The high cost of osteoporosis
By Anne Hilton Tuesday, July 10 2012
Following is the second part of the series in which Newsday columnist Anne Hilton candidly talks about her experience being diagnosed and dealing with Osteoporosis.
Osteoporsis is a sneaky disease, especially if you’re a woman. Let’s say you’re about 55, in other words, past menopause – “the Change.” You’re fit as a fiddle, with no more “times of the month” to slow you down.
Well, perhaps your free cholesterol test in the health clinic, or the mall or wherever shows your nasty LDL (the ‘bad cholesterol) level puts you at risk of heart disease so the doctor at the health clinic, or your own private doctor can give you a prescription for pills available free of charge through the Ministry of Health’s Chronic Disease Assistance Programme (CDAP). Or, on having a health check-up you’re told you are hypertensive (have high blood pressure) – in which case you can get pills to control your pressure also on CDAP. And if you’re diabetic (as so many of us are) you can also get medication to control diabetes on CDAP.
But what if osteoporosis is creeping up on you? Your private doctor may suggest (as mine did) that you take a Bone Mineral Density (BMD) test. She didn’t insist (I wish now that she had) but I was short of cash at the time and didn’t take the test.
Short of cash I may be, but I still go to my private doctor for most minor ailments and the occasional check-up. However, as I don’t have health insurance and if I wasn’t part of a drug trial that paid for the test, and if I didn’t have the money to consult a private doctor and went to the health clinic for a check-up, I know the doctors in the health clinics of Trinidad — even if they suspect a patient may have/be developing osteoporosis — can’t order a BMD test because there is not one machine in the Trinidad Health Service to test bone mineral density. As we saw last time, there is one machine to test BMD in the public health service in Tobago – but no machine to test bone density in Trinidad.
Supposing, just supposing the family club together (or have a win on the lottery) to pay for a BMD test for mum (or gran), the expense doesn’t end there. Oh no. Although there is medication available on CDAP for hypertension, diabetes and high blood cholesterol you can’t get drugs to combat osteoporosis on CDAP – even though, like hypertension, high blood cholesterol and diabetes, osteoporosis is a non-communicable disease.
The medication I’ve been taking everyday on the clinical trial to introduce in TT a drug to increase bone mineral density seems to work. At any rate in my case after taking the drug for six months my bone mineral density improved significantly – even though it didn’t, it couldn’t build back my crumpled vertebrae.
If I’d not been part of the trial, the drug would have cost me TT$300 a month – wholesale. I’m told the other osteoporosis drugs on the local market cost about the same and not one of them are on CDAP.
It’s worth repeating that osteoporosis affects women more than men, but men can suffer from it as well. There is also the old wives’ tale that women of African descent don’t get osteoporosis. In fact, they do, although not nearly as many as Caucasians or East Indians or Chinese.
But, surely, osteoporosis isn’t life-threatening? We know hypertension, diabetes, ‘bad’ cholesterol leading to heart disease can kill – but soft bones, breaking bones – can’t doctors treat, mend broken bones? They can – in young people, in women before menopause, and men before andropause (the male menopause, remember?).
So far as I’m aware my crumpled vertebrae aren’t likely to kill me. But the pains of sciatica can be excruciating; they slow me down, I have to take painkillers almost everyday. I have to walk with a stick, a cane, as a precaution against tripping and a fall that could be fatal because if I fall, I could fracture a hip – or worse.
Dr Godfrey Araujo estimates when an elderly person falls and fractures a hip, between 30 and 40 percent of patients die. While in my twenties in hospital for appendicitis there was an elderly woman in the same ward with a fractured hip, she got pneumonia and within a week she was dead.
However, when elderly patients survive the surgery to mend, to pin a fractured hip, that’s not the end of the treatment. They will need weeks, if not months of physical therapy to recover mobility – that is if they recover and are able to move around and take care of themselves.
In the meantime, someone has to take care of the patient, has to take care of the housekeeping, cook, serve meals, help the patient to bathe, to dress, drive her/him to physical therapy sessions. Some member of the family – or a paid caregiver – has to tend the patient during recovery. This can have a disastrous effect on the family if, for example, mum has to take time off work, or leave work altogether, put dad and the children on hold while taking care of granny or grandpa. Once out of hospital, the patient is going to need a wheelchair and/or crutches – either rented, or bought outright – for the weeks and months needed for the patient to be able to look after him/herself.
Mending a broken hip can put a very nasty dent in family finances. Dr Araujo reckons it costs around $35,000 – in TT (at private hospitals and probably costs the health service as much as that in Port-of-Spain General or San Fernando General Hospitals). Take your elderly relative by air ambulance to the US and you could be paying out the same amount in US dollars – if not more – plus the airfare and accommodation for whoever accompanies the patient.
Could anything be done to combat osteoporosis – the disease that deforms the elderly back, leaving them hunched over and shuffling along with a cane, that means the slightest trip and fall or tap on arm and leg means broken bones?
We’ll see what could be done to combat osteoporosis – next week.