At the international media launch of "Staying Power: Closing the Adherence Gap in Osteoporosis" by the International Osteoporosis Foundation at the Grand Hotel in Vienna, Austria, mediamen from around the world, including the Philippines, get to meet Britt Ekland, turning 64 on Oct. 6, up close and very personal. The cameras zoom in on the star of the launch and a hush falls as everyone in the SRO-packed room listens to Britt tell the story of her life: "I was born in Sweden, where there’s a lot of milk. I was a fat teenager and started dieting at 15-16. I studied theater in Sweden and then I did small parts on Swedish television. At 20, I went to Italy to do my first movie. I was discovered sitting in a cafe sipping a cappuccino by a talent scout from 20th Century Fox. I was sent to London to start my first movie. By the way, they told me to lose weight. I met Peter Sellers at Dorchester and he asked me for a drink and to see his latest movie The Pink Panther. Ten minutes later, we were married (laughter from the audience). He, too, started eating, dieting, working – well, that was my life. When I did the Bond film, the producers told me, ‘You’re too thin.’ I think one of the reasons I have osteoporosis is because I have been eating and dieting and eating and dieting all my life. Unfortunately, it’s part of this profession.
"I had my third and last child when I was 45. I was fit, I was healthy. I was in the best time of my life. At 53, my doctor insisted that I have a bone density test. This is the doctor who delivered my son. As I have a yearly mammogram and a yearly Pap smear, why not? He diagnosed me with osteoporosis and put me on immediate medication. And he explained very seriously what would happen to me if I didn’t cooperate. I was so shocked and so stunned; I couldn’t believe it. I couldn’t have this. My best girl friend’s mother had osteoporosis and she was a little bent-over old lady and in constant pain. This is for old people, not for me.
"On Aug. 31, 2000, I was asked to give an award at the Rock n’ Roll show. It was an afternoon show – it was vodka, champagne, whisky and wine, and plenty of rock stars. The centerpieces were all watermelons cut in half and, of course, they had been thrown around the room. I was to present the last award to Marilyn Manson. I stood up, I put my high heel on the floor, and it turned out that I put it in the half watermelon and it took my leg away and I fell with a crash to the floor. I was carried on stage and gave Marilyn Manson the award with my healthy left hand. Then it was the hospital with two fractures. My ankle was broken in six places and my wrist my broken, both on the right side. My surgeon put me on a cast; he wanted to avoid putting metal pins on my body.
"I spent two days in the hospital and then I was sent home. I had a house in Chelsea and my bedroom was upstairs. I had to move into the basement with my wheelchair and crutches – one of them, the right one, an ankle crutch. With my right hand completely out of use, I had to use my left hand for everything. It was the most horrifying experience. I was completely alone. I was dependent on people coming and giving me food. The young man who used to come and clean for me had to wheel me into the shower. It was an embarrassment! I had skied with the American ski team, I had roller bladed. (She even came out her own exercise video titled Britt Fit.) And here I was a complete cripple, totally unable to take care of myself!
"I had signed a contract to do pantomime at the Grand Opera Theater, where Snow White and the Seven Dwarfs was playing. Management was terrified! I wasn’t gonna make it; they had a sold-out season and the star was broken. I spent eight weeks in a cast. After that, I was determined to work. I went back to do Pilates which I have done all my life. When I went to start my first session in the Pilates studio and I took my cast off, I had one thin, thin leg that wouldn’t move, a foot that wouldn’t move. But I thought, I gotta keep going, this is no time for self-pity. And I was determined to do the panto, I’ve lost work already and I couldn’t lose anymore. So I started rehearsals on crutches. By the end of 10 days, which were all the rehearsals we got, I walked on stage without crutches and without the support. Yes, I had flat heels when normally I had high heels.
"The thing with osteoporosis is that you can live with it, but you gotta take care of it. You don’t know that you have osteoporosis that’s why in my mind, mandatory bone density testing is absolutely necessary in every country. I was very lucky I found a doctor who really understood me, supported me, checked on me. Every year, he’d measure me ...
"Some of the medications 10 years ago were horrible – they gave me indigestion. Today, I found the medication that works fine. The problem is, even with medication, you don’t feel any better or worse, you don’t feel anything. You can’t feel osteoporosis until it’s too late and then come the pain and fracture.
"I’ve had osteoporosis for 10 years. I have a fabulous life. I do anything I want. I exercise, I do weight-bearing exercises, and I found the ultimate weapon – the power plate. You go and google that and find out what it is. I take calcium. I take high, high doses of vitamin D and, of course, I stay on my medication. I wouldn’t be here in front of you if I hadn’t been doing all that. Believe me, my experience of having lived in the basement with my wheelchair and crutches never leaves me."
