October 5, Toronto Star

Virtual osteoporosis initiative first of it’s kind

When Darlene Sheehey needed to regain her health, she turned to a TV screen.

She had broken both of her hips, her left wrist, and had fractured her spine eight times as a result of osteoporosis. But she didn’t realize the importance of making lifestyle changes to help strengthen her bones. So the 69-year-old retired elementary-school teacher from Fenelon Falls turned to a new virtual osteoporosis education program. She went to her local medical centre and participated in a real-time workshop with specialists via a two-way screen.

She learned about the role of nutrition and exercise in better managing osteoporosis, a chronic and progressive bone disease that’s characterized by low bone mass, making bones thin, porous and brittle.

The first-of-its-kind initiative, which includes lectures and demonstrations, is provided by rheumatologists, occupational therapists, physiotherapists, kinesiologists, pharmacists and dietitians.

It’s the brainchild of staff at the Southlake Regional Health Centre in Newmarket. The hospital’s Arthritis Program has long offered day-long osteoporosis education classes to its patients — and it seems the message is being heard.  Studies have found treatment adherence rates for osteoporosis in First World countries is between 20 to 40 per cent, six to 12 months after they begin treatment. At Southlake, surveys show an adherence rate of 70 per cent.

That class is now available in real-time across the province, thanks to a partnership between Southlake and the Ontario Telemedicine Network.

The OTN provides two-way video conferencing in telemedicine studios at more than 1,200 sites in Ontario — hospitals, health-care centres and community centres. With just the click of a remote, patients and professionals are connected for meetings, clinical care and educational initiatives.

‘It’s not like watching a webinar that is taped. This is interactive so patients really have the opportunity to learn with each other and ask questions,” says Lorna Bain, co-ordinator of The Arthritis Program.
The virtual classroom is especially valuable to people in remote areas or communities without local specialists because it saves people the time and money of having to travel great distances to tap into this education.   The aim is to “reach out to as many places as possible ... because the market is there,” says Dr. Carter Thorne, medical director of The Arthritis Program. “We believe we can have an impact in many communities.”

Although the virtual osteoporosis initiative is in its infancy — it was launched this summer — it has already provided access to education to patients in Espanola, Sudbury, Orangeville, Alliston and Shelburne.

Through the virtual class, Sheehey learned the importance of doing weight-bearing exercises, eating calcium-rich foods to help maintain bone density and taking a vitamin D supplement to aid calcium absorption. She also learned that excess salt — Sheehey loves salty foods — and caffeine make it tough for the body to absorb calcium.  She had been prescribed a medication to increase bone density, but that’s about it, she says.

“The medical model, unfortunately, oftentimes is, ‘Take this pill and have nice day,’ ” says Thorne, a rheumatologist.

Barbara Beauchamp, an area manager for Osteoporosis Canada applauds The Arthritis Program, pointing out that more than 80 per cent of fractures in people over 50 are caused by osteoporosis.

At least one in four women and one in eight men over the age of 50 will have osteoporosis. Older women are especially susceptible because estrogen helps keep bones healthy. During menopause, when estrogen levels decline, loss of bone mass begins. As the population ages, the incidence of osteoporosis will continue to increase, so it’s important to teach people how to modify their behaviour, say the experts.  Because peak bone mass is built during the first three decades, osteoporosis has been referred to as a pediatric disease with geriatric consequences. But it is preventable and treatable in later life.

According to a study published in the journal Osteoporosis International, treating osteoporosis and related fractures cost the Canadian health care system $2.3 billion in 2010 — that includes acute care costs, outpatient care, prescription drugs and indirect costs. More hospital beds are used for those who have suffered hip fractures related to osteoporosis than for people who have diabetes or have had strokes or heart attacks, says Beauchamp.  Osteoporosis is often referred to as a silent disease because many people don’t know they have it until they suffer a fracture during a minor movement or accident. And once you’ve suffered a fracture, you’re at greater risk of having another, a phenomenon referred to as the fracture cascade.

After her multiple fractures Sheehey says she moves slowly and uses a walker. Gone are the days of dancing and gardening. She was forced to move from her home, which had too many stairs, to a condominium.  Sheehey participated in the virtual osteoporosis class in August after her family doctor recommended it. She also purchased a workbook, which she says she has referred to many times since.

“It was excellent,” says Sheehey of the class, adding that she appreciated how close it was to home. “It’s really affected how I eat. And I’ve incorporated the exercises.”

Gone are the days when she would eat meat and white potatoes for dinner, and packaged foods. She’s now serving up fresh vegetables, salads, nuts and whole-grain breads. And she’s replaced her customary cup of tea, which used to accompany lunch and dinner, with a glass of milk. Plus, she takes vitamin D every day.

She vows to keep up her lifestyle changes in hopes they will give her an edge in the battle against osteoporosis. As a result of the recent changes, she says she’s starting to feel “a little bit better.”
“But it takes time,” she says. “I’ve learned patience with this disease, if nothing else.”