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Madam Deputy Speaker (Dame Janet Fookes): Order.
1 pm
Osteoporosis
Mrs. Teresa Gorman (Billericay): I am pleased to have this opportunity, 10 years after the launch of the National Osteoporosis Society and two days after the first World Osteoporosis Day, to tell the House about brittle bone disease, or osteoporosis, and how it relates to our lives.
It is an old disease in two senses. Fossil skeletons show that Cro-Magnon woman suffered from it--if she survived being dragged off by some caveman to bear him umpteen children. Most such women would have been dead by 50, the age after which people become increasingly vulnerable to the disease. We can all look forward, if that is the right expression, not only to a ripe old age but to the risk of the disease.
Today, the average longevity of women is 84; for men, it is 79. It is not surprising that the disease is becoming more and more common. The incidence has almost doubled in the past 30 years. In 1990, according to the World Health Organisation, 1.7 million osteoporotic hip fractures occurred in the western world. If we do nothing about it, the number is predicted to rise to 6.26 million by the year 2050. That is an awful lot of people and an awful lot of pain and cost. Osteoporosis is reckoned to cause around 200,000 fractures in Britain alone each year and it costs the national health service around £750 million to care for those people.
Fairy tales are full of stories that feature old crones--women shrunken, bent double and hobbling along with a stick, or long in the tooth as we say. Those problems are all due to osteoporosis. The tooth problem is caused by shrinkage of the jaw. Today, we hide people in that condition in old people's homes and give them zimmer frames. It was in such homes that I first became of the aware of the extent of this crippling disease. Osteoporosis can affect all parts of the skeleton. We shrink as we get older. Two or 3 in is common, but 10 or 15 in is not unknown. Such cases involve great curvature of the spine, the head sinks into the chest, pressure is caused on the lungs, and the people afflicted often die from lung disease before the bone disease gets them.
If the crones were young today, the National Osteoporosis Society would be there to tell them how to prevent distorted frames and save them from their suffering. It does a wonderful job with the money that it raises and it deserves as much as the Government can give it. Apart from anything else, it would be a terrific investment. About a third of our hospital beds are occupied by people being treated for osteoporotic fractures. Some never get out of their beds; they are crippled for life. We must thank the society and its campaigning for the fact that women, in particular, are much more aware of the risks that they run. However, it is still difficult to get women to do something about the problem sufficiently early. Not for nothing is it called the silent disease; it creeps up on people over the years. By the age of 60 to 70, people are at severe risk of fractures; by 70 to 80, there is a one in three chance of something serious happening to the skeleton.
At first glance, bones look solid, but that is far from being the case. When they are young, they are hollow and the material of which they are made is full of tiny holes.
As we grow older, the holes get bigger, like in a piece Swiss cheese, and the bones become fragile. One can suddenly suffer a broken bone from a fit of coughing, lifting a grandchild or using a vacuum cleaner. One does not have to fall over to sustain a fracture in one's 60s or 70s. When such people fall over, they have a big chance of breaking their ankles, wrists or pelvic girdles. Such fractures can be lethal; 15 per cent. of women who fracture their pelvic girdles--which are not to be confused with hip joints--die of the condition, even though they are operated on. Patching up that part of the body is difficult, because the bones are naturally thin. There is a good chance that people who survive will need zimmer frames for the rest of their lives. The quality of life is greatly reduced.
In the past, women over 50 were considered to be over the hill or on the shelf, partly because of the decline in their health. There are many things that such women can do with their talents, but good health is essential. The early treatment of osteoporosis can go a long way towards improving the chances for older women to continue to make an important contribution to our society.
The good news is that osteoporosis is preventable and treatable. A healthy diet with lots of calcium, which means butter, cheese and milk, gives bones strength. Vitamins are important, especially vitamin D3, which is obtained from dairy products and sunlight. Exercise is important; during exercise, the muscles pull on the bones, which strengthens them. However, the most important ingredient in preventing bone loss in women is the replacement of the natural hormones, which begin to decline as women grow older.
It is a well-known medical fact that, if hormone replacement therapy is taken by women of 50 and over for 10 years after the menopause, the risk of brittle bones is very much reduced. A study of 6,000 women in Hull between the ages of 50 and 54 showed that 37 per cent. of them were already experiencing bone loss. Most of them went on to hormone replacement therapy, and the bone loss stopped. Not all women want to take hormone replacement and the pharmaceutical industry is developing non-hormonal treatments to counter the disease.