The statistics leave a trail of grim tales (as culled from the osteoporosis factsheet courtesy of the International Osteoporosis Foundation):
• Osteoporosis – literally porous bones, where the density and quality of bone are reduced, leading to weakness of the skeleton and increased risk of fracture – affects an estimated 75 million people in Europe, the USA, and Japan.
• A third of postmenopausal women and one in five men – yes, even men can have osteoporosis – over 50 are affected by osteoporosis.
• In women over 45, osteoporosis accounts for more days spent in the hospital than many other diseases, including diabetes, heart attack, and breast cancer.
• Osteoporosis remains hugely under-diagnosed and under-treated, despite the availability of proven diagnostics and treatments.
• Vertebral fractures are the most common osteoporosis-related fracture, causing patients to suffer back pain and disability, and leading to an increased risk of subsequent vetebral deformities.
• After suffering one vertebral fracture, women have a five-fold increase in the risk of developing a new vertebral fracture within a year. Prevention of the first fracture is, therefore, critical.
• In Europe, vertebral fracture rates are set to rise by 70 percent by the year 2050.
• The lifetime risk of a woman dying of hip fracture complications is equal to the risk of dying of breast cancer.
• Approximately 25 to 30 percent of patients who suffer a hip fracture die within a year.
• The annual number of hip fractures is expected to reach over six million worldwide by the year 2050.
• The cost to healthcare systems worldwide as a result of osteoporosis-related fractures is estimated to be several billion euros each year.
• The worldwide cost burden of osteoporosis (for all ages) is expected to increase to almost 106 billion euros by 2050.
There’s bad news and there’s good news, according to Paul Spencer Sochaczewski, head of communications for the International Osteoporosis Foundation, who has spearheaded public awareness campaigns to draw attention to the seriousness of osteoporosis and what can be done to beat the disease. The good news is osteoporosis can be treated and the risk factors can be reduced through diet, exercise, among other things. While there’s no cure for osteoporosis, treatment can strengthen the bones and help reduce the risk of fractures. But the bad news, says Sochaczewski, is "but what happens to people who don’t stay on the treatment? It’s a chronic disease so you need to continue with treatment."
He adds, "People want to regain their health, but doctors are putting fear in their heads and hearts. There’s a real communication problem. There’s not a lot of communication between the patient and the doctor – they’re in different worlds, on different planets."
Dr. Tito Torralba, founding president of the Osteoporosis Society of the Philippines and coauthor of the Osteoporosis Tool for Asians, can’t stress this enough: "There have been a number of significant advances in osteoporosis treatment in recent years. (Time was when the controversial hormone replacement therapy or HRT was one of only a few options.) However, improving patient adherence to treatment has the potential to have a far greater impact in tackling this widespread and serious disease."
Notes Dr. Yves Tanael, medical marketing manager of Roche (Phils.) Inc. Regulatory Affairs Department, "There are several modes of treatment that can be combined to stop the progression of bone loss. These include medication, nutrition, exercise, and lifestyle changes. The choice of treatment should fit a patient’s specific needs and lifestyle. A doctor can help determine what treatment choice will work."
He elaborates, "Most of the advances in osteoporosis treatment are seen in the drug development. Antiresorptive drugs such as bisphosphonates slow down the progression of bone loss. Although bisphosphonates have been available widely, recently available bisphosphonates, such as ibandronic acid, are taken less frequently, that is, monthly instead of daily or weekly. Bone-building drugs are also being developed by researchers and are just becoming available on the market."
Compliance to bisphosphonates has been a problem because patients experience the discomfort of the side effects and the inconvenience of the requirements (like having to sit straight for 30 minutes upon intake), says Dr. Tanael. "With the once-monthly regimen, women will find it easier to comply with the regimen and thus realize the benefit of the drug. Ibandronic acid is the first and only drug in the bisphosphonate class that can be taken orally once a month."
Roche is a leading supporter of the "Staying Power: Closing the Adherence Gap in Osteoporosis" campaign.
Adherence is the key word. The lack of adherence to osteoporosis treatment has been recognized as a "worldwide problem of striking magnitude." In France, for instance, half of people with osteoporosis discontinue treatment after one year and only a small percentage of patients take their treatment correctly.
