This document summarizes the history of osteoporosis in Ireland over the past 3 millennia. It discusses key developments like the first use of DXA scanning in 1990, establishment of the Irish Osteoporosis Society in 1996, and current issues like the need for better prevention, earlier diagnosis, and a multidisciplinary approach. It highlights important contributors to the field and their research. Overall, it provides a high-level overview of osteoporosis treatment and management in Ireland from ancient times to the present.

1. Forever Autumn Community of Practice falls
Conference
History of
Osteoporosis in Ireland
Professor Emeritus Moira O Brien
FRCPI,FFSEM,FFSEM(UK),FTCD
Trinity College
President of the Irish Osteoporosis Society
30-09-2015

2. Osteoporosis
Osteoporosis has been around for Three Millennia and skeletons
have been found from the dark ages

3. Osteoporosis: Three Millennia
0 1000 AD 2000 AD1000 BC
400 BC
Hippocrates
of Kos
700 AD
Saxon
tomb, Wells
1825 AD
Sir Astley
Cooper
1850 AD
Osteoporosis
1950
2003 2007
199019801970
1948
Albright
1963
SPA
1976
HRT
1987
DXA
1990–99 WHO
Calcium,
Fluoride
Bisphosphonates
Serms, PTH
1940 1960
Cooper (2002)
Protelos
Prolia

4. Treatments
• HRT was the first medication used for osteoporosis, which still
has its place, but thankfully more treatments were developed
• Calcium, Vitamin D and appropriate weight bearing exercise for
everybody
• In 1990 -1999 Bisphosphonates, Forsteo and SERMS
• Protelos in 2003 and Prolia in 2007
• Combined Therapy anabolic and antiresorptive
• Preventative osteoporotic medication before treatment that will
cause bone loss
• More medications are in the pipeline
• Check and beware of Polypharmacy

5. Sports Medicine
• I have always been involved in Sport and in the early 70’s I started doing
research in Women in Sport, Menstruation and Exercise, effects of jet lag
and baby swimming Physiological testing
• Research with Dr Dermot Fitzgerald in St. Marys on Vascular changes in
athletes
• I was appointed Irish Olympic Medical Officer in1979 and this was my
pathway into Osteoporosis
• I founded the Irish Sports Medicine Association in 1980, the Irish
Menopause Society in 1993 and the Irish Osteoporosis Society in 1996
• In the early 80’s I met Prof Barbara Drinkwater in Gotenberg, who had done
numerous studies on menstrual irregularities in Sport and their affect on
Bone Mineral Density using DXA

6. Osteoporosis Birth in Ireland
• In the 60’s and 70’s Osteoporosis was diagnosed by Single or
Dual Photon. The Menopause Clinic in the Rotunda had the first
Photon in Ireland and later changed to DXA
• DXA was developed in 1984
• The Anatomy Dept in Trinity College had the first DXA in
Ireland in1990, in which Bernard Dunne played a major role

7. Osteoporosis Service
• In 1990 Bernard Dunne and I
set up the first DXA service in
the Anatomy Department in TCD
• Clinical Trials and MSc research
projects on Osteoporosis on
Athletes and Anorexics

8. Professor Bernard Walsh
• Professor Bernard Walsh is a Director Mercer’s Institute for Research on
Aging in St James Hospital and set up their Osteoporosis service.
• Clinical Professor Clinical Professor, Department of Medical Gerontology,
Trinity College Dublin
• He is a Professor of Geriatric medicine and past president of the Irish
Gerontological Society
• He has played a major role in the advancements of bone health, both its
diagnosis and treatment.
• He also was involved in a significant amount of research in this area

9. Bone Diseases
• David Powell and Malachi Mc Kenna were involved in the
treatment of Bone Diseases and also research
• In the early 1990’s David Powell and Malachi Mc Kenna used
the DXA machine in TCD to do clinical trials
• Kevin Cashman has played a major role in the research on
Vitamin D

10. Birth of Fall Prevention in ROI
• Michele O’Brien set up the first private Falls Prevention service
in 2001
• I asked her to help with the IOS for a couple of months while
she was promoting her business, she has now worked for the
Charity for 14 years and Fall Prevention is still one of her
passions
• Professor Rose Anne Kenny has played a major role in the fall
prevention and bone health area and was successful in
obtaining significant funding for St James Hospital in 2003 to
start up a Falls Prevention clinic

11. Irish Osteoporosis Network
• The Irish Osteoporosis Network (ION) was set up in 2002. It
was an All Ireland Network of all groups interested or involved
in Osteoporosis and Osteoporotic fractures
• It was Chaired by Professor David Marsh, Professor of Trauma
and Orthopaedics, Queens University Belfast and President of
the International Society for Fracture Repair
• The aim of the ION was to identify and prevent low trauma
fractures throughout Ireland, using a Multidisciplinary approach
and to set up audits of hip fractures, ideally in all the major
Orthopaedic units

12. All Ireland Action Plan
Irish Osteoporosis Network 2003
• Cross-Border research proposals by Prof David March
• Osteoporosis fracture registry
• Integrated services using Orthogeriatric Liaison
• Programme of raising awareness
• The IOS with the OMBI (Osteoporosis Medical Board of Ireland) and David
March organized the meetings
• David and myself tried to set up a hip fracture database but funding was not
available in the ROI, however David was able to secure funding for the UK
• Emer Ahern was an IOS board member and very kindly took the baton and
has run with it
• Louise Brent and Conor Hurson have both played important roles
• Hip fracture registry has been successful due to all the volunteers who have
contributed to this project

