EU Osteoporosis Report 2007-2008 CYPRUS Completed by: Dr Christodoulos Kaisis, M.D., Specialist. in Internal Medicine, G.P., M.P.H. Dr George Georgiades, M.D., Specialist. in Endocrinology OVERVIEW 2007 New data collected for 2007 audit National population 766,400 Population over 50 Women: 115.900 Men: 103.700 Total: 219,600 Number of hip fractures in 1998 1022 -See the following table Number of hip fractures in 1999 888 - See the following table Number of hip fractures in 2000 Number of hip fractures in 2006 Individual hospital cost of hip fracture: direct costs indirect costs Average number of hospital days in acute care Cost/day ( ) Average number of days in rehabilitation or long term care Cost/day ( ) Total direct hospital costs of hip fractures Number of diagnostic scanners (DXA) per million population Recommended: 10.6 953 - See the following table 675 - See the following table 8.8 hip fractures per 10,000 population 3.8 days Not available Not available In the public sector there are 3 DXA and more than 30 in the private sector 43 per million population
Waiting time for DXA scan in the public About 3-4 months health system Cost for DXA scan of hip and spine 40-45 = 76 How many DXA scans are carried out/year? DXA reimbursement (public system) Economic criteria, family size, chronically ill, urgency criteria for reimbursement Reimbursement of proven therapies All eligible for free health care (80% of the population) In 2005, 199 patients with disorders of bone density and structure discharged from General Hospitals. 147 were males and 52 females. Total hospital days measure 748 with the average length of stay 3.8 days. In patients General & Rural Hospital: 1998, 1999, 2000, 2005 Diagnosis 1998 1999 2000 2005 Male Female Total Male Female Total Male Female Total Male Female Total Osteoporosis with pathological fracture 1 1 Osteoporosis without pathological 3 3 1 5 6 5 5 3 2 5 fracture Disorders of the continuity of bones 7 2 9 1 4 5 4 4 1 1 Other Disorders of bone density and 54 31 85 86 37 123 58 20 78 145 49 194 structure Fracture of lumbar spine and pelvis 46 61 107 53 50 103 57 53 110 51 50 101 Fracture of Femur 391 631 1022 322 566 888 368 585 953 225 450 675 Fracture at wrist and hand level 102 80 182 119 71 190 111 59 170 129 80 209 Total hip replacement 125 70 147 72 All the above data were provided by the Statistical Services of Cyprus. Nowadays we are in the process of introduction of I.T. among the Medical and Public Health Services. We have established an Information Technology and Monitoring Department in the Ministry of Health. For the present we are introducing information technology in two hospitals as pilot. We hope in the near future we will be able to provide accurate data 2
8 RECOMMENDATIONS 1. IS OSTEOPOROSIS A PRIORITY? 1:a Has your government made osteoporosis a national health priority? 1:b Has your government supported national or regional osteoporosis campaigns? Osteoporosis is a major healthcare target for Cyprus. The Ministry of Health has various programs for the prevention of Osteoporosis i.e. health promotion activities for exercise, for nutrition and the consumption of milk, research on dietary habits, and various programs for the prevention of injuries among the elderly, participation in EUNESE etc. Also there is close collaboration between Ministry of Health and NGO s i.e. the Scientific Society for Osteoporosis, Osteoporosis Associations etc in the promotion for prevention and early detection of osteoporosis., the Ministry of Health has close collaboration with the Scientific Society for Osteoporosis and the Osteoporosis Association. Moreover, MoH is in the process of editing a new leaflet about osteoporosis. 1:c Do national initiatives advance or restrict the cause? 2. FRAGILITY FRACTURE STATISTICS 2: a Has a national fragility fracture registry been established for data collection and monitoring? 2:b If so, give dates for data 2:c Is collected data from general or selected populations? 2:d Incidence rates for hip fracture for men & women over 50 years (per 10,000 population) Not Yet. But a monitoring department has been established at the Ministry of Health which is working on the classification and the IT System that will be introduced in the next year. Collected data concerns only the Government Sector (Public Hospitals). 3
2:e Prevalence rates for vertebral fracture for men & women over 50 years (per 10,000 population) 2:f Incidence and/or prevalence of wrist and other non-vertebral fracture for men & women over 50 years 3. CO-OPERATION AND FUNDING 3:a Which partners have been supportive of your osteoporosis efforts? (corporate, allied health, government) Give specifics 3:b Did these partners collaborate on mutual goals & objectives? Ministry of Health, Society for Osteoporosis and the Osteoporosis Association. 4. CALCIUM AND VITAMIN D 4:a Is there a national public health program? 4:b Are there national guidelines on optimum daily intake? 5. ACCESS TO BONE DENSITOMETRY SYSTEMS 5:a Number of hip & spine DXA units (per million population) 5:b Is the distribution of services equitable throughout your country? Recommendation 43 per million population 4
5:c Cost of DXA (public and private health systems) For the public it is free of charge based on person s economic and family status, government employee, university student, chronic illness. 40-45 = 76 private sector 5:d Utilization of scans: Public Private 5:e Are diagnostic procedures (DXA) reimbursed? If yes, what are the criteria for reimbursement? 5:f Average wait time for DXA (public and private systems) 5:g Quality Assurance: is there standardized training of technologists? 3 in the public sector. More than 30 in the private sector. Same as section 5:c. 3-4 months in the public sector. Technologists are also technicians, radiologists with special training on the use of DXA. Reporting and diagnosis is provided by doctors, specialists and radiologists. 6. PREVENTION, TREATMENT AND REIMBURSEMENT 6:a Do evidence based guidelines exist on prevention, diagnosis and treatment? (if yes, give date & link to publication) 6:b What approved drug therapies are available? 6:c Are the most effective treatments reimbursed? What is the criteria for reimbursement? Every doctor follows the International Guidelines about prevention, diagnosis and treatment. Osteoporosis is one of the topics that is most often discussed in Medical Congresses in Cyprus. All All eligible for free health care in the public sector based on same criteria as 5:c, ie economic and family status, dependants, government employees, 5
6:d Are patients at high risk for fractures eligible for treatment reimbursement BEFORE the first fracture?. Same criteria as 5:c 6:e Do lifestyle prevention programs exist? 7. THE NGO SECTOR AND TRAINING HEALTHCARE PROFESSIONALS 7:a Has the government supported (financially or through public information) patient and scientific societies? 7:b Do appropriate training programs exist for health professionals? 8. RESEARCH 8:a How many funding agencies are there in your country that fund bone research? Include details if available 8:b Specify major osteoporosis or related research One. The Research Promotion Foundation. 8:c Include references/links to publications Not available 6