Wed, Nov 01, 2017 - Page 8 News List


NHI has learned little

I was surprised to read that an international conference was held in Taipei “to discuss osteoporosis prevention and improvements to treatment” (“Osteoporosis on the increase as nation ages,” Oct. 29, page 3).

My surprise arises from how little was apparently learned from that exercise. Having been diagnosed with osteopenia (reduced bone mineral density that is not full-blown osteoporosis) I am generally aware of the issues.

The road to osteoporosis usually starts with low blood levels of vitamin D3 and low intakes of calcium (at least in comparison with intakes of phosphates). There are many other conditions for healthy bone formation, including liver, parathyroid glands and kidneys in good working condition; but adequate vitamin D3 levels and calcium intake are of primary importance.

Calcium is commonly available, but the intake levels recommended for people over age 50 are 1,500mg per day. That sounds easy enough, but if you want to make it up by eating very hard cheeses such as Parmesan you need to eat about 120g per day. Soft cheeses contain less calcium so you would need 750g. If you had to do it by eating tofu you would need to consume 430g per day.

With a mixture of foods reasonably rich in calcium you would have to eat about 4kg per day. That is probably more than most people eat in one day. The alternative is to take calcium supplements; these are not covered by National Health Insurance (NHI). How is NHI helping to prevent osteoporosis?

Vitamin D3 is another matter. If you have a reasonably normal diet and expose your body to the sun you should, under normal conditions, have enough for bone formation. However, many Taiwanese take great care to not allow the sun on their skin. It is not very surprising that vitamin D3 levels are low, especially in women (“Vitamin D deficiency a concern: survey,” June 26, 2015, page 3).

Alas, NHI does not cover tests for vitamin D levels so you would have to pay out of your own pocket.

If you are willing to do that you meet another problem: Few people ask for tests, so they are done only once a month. That means you face an extra trip to the hospital. And after you have done that and have found, as I did, that in spite of several hours of sun exposure a week your level is low then there is another problem.

My doctor refused to prescribe the vitamin D pills covered by NHI because the dosage is so low that I would have to take about 10 pills a day.

Now you are out on your own searching for a source to fix the problem in spite of the warning in the 2015 article that too much vitamin D may have adverse effects.

If you want to have occasional checks on your blood level you have to take that extra trip to the hospital and pay for the test yourself.

Again, how is NHI helping to prevent osteoporosis?

NHI does cover Fosamax Plus, one of the modern drugs against osteoporosis. The hitch is that, no matter how bad the osteopenia or osteoporosis might be, you need to have experienced a bone fracture attributed to low bone mineral density or had serious enough loss of bone in your spine before that drug is covered.

This may reduce the burden of age-related bone fractures after the first one, but does nothing to prevent osteoporosis.

Once more, how is NHI helping to prevent osteoporosis?

In the 20 years since [the establishment of the Taiwanese Osteoporosis Association], little appears to have been done to prevent osteoporosis. A study of the effect of NHI policies on the prevention of osteoporosis might be a fitting memorial to the conference.

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