Insurance cover for broken bones
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Unlike western counterparts, pre-menopausal Indian women have a lower peak bone mass of 1.2 that is slightly higher than the ideal value of 1.This comes down after they attain menopause and problems crop up earlier.
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BREAKING ONE'S bone on falling is common. But ever heard of falling down because of broken bones? Incredible, but true. Blame it on osteoporosis, many post-menopause women world over are victims of such falls and Indian women are no exception. On the other hand, such instances may only be on the higher side in India.
The reason — Indian women have a peak bone mass of about 1.2 that is slightly higher than the ideal value of 1, according to Sandeep Bhattacharya, Director (Commercial Operations) Aventis Pharma Ltd, Mumbai. Compare this with western women who have a peak bone mass of 1.6-1.7. The peak bone mass value comes down after women reach menopause as the hormone oestrogen is no longer produced by the body.
Absence of oestrogen hormone in post-menopause women has a direct effect on reducing bone mass as the activity of a specialised cell called osteoclast increases. Bones have two specialized cells — osteoclasts and osteoblasts. While osteoblasts are responsible for the creation of new bones, osteoclasts are the ones that eat up the bones.
A delicate balance between these two cells is required to maintain the bone mass. But as the activity of osteoclasts increase in the absence of oestrogen, the bone mass reduces over a period of time. But a very crucial factor to be considered at this point is thus the peak bone mass — lower the value, earlier will be the date when the value dips below the ideal value of 1 and problems crop up. Lower values seen in the Indian women thus place them at a disadvantage.
Osteoporosis, is not a purely woman's issue. Men also suffer from this disease although the numbers are few. If oestrogen maintains the balance between the two specialised cells in women, it is the testosterone that does it for men. Unlike women, the testosterone production continues till the end thus keeping the activity of osteoclasts under check. However, osteoporosis strikes in men when this hormone production is affected. Fortunately, such instances are not common.
The traditional method to treat women suffering from osteoporosis was hormone replacement therapy where oestrogen is given externally. But this line of treatment carries its own baggage of problems.
"External replacement of oestrogen cannot mimic or replicate all the biological effects produced by the hormone when naturally produced by the body, avers Dr. Bhattacharya. "Same is the case with insulin produced by the body and when given externally. Recent studies published in reputed international journals even point out the possibility of cardiovascular risks due to hormone replacement therapy."
Against this backdrop the drugs already existing in the market and the one now introduced by Aventis tend to reduce the osteoclast activity thus keeping the peak bone mass from dropping. "At the same time the osteoblast activity goes up thereby increasing the bone density," elucidated Dr. Bhattacharya.
What makes the drug from the Aventis stable different from others is not its superior osteoclast reducing action, but the way the company has packaged it. It is for the first time in the country that a pharmaceutical industry is offering managed care — diagnosis, treatment, overall patient care and believe it or not insurance cover to the tune of Rs1.5 lakh per episode of hospitalisation.
"No insurance company in the country offers a cover for fracture and we considered the maximum amount that a woman can incur when she fractures her hip," asserts Dr. Bhattacharya. It becomes all the more attractive as the patient is covered the moment she joins the programme and provided she continues to be enrolled in the programme. To start with the scheme is offered in six cities — four metros, Bangalore and Hyderabad. Patients in these cities can directly approach the company or through their doctors.
Apart from the insurance cover, what makes the osteoporosis management program called the `Wishbone' attractive is the holistic approach to treat the disease — regular counselling, physiotherapy, occupational therapy, dietary and exercise advice at home. There are other additional features thrown in too. The higher cost of the programme apart, the catch is that the patient can never buy the drug from a chemist. "It would be available only to those who have enrolled in the programme," he clarified.
The unusual type of drug availability is because it comes with an insurance cover. And there will be no way to monitor that the patient is under medication unless the company delivers it to patients directly. "The Rs. 2000 per month for the drugs may seem costly, but one should look at the way we have ensured to cover our patients from day one, not to speak about other benefits," he stressed. "So the cover is no longer valid if the person opts out of the programme."
The price one pays is high considering that the disease could have been avoided in the first place. Increasing the peak bone mass by having calcium rich food especially milk is the simple and only way out. And most importantly this should be done before the age of 30. Unfortunately the need to have calcium supplements dawns on women when they have already attained menopause. Too late to make amends.
R. Prasad
in Chennai
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