An IOF report in 2005 traces this global problem to the fact that physicians and patients have different perspectives on adherence, to wit: Most physicians affirm that they want their patients to take their treatment long-term – between "one year" and "indefinitely." But it seems the message is not being communicated effectively – just over a half of the patients could not recall being told how long their treatment should last.
"The best drug will not work if the patient does not take it," says Jean-Yves Reginster, professor of epidemiology, Public Health and Health Economics at the University of Liege, Belgium, and IOF general secretary. "The social and economic costs of women not staying on their treatment simply cannot be sustained. Doctors, women, and patient groups must all work together now to combat this situation. Ensuring that osteoporosis treatments are more patient-friendly is crucial and there are new options available, including less frequent dosing, which can help."
Prof. Reginster adds that the indirect costs of osteoporosis are even more important than the medical costs. "You’re unable to go to work, there’s lost productivity, and even the patient’s family is affected . . . It is not as fashionable a disease as heart disease or cancer so it’s not the government’s top priority. We spend 40 billion euros each year for a disease that we can prevent and for which we have the proper medication. And we’re not talking of a disorder that hits only one country or one part of the world – it’s something that happens all around the world. It’s a massive global burden – socially, clinically, and economically. A rational use of health resources is needed. Osteoporosis is a killing, disabling disorder but we can prevent it."
Here lies the solution, says the good professor, "We need to understand why patients stop treatment and provide them solutions in accordance with their expectations. Diagnosis is important, but that’s not enough. We need to have the cooperation between health professionals, patients, and policy makers. We need to make sure that we talk to the patients and the doctors, we close this gap and make sure that what the patients want is something we’re able to give them – to provide them with user-friendly medications and make sure that at the end of the day, they’ve taken the drug and they get the positive effect."
Painting a positive picture for osteoporosis is Roswitha Horn, 69, an osteoporosis patient from Austria, where there some 700,000 people out of a population of eight million suffering from osteoporosis. Roswitha was diagnosed with osteoporosis in 1994, something she dismissed because of its "silent" symptoms. Until a bone density scan revealed the lowest results she’d ever had. Alarmed, Roswitha went on treatment and a health regimen. Her most recent scan last May revealed that her bone density has improved since she started treatment two years ago. Today, this widow lives an active, productive life, and helps other osteoporosis patients live productive lives, too, as a member of an osteoporosis self-help group in Austria.
"Personally, I take a lot of milk products," says Gabriele Suppan, chief executive, Action of Healthy Bones, Austria. "I’m taking care that I don’t eat too much chocolate or drink too much coffee, which is not good for the bone. I stay away from too much meat, too."
Of course, Gabriele never forgets to take her calcium supplement (you should take at least 1000 mg of calcium daily, she says). "But in the Philippines, you have very small fishes that have a lot of calcium," she tells me during a one-on-one interview. "Asian women are more prone to osteoporosis because of the combination of diet and genetic makeup. In Vienna, every third woman over 50 has osteoporosis; and one in five men has osteoporosis."
But calcium is not enough, adds Gabriele. "You have to take the proper diet, take your osteoporosis treatment, and exercise to get good muscles and increase bone density. Because even at a late age, bones still develop. It’s never too late to begin treatment."
On the other hand, Prof. Heinrich Resch, president of the German Society of Osteology and board member of the osteoporosis self-help group, Vienna, has a mouthful to say about osteoporosis, "Nutrition has a big impact on osteoporosis. It starts in kindergarten, where children don’t get enough calcium and vitamin D. For a person to reach peak bone mass, he must have an adequate vitamin D supply in his diet. Another very important point is the lack of mobility. Young people don’t really exercise, they don’t move enough. They’re just sitting in front of their computers or watching TV, which is the reason why the bones do not build up properly. If you move, you need more bone and the skeleton will produce it; if you don’t use it, the skeleton does not need too much bone, so it’s not producing bone."
To beat the "silent bone thief," Dr. Resch talks of government efforts to come up with fortified yogurt (with calcium and vitamin D) for schoolchildren.
For foreign journalists covering this launch, it’s an awesome time as any to be in Austria, which is celebrating the 250th birthday of composer Wolfgang Amadeus Mozart. Boning up on Austria’s immortal homespun celebrity, you see Mozart’s face in every conceivable item (from matchboxes and ref magnets to shirts and throw pillows) in almost every place you go to in Vienna (he’s from Salzburg, Austria, by the way). Austria is most certainly Mozart-crazy. Yeah, rock me, Amadeus!
With Mozart’s robust concerto playing in the background, you leave Austria on this note: Break a leg, but please don’t break your bones!