Baroness Cumberlege, the Under-Secretary of State for Health, has taken much interest in the subject. She is actively encouraging health authorities to provide a comprehensive service for osteoporosis sufferers. So far, 12 per cent. of health authorities have responded. The number is growing, but clearly we want to encourage them to do more. More hospitals have scanning facilities for measuring bone loss, although it is, of course, much better for people to take precautions when they are younger and not wait for the loss to begin.
Fewer than 10 per cent. of the sufferers of osteoporosis receive adequate treatment, but if a woman's mother or other women in her close family display some of the crippling problems of old age, she should think seriously about requesting a bone scan. The more people ask for that, the more chance that facilities will be made available in Britain for women and, I might say, for men.
Above all, professional and public education is needed. It would be, as I have said, a tremendous investment. We would be saving hundreds, possibly thousands, of millions of pounds in the future each year, because more and more
people would avoid this crippling disease which, in the past, has been taken for granted as part of the problems of old age.
For myself, I certainly take this treatment. I am told that I have the skeleton of a 15-year-old and that my jaws and teeth are in equally good condition. Sometimes we forget that teeth are part of the skeleton and the fact that old people lose their teeth has as much to do with bone loss as it has to do with the condition of their teeth.
I have talked a lot about osteoporosis as it affects women. It is true that most of the sufferers are women. On average, one in three women are likely to suffer a fracture as they get older. But, of course, men can suffer too. One in 12 experience bone loss during their lifetime, although the onset usually occurs much later.
Mr. John Austin-Walker (Woolwich):
I only hope that my voice will last long enough to allow me to make my points.
First, I thank the hon. Member for Billericay (Mrs. Gorman) for giving me the opportunity to participate in the debate and for having requested it. I fully endorse all her remarks about the work done by the National Osteoporosis Society. I draw the Minister's attention to early-day motion 1037 in my name which was tabled on Monday to coincide with World Osteoporosis Day and which I understand has now been signed by more than 200 hon. Members on both sides of the House.
The hon. Lady is correct to say that osteoporosis is a devastating illness for women. She is right to point out that it is not exclusively a women's disease. She has said that one in 12 men can expect to experience a fracture as a result of osteoporosis at some time during their life. Recent research has suggested that the figure may be as high as one in eight. What is worrying is that the figure is increasing. Therefore, we must address the early identification and treatment of the disease.
The hon. Lady has mentioned that about 200,000 fractures a year are caused by osteoporosis. The National Osteoporosis Society estimates that there may well be 40 premature deaths every day as a result of this crippling disease; but, as the hon. Lady has said, it causes misery not only for those affected by this disabling disease but for their families and loved ones.
The main thing that we have to say is that prevention is possible and early diagnosis can lead to effective treatment. The hon. Lady has referred to hormone replacement therapy. She is affectionately known as the queen of HRT. My secretary has asked it to be known that, if the hon. Lady is the queen, she claims the role of princess. But it is clear that HRT has been shown to reduce the risk of osteoporosis in menopausal and post-menopausal women. However, there is a need for a wide public education programme about other ways in which the disease can be reduced in both men and women.
First, smokers are more at risk of osteoporosis than non-smokers. As the hon. Lady has said, diet is also an important factor. Exercise has certainly been shown to be effective in building up bone density. Some drugs can be effective in treating osteoporosis, but much more research needs to be carried out into prevention through non-hormonal drug programmes. Further research, monitoring and prevention will ensure that future generations of men and women, but more particularly women, can lead full lives unhindered by the pain and disability of osteoporosis.
The hon. Lady and I ask the Government to give a higher profile and priority to osteoporosis. As the hon. Lady has said, one third of orthopaedic beds in the NHS are occupied by patients with osteoporosis, and the estimated cost to the NHS of fractures caused by osteoporosis is around £750 million a year. But that is only part of the cost. One in five people sustaining a hip fracture die within six months, and more than half cannot walk independently afterwards, many becoming highly dependent. There are then the unseen costs of care in the community and the on-going costs of drugs, physiotherapy, occupational therapy and other support services provided by the NHS and local authorities. There is also the cost to an individual in terms of the quality of life and the quality of a carer's life. The chronic pain, the disability and the possible deformity which were outlined earlier cannot be overestimated.
Diagnostic tools should be more widely available. The facilities in the United Kingdom for measuring bone density are scarce, although I recognise that they are increasing. But in my view and that of the National Osteoporosis Society, every health authority should have a designated lead clinician with a special interest who can update other professionals on the prevention and effective management of osteoporosis.
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