Does a patient with osteoporosis and good cardiovascular health require avoidance of medical travel for expeditions, such as to Antarctica?

Osteoporosis Does Not Warrant Absolute Avoidance of Antarctic Expeditions in Cardiovascularly Healthy Patients

Osteoporosis alone is not an absolute contraindication to Antarctic travel for patients in good cardiovascular health, but requires careful pre-travel risk assessment, fracture prevention strategies, and individualized evaluation of fracture risk severity and expedition demands. 1

Risk Assessment Framework

The decision to travel should be based on:

• Fracture risk stratification using validated tools (FRAX score, prior fractures, T-score severity) to determine if the patient is at high, very high, or imminent fracture risk 1, 2
• Recent fracture history - patients with fractures within the past 12 months or multiple fragility fractures are at very high risk and should strongly reconsider expedition travel 1, 3
• T-score severity - patients with T-scores below -3.0 are at very high fracture risk and face substantially elevated injury risk during physically demanding travel 1, 2
• Current treatment status - patients on appropriate osteoporosis therapy with stable bone density have lower risk than untreated patients 2, 4

Specific Antarctic Expedition Considerations

Antarctic expeditions present unique challenges that amplify fracture risk:

• High injury rates - injuries account for 27.25% of medical consultations during Antarctic expeditions, with musculoskeletal injuries (14.68%) and bruises/lacerations (10.31%) being most common 5
• Bone density changes - prolonged Antarctic expeditions cause reversible decreases in bone mineral density and bone mineral content, even in healthy pre-screened individuals 6
• Limited medical evacuation - the remote environment makes emergency fracture management extremely difficult, with no immediate access to orthopedic surgery or advanced imaging 7, 5
• Physical demands - Antarctic treks involve prolonged physical exertion, ice/snow hazards, and risk of falls that substantially increase fracture probability 7, 6

Pre-Travel Requirements for Patients Considering Expedition

Mandatory pre-travel evaluation should include:

• Comprehensive fracture risk assessment using FRAX with country-specific thresholds to quantify 10-year hip fracture risk (>4.5% indicates very high risk) and major osteoporotic fracture risk (>30% indicates very high risk) 1, 2
• Recent BMD testing (within 1-2 years) to establish current bone density status 1, 2
• Optimization of osteoporosis treatment - patients should be on appropriate pharmacologic therapy (bisphosphonates, denosumab, or anabolic agents) with documented treatment response before travel 2, 4
• Vitamin D and calcium repletion - ensure adequate intake (1,000-1,200 mg calcium daily, 800-1,000 IU vitamin D daily) before departure 1, 2

Contraindications to Antarctic Expedition Travel

Absolute contraindications include:

• Recent fragility fracture (within past 12 months) 1, 3
• Multiple vertebral fractures or severe spinal deformity 1, 3
• T-score below -3.0 without established treatment response 1
• Fractures occurring while on osteoporosis therapy (indicating treatment failure) 1
• Spinal instability or neurological deficits from vertebral fractures 3

Relative contraindications requiring specialist consultation:

• High FRAX scores (hip fracture risk >4.5% or major osteoporotic fracture risk >30%) 1, 2
• Untreated or newly diagnosed osteoporosis without established treatment response 3, 2
• History of falls or impaired balance 1
• Concurrent use of medications that increase fracture risk (long-term corticosteroids) 1

Risk Mitigation Strategies for Approved Travel

If travel is deemed acceptable after risk assessment:

• Ensure optimal pharmacologic treatment with first-line bisphosphonates (alendronate or risedronate) or second-line agents (denosumab, zoledronate) for at least 6-12 months before travel with documented BMD improvement 2, 4
• Implement fall prevention strategies including balance training, resistance exercises, and flexibility training in the months preceding travel 1, 2
• Maintain adequate calcium and vitamin D throughout the expedition, as Antarctic explorers experience decreased appetite-regulating hormones despite high caloric needs 1, 6
• Arrange pre-travel consultation with expedition medical team to discuss fracture risk and emergency protocols 7
• Consider travel insurance that covers medical evacuation for fracture-related emergencies 7

Common Pitfalls to Avoid

• Do not assume cardiovascular fitness compensates for fracture risk - these are independent risk domains that require separate evaluation 1
• Do not underestimate the physical demands - Antarctic expeditions involve ice/snow hazards, prolonged physical exertion, and high injury rates even in healthy individuals 5, 6
• Do not delay osteoporosis treatment - patients should have established treatment response before considering expedition travel 3, 2
• Do not ignore the reversible bone density loss that occurs during prolonged Antarctic expeditions, which compounds pre-existing osteoporosis 6