New report reveals low treatment uptake, inadequate
implementation of national osteoporosis guidelines and poor
adherence to therapy

In Europe, a serious treatment gap is leaving millions of people
at high risk of fragility fractures.

The findings were revealed in ‘Osteoporosis: Burden, health
care provision and opportunities in the EU’, a landmark
report prepared by the International Osteoporosis Foundation (IOF)
in collaboration with the European Federation of Pharmaceutical
Industry Associations (EFPIA). The report found that only a
minority of high risk patients are receiving treatment to prevent
fractures – contrary to the recommendations of most national
osteoporosis guidelines and despite continued advances in risk
assessment and the wide-spread availability of effective
medication.

Approximately 6% of all men and 21% of all women aged 50–84
years in Europe’s five largest countries (France, Germany,
Italy, Spain, UK) and in Sweden, are estimated to have
osteoporosis. Osteoporosis is a chronic disease, more common in
older adults, that leaves people at higher risk of bone fracture.
Of most concern are spinal and hip fractures which may result in
long-term disability, loss of independence and even early death. In
the six countries studied specifically in the report, approximately
34,000 deaths annually are caused by fractures – the
equivalent of 80 deaths per day. The health care cost, including
pharmacological prevention, was estimated at Euro 30.7 billion for
the six countries alone – corresponding to 3.5% of the total
spending on health care in those countries.

The report found that a serious treatment gap continues in Europe,
for many reasons, including:

• Recommendations in national management guidelines are not
always implemented;

• There is insufficient case-finding, i.e., those at risk of
fracture (including secondary fracture) are not being identified
and recommended for treatment;

• DXA resources to measure Bone Mineral Density (BMD) are
insufficient in 40% of European countries (despite the fact that
BMD is significantly more effective in predicting fracture than
serum cholesterol is in predicting heart attack);

• Advances made in calculating the 10-year absolute risk of
fracture, such as the WHO Fracture Risk Assessment Tool
(www.shef.ac.uk/FRAX), are not being widely implemented;

• In some countries there is stringent criteria for the
reimbursement of diagnostic testing or treatment (for example, only
following a fragility fracture);

• Compliance and persistence with osteoporosis treatment are
poor – approximately 50% of patients do not follow their
prescribed treatment and/or discontinue treatment within one
year.

The treatment gap was found to vary between countries. Spain was
estimated to have the lowest treatment gap (about 19% for women)
and Sweden the highest (about 71%).

“We have found that there is a large gap between the number
of people that are treated compared to the proportion of the
population that could be considered eligible for treatment based on
fracture risk,” said Professor Bengt Jonsson of the Stockholm
School of Economics and principal investigator of the report.
“This means that thousands of patients go on to experience
fractures which could have been prevented. Improved implementation
of clinical guidelines and better treatment uptake to close this
‘treatment gap’ is cost-effective – we estimated
that almost 700,000 fractures could be potentially avoided from
2010 to 2025 with increased treatment uptake.”

Professor John Kanis, IOF President, also noted that even those
patients who are identified and are placed on a treatment regimen,
will often fail to comply with their treatment. “With a
chronic condition like osteoporosis, staying on treatment can be a
challenge. Patients may fail to appreciate the benefits of a
treatment as they can’t immediately feel or see their bones
getting stronger. However, without regular medication, there is an
increased risk of suffering debilitating fractures. From a
socio-economic perspective, better adherence would lead to more
avoided fractures and better cost-effectiveness,“ he
noted.

The comprehensive report, published online in ‘Archives of
Osteoporosis’ provides an introduction to osteoporosis and
reviews medical innovation and clinical progress in the management
of osteoporosis, the epidemiology and burden of the disease, the
current uptake of osteoporosis treatments and the future burden of
fractures as a consequence of increasing treatment uptake.

The report can be accessed via the IOF website
here and will soon be available on the ‘Archives of
Osteoporosis’ website at http://www.springerlink.com/content/1862-3514
.

Osteoporosis: Burden, health care provision and
opportunities in the European Union

Archives of Osteoporosis (2011). O. Ström, F. Borgström,
J.A. Kanis,J. Compston, C. Cooper, E. V. McCloskey & B.
Jönsson. DOI 10.1007/s11657-011-0060-1

ENDS

About IOF

The International Osteoporosis Foundation (IOF) is a non-profit,
nongovernmental umbrella organization dedicated to the worldwide
fight against osteoporosis, the disease known as “the silent
epidemic”. IOF’s members – committees of
scientific researchers, patient, medical and research societies and
industry representatives from around the world – share a
common vision of a world without osteoporotic fractures. IOF now
represents 199 societies in 93 locations.
http://www.iofbonehealth.org

About EFPIA

EFPIA represents the pharmaceutical industry operating in Europe.
Through its direct membership of 31 national associations and 40
leading pharmaceutical companies, EFPIA provides the voice of 2,200
companies committed to researching, developing and bringing new
medicines to improve health and quality of life around the
world.

http://www.efpia.eu/