Frequently Asked Questions

Osteoporosis is a condition characterised by a loss of bone density and structural deterioration, making bones weaker and more susceptible to fractures. Often called the "silent disease," osteoporosis progresses without symptoms until a fracture occurs, typically from minimal trauma such as a fall from standing height.

A fragility fracture is a broken bone that results from a fall from standing height or less, indicating compromised bone strength. Common sites include the hip, spine, wrist, pelvis, and humerus. Addressing fragility fractures is crucial because individuals who sustain one fragility fracture are at a significantly higher risk of additional fractures, leading to increased healthcare costs and reduced quality of life.

Age (especially 50+), family history, low body weight, smoking, excessive alcohol intake, and taking certain medications (e.g., glucocorticoids) increase osteoporosis and fracture risk. Long-term conditions including rheumatoid arthritis, COPD, and diabetes are also associated with increased risk.

Osteoporosis leads to around 22,300 fragility fractures annually among New Zealanders aged 50 years and older, including nearly 3,900 hip fractures and 2,900 symptomatic spine fractures. The resulting demand on healthcare resources is substantial, with over 300,000 bed days each year attributed to fragility fractures and other injurious falls. If these cases were managed in a single facility, it would be the third largest hospital in New Zealand. Many of these fractures and falls are preventable and addressing them proactively could free up resources for other healthcare needs.

Fragility fractures among older adults cost New Zealand’s Accident Compensation Corporation (ACC) $345 million annually, with projections suggesting this cost could more than double by 2035 without intervention. Beyond direct medical costs, fragility fractures also lead to lost productivity, increased need for informal caregiving, and long-term disability. Osteoporosis New Zealand estimates that around 6,200 working-age New Zealanders sustain fragility fractures each year, resulting in significant sick leave and more than 2,000 people leaving the workplace prematurely.

A range of effective and safe medications, including bisphosphonates, denosumab, and hormone replacement therapy, can reduce fracture risk by 30% to 70%. Ensuring equitable access to these treatments could significantly reduce the frequency of costly fractures, thus alleviating demand on the healthcare system. However, regional disparities and patient access barriers, such as infusion fees in certain areas, need to be addressed to maximise the impact of these treatments nationwide.

Fracture Liaison Services (FLS) are specialised teams dedicated to assessing and managing patients over 50 who have sustained a fragility fracture, aiming to prevent future fractures. FLS conduct risk assessments, provide guidance on osteoporosis treatment, and address falls prevention. In New Zealand, FLS align with national Clinical Standards and international best practices, and data from the Australian and New Zealand Fragility Fracture Registry (ANZFFR) enables real-time tracking of secondary fractures and care quality. ACC analysis suggests that universal FLS access could save nearly 58,000 hospital bed days over five years, underscoring their value as a core healthcare service.

New Zealand’s National Clinical Network for Fracture Liaison Services (FLS), developed in partnership with Osteoporosis New Zealand and ACC, integrates FLS teams within the national Live Stronger for Longer Programme. This network, although currently informal, promotes consistent, high-quality osteoporosis and fracture care. Expanding this network to include orthogeriatric leads, hip fracture experts, and primary care leaders would support uniform excellence in fracture prevention. Formal recognition of this network as a National Clinical Network by Health NZ – Te Whatu Ora would reinforce its role in New Zealand’s healthcare infrastructure and facilitate cross-specialty collaboration.

A unified government commitment to bone health is essential to address osteoporosis and fragility fractures with the urgency and coordination they demand. Effective collaboration must extend beyond the health sector, involving the Ministry of Education and Sport NZ to promote peak bone mass in youth, the Ministry of Housing and Urban Development to create age-friendly environments, and the Minister of Finance to acknowledge the economic burden of poor bone health. Establishing an All-Party Parliamentary Group on Bone Health would further facilitate a cohesive legislative response, supporting initiatives like the Live Stronger for Longer Programme to improve bone health across all age groups in New Zealand.

Yes, integrating cognitive assessments into secondary fracture prevention programmes offers a valuable opportunity to improve the management of comorbidities such as dementia. Individuals with dementia experience higher rates of falls and fractures, yet they are often under-assessed for falls risk factors and less likely to receive osteoporosis treatment. Incorporating cognitive evaluations into the protocols of Orthogeriatric Services and Fracture Liaison Services facilitates earlier detection of cognitive impairments. Conversely, Memory Clinics can utilise online fracture risk calculators, enabling timely referrals to appropriate services. This integrated approach not only addresses bone health but also promotes comprehensive care for older adults, aligning with New Zealand's Dementia Mate Wareware Action Plan, which emphasises early diagnosis and integrated service delivery.