13. 2004
• In February 2004 there was a two-day conference entitled “An Integrated
Approach to the Prevention and Treatment of Osteoporotic Fractures”
• The conference was organised in association with the IOS,IOF, the NOS
and the Irish Orthopaedic Association
• The conference attracted speakers and delegates from as far away as
Australia, Israel and Italy, as well as Ireland and the UK
• The Duchess of Cornwell, who is a patron of the UK’s NOS was guest of
honour at a Charity lunch and launched the IOS Osteoporosis educational
pack, aimed at 12 to 18 year olds

14. Workshop
• In April 2004, the IOF and IOS organised an osteoporosis workshop. It was
held in Cork and had representatives from the Irish Department of Health
and Osteoporosis Patient Societies from other EU countries.
• The workshop, entitled “Delivering patient expectations and managing
European health priorities.
• We explored issues such as achieving a better understanding of the needs
of European osteoporosis patients; how medicine and innovation can meet
the needs of the patients and determine the conditions which would ensure
the patients take on more responsibility for their healthcare spending
choices.

15. 2005 to 2010
• IOS Annual Medical Conference
• Increase of DXA clinics
• Increase of Fall prevention clinics
• Representation in the EU and World congress
• Increase of education of public

16. 2011 to 2014
• Rise in hip fractures
• Rise in loss of independence in our senior
citizens

17. Present situation in Ireland
• The number of hip fractures is increasing
• There is a wide variation in access to diagnostic and specialist services and
in prescribing patterns
• Sadly the standard of DXA scanning and reporting ranges from excellent to
appalling.
• There is a range of therapeutic interventions now available but there are
concerns regarding inappropriate prescribing
• There is limited proactive treatment for high risk individuals to prevent bone
loss and a general lack of knowledge of prevention, causative factors and
treatments of osteoporosis among the general public
• Sadly due to the significant decline in the IOS funding over the last three
years, progression has been very slow. Hopefully this will change and
billions can be saved, senior citizens in Ireland will be able to stay
independent in their own homes, the number of fractured hips and falls will
decline and we will have much healthier citizens

18. Currently in ROI
• Michele O’Brien and I represent the IOS on the European Osteoporosis panel since
1997
• Mr Derek Bennett and I have got Osteoporosis on the curriculum for the training
programme for Orthopaedic and Trauma surgeons in the EU
• The Hip Fracture database is going from strength to strength
• A Fracture liaison service is the most effective way to prevent further fractures and
every hospital should have one
• I would like to thank all the Fall prevention staff, DXA unit staff, members and staff of
the IOS, and all those who have supported the IOS over the years and the uphill
battle in the promotion of Bone health.
We need everyone here to promote bone health, the
importance of Fall Prevention and much earlier diagnosis
and most importantly the importance of WORKING
TOGETHER

19. Ireland 2015
• Ireland still has not adopted the Prevention of Osteoporosis as a Major
Governmental Health Policy
• The European Commission report Osteoporosis in the European Community
(1998) provided a comprehensive guide to the prevention of osteoporosis.
According to this report the best prevention is to establish a healthy lifestyle
at a very young age and to continue throughout life
• The most effective preventative measures are those that are taken during
childhood and adolescence, when 60% of bone is laid down, to form peak
bone mass. Maintaining bone strength in later life is vital for reducing risk of
fractures. It is important to realise that in many cases osteoporosis can be
prevented and it is important that all health care professionals are aware of
this
• This is why Physical Education should be mandatory and part of the
leaving certificate in schools: Osteoporosis, Obesity, Diabetes, Heart
disease, Mental health and Respiratory disorders

20. Carrying the torch
• Dr Donncha O’ Gradaigh – Education and
advancement of Osteoporosis care
• Professor Declan Lyons – Osteo and Falls clinic
• Dr Emer Ahern – Hip Fracture database
• Louise Brent – Hip Fracture database
• Doctor Tara Coughlan - Hip Fracture database
• Mr Derek Bennett - Orthopaedic Surgeon
• Daragh Rodgers - Bone Health in the park
And everyone else involved, too many to mention

21. Dr John Carey
• Dr John Carey and his wife Dr Miriam Delaney returned from
America and have been very involved in attempting to improve
the standard of care for Osteoporosis patients.
• John has run the International Clinical Densitometry Courses
and Body Composition Course in Galway
• For your calendar: International Clinical Densitometry Meeting
and Course will be held in Galway in 2016 – Kerry@gowest.ie

22. The Future
• Educate all Health Care Professionals
• Educate all patients about prevention, assessment, diagnosis
and treatment
• Medical groups have the opportunity to implement a systems-
based approach as well
• More specialized bone health developed specializing in disease
management programs and appropriate care
• Implementing strategies that millions were spent developing, for
improving overall bone health and preventing falls

23. Irish Osteoporosis Society
• The Irish Osteoporosis Society (IOS) established in 1996
• It is a registered Irish Charity dedicated to preventing
Osteoporosis, giving support and advice to those at risk and the
few that are diagnosed - 280,000 are undiagnosed
• Also a resource for Health Professionals
• IOS Annual Medical Conference, strictly for Health
Professionals, this year it is in TCD on Saturday 31st
October, 9am to 5pm. Contact the IOS or Kerry@gowest.ie
• Mark Pollock is opening this conference!
THANK YOU