low body mass index, certain diseases associated with secondary osteoporosis in endocrine or metabolic diseases like Diabetes mellitus, Cushing’s syndrome, hyperparathyroidism and pregnancy. He further contends that the diagnosis and treatment of osteoporosis involves several specialists, adding that prevalence of primary osteoporosis is high and therefore the general practitioners see most of the patients.
All fragility fractures require intervention by orthopedic surgeons currently available in almost all County referral hospitals in Kenya, while other specialists that see and manage Prof. Lawrence Gakuo, Orthopedic Specialist Focus on Osteoporosis Focus on Osteoporosis osteoporosis are gynecologists, rheumatologists and endocrinologists. R h e u m a t o l o g i s t s a n d endocrinologists are only available in Nairobi, Mombasa and Kisumu.
In the management of osteoporosis, he says measures of musculoskeletal rehabilitation should be considered along with pharmacotherapy so as to optimize the musculoskeletal health, improve quality of life and reduce fracture risk. This is done by improving muscle function, strength, coordination and balancing.
“The use of spinal orthosis, hip and knee protectors and in vertebral lesions Kyphoplasty, which is percutaneous transpedicular cement inject in to partially collapse vertebral body is done.” Estimates show that by 2050, 17 percent (14 million) of the population will be over 50 years who are the most affected by osteoporosis.
There is currently paucity of data on the degree and extent of osteoporosis in Kenya and sub-Saharan Africa. He says that the osteoporosis study currently being done by Dr. Sitati, an orthopedic surgeon at the University of Nairobi is set to give more insight by next year.
“This will help policy formulation to develop preventive measures and strategies. Osteoporosis is being taught both in the undergraduate and post graduate curriculum in Kenyan Universities.” Prof Gakuo notes that research on osteoporosis in Kenya is hindered by financial assistance.
He supports population mass screening and education which he said is possible and can be done cheaply by ultrasound (QUS). There are other methods of non- invasively assessing the bone strength including X-ray, CT Scans, Dual phot or absorptiometry and dual energy x-ray absorptiometry (DEXA).
