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Osteoporosis: "We Must Act Now"

An Exclusive Interview with Dr. Gro Harlem Brundtland, director general of World Health Organization, WHO

Dr. Gro Harlem Brundtland Dr. Gro Harlem Brundtland,
Director General, WHO

IOF Press Release 01-99
Geneva, Switzerland.

When Gro Harlem Brundtland of Norway began her term as director general of the World Health Organization, she said that she would move swiftly to put health where it belongs -- at the top of the global development agenda, alongside poverty alleviation and job creation.

"Health is the core of human development," Dr. Brundtland, 60, said shortly after her election. She noted that good health requires the empowerment of both women and men.

On behalf of IOF, journalist Paul Spencer Sochaczewski obtained Dr. Brundtland's first interview devoted exclusively to women's health and osteoporosis. In the interview that follows, Dr. Brundtland notes that osteoporosis is a leading cause of suffering in women. She predicts a significant increase in osteoporosis in the developing world and urges that policy makers collaborate with different sectors of society.

Mary Fraser, executive director of IOF-International Osteoporosis Foundation, notes that "osteoporosis is serious but it can be prevented and treated, provided action is taken early enough. IOF agrees with Dr. Brundtland. We must act now."

IOF: How important is women's health in general, and osteoporosis in particular in WHO's new programme?
GRO HARLEM BRUNDTLAND: Women's health is one of WHO's highest priorities.
Non-communicable diseases such as cardiovascular diseases, cancer and osteoporosis are major threats to women's health.
Cardiovascular diseases are the leading cause of death in women. Cancers of all types among women are increasing.
Osteoporosis, as the third threat, is particularly attributable to women's physiology. The accelerated bone loss that occurs after menopause dramatically increases the risk of osteoporosis fracture and causes debilitating pain, loss of height and humpback. The lifetime risk of women suffering an osteoporotic fracture is close to 40%.
About 15% of people who suffer hip fractures die as a result, mostly within the first six months following the fracture. The main complications are pneumonia, other infections and cardiac insufficiency. Such hip-fracture related death outweighs death caused by many types of cancers.

How common is osteoporosis?
Today osteoporosis affects more than 75 million people in the United States, Europe and Japan and causes more than 2.3 million fractures in the USA and Europe alone.
It was estimated that in 1990 1.7 million hip fractures occurred world-wide. Almost half of these fractures occurred in Europe, North America and Oceania, while 30% of all hip fractures occurred in Asia.

Is osteoporosis of concern only to the developed world?
Osteoporosis, with its resultant complications, will soon represent a major public health problem for the developing, as well as the developed world.
Although approximately 80% of osteoporosis sufferers are women, as the longevity of the male population increases, the disease will assume increasing importance in men. We predict an exponential growth in hip fracture incidence.
According to world-wide projections, the number of hip fractures could rise to 6.26 million by 2050, with 71% (4,430,000) of these likely to be in Africa, Asia, South America and the eastern Mediterranean region. This will lead to progressive health deterioration, morbidity, and escalating health care costs. These costs will only increase as the population of developing nations ages.

Does WHO have any specific goals for reducing the incidence of osteoporosis?
In recognising the global problem posed by osteoporosis, WHO sees the need for a global strategy for prevention and control of osteoporosis, focusing on three major functions: prevention, management and surveillance.
Epidemiological studies have identified biological and environmental risk factors for the development of the disease. Such lifestyle factors such as cigarette smoking, excessive alcohol consumption, little physical activity and low dietary calcium intake are risk factors for osteoporosis as well as for many other non-communicable diseases.
Since the reduction of risk factors is the scientific basis for primary prevention, the World Health Organization promotes the development of an integrated strategy for prevention of several diseases, rather than focusing on individual ones. This integrated approach is based on evidence that the reduction of risk factors contributes more to the control of non-communicable diseases (including osteoporosis) than health care alone.

This implies intervening at an early age, before someone gets the disease.
That's right. In order to achieve the best results to prevent osteoporosis and its complications, the prevention should ideally begin at the earliest possible age. Adolescence is the crucial period for the formation of bone mass and any prevention programme should ideally start at least at that time.

Is osteoporosis only a problem for doctors or do other sectors of society have a role to play?
Collaboration between different sectors plays a crucial role in the prevention and control of osteoporosis. It should involve the collaboration of policy makers with different sectors of society: industry, media, legislature, sport and leisure, food and agriculture, and trade unions.
Intervention for the prevention and control of osteoporosis should comprise a combination of legislative action, educational measures, health service activities, media coverage, and individual counselling to initiate changes in behaviour.
To assess the effect of community-based prevention of osteoporosis and its complications, evaluation mechanisms should be developed and "built in" to the health system. New cases of different fractures and various measures of bone mineral density could provide the end points for the monitoring and evaluation of osteoporosis. This will allow planning, monitoring and evaluation of the community based programmes and their impact on a community's health.

What lessons have been learned about other diseases that are relevant to osteoporosis?
Twenty-five years ago, the world's leading experts in cardiovascular diseases warned of an impending epidemic of heart disease in developing countries. This warning was largely ignored and we are now seeing a dramatic increase in prevalence of cardiovascular diseases in the developing world.
We must not allow the same thing to happen for osteoporosis. We must act now.

What is the role of the European Community and of NGO's such as International Osteoporosis Foundation and its member societies in promoting awareness of osteoporosis?
We want to strengthen our collaboration with the European Community. The "Report on Osteoporosis in the European Community" calls for prevention of osteoporosis in the European Community and this step is warmly welcomed by the World Health Organization. The launch of the report coincides with the initiation by WHO of the global strategy for the prevention and control of osteoporosis, and I think a good partnership could be established in our common efforts to prevent osteoporosis.

Do you feel that World Osteoporosis Day is a useful way to increase public awareness? How do you think WHO might be involved in the future ?
The 1998 World Osteoporosis Day (WOD), cosponsored by WHO, was a remarkable event with a broad media response. WHO and IOF worked together in planning the event, with the assistance of the German Green Cross. A press pack was produced in 14 languages and disseminated to national osteoporosis societies and to all WHO regional and country offices.
Over 30 countries throughout Europe, the Middle East, Africa, the Americas and Asia participated in WOD 98. Public awareness about osteoporosis is a very important element of the annual WOD and we shall continue our collaboration with IOF in building awareness about osteoporosis through such events.

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