The burden of fragility fractures: where are we now?

Worldwide osteoporosis affects around 200 million people¹, causing one fragility fracture approximately every three seconds.² According to the International Osteoporosis Foundation, the prevalence of osteoporosis in the UK is 3.5 million and yet it is often referred to as the ‘silent epidemic’ as very few people know they have it until they break a bone.³

The incidence of fragility fractures in the UK is half a million every year.³ Although a high number of men are affected, it is a significant women’s health issue that’s far too often overlooked. After a fracture, postmenopausal women with osteoporosis are five times more likely to fracture again in the subsequent year⁴ and these fractures can often be life-changing.

For example, in women over 45 years of age, osteoporosis accounts for more days spent in hospital than many other diseases, including diabetes and breast cancer.⁵ Yet, an estimated 77% of women aged 67 or older remain undiagnosed and untreated following a fracture.⁶

Osteoporosis is not ranked high enough from a public health standpoint despite the cost of fragility fractures to healthcare services in the European Union being ‚¬37 billion in 2010⁷ with the cost predicted to double by 2050.¹

We conducted a survey this year of 401 bone specialists from 11 European countries about their experience of osteoporosis and fragility fracture management. It revealed that bone specialists consider osteoporosis and fragility fractures are neglected and under prioritised by their healthcare systems, and action needs to be taken.⁸

Of those surveyed, 66% agreed that osteoporosis is a neglected condition and only 10% of specialists agreed that osteoporosis and fragility fractures are currently given a high priority by their local health authority.⁸ When asked, the majority (90%) agreed that the condition should be a public health priority, with 91% agreeing that effective management can improve outcomes and reduce costs.⁸

The survey results also showed specialists feel their patients believe that osteoporosis or fragility fractures will only impact them in the short term, despite clear evidence of its long-term impact on quality of life and independence.⁸

The role of primary care in osteoporosis diagnosis and management

In the survey, the majority (84%) of specialists felt that increased awareness and understanding of osteoporosis is needed for GPs.⁸

This is important as primary care can play a key role in helping to reduce the burden of fragility fractures. Any patient thought to be at risk of a fragility fractures should be assessed using appropriate risk assessment tools (for example FRAX or QFracture in the UK). At-risk groups include patients over the age of 50 years, prior fracture sufferers, people with a family history of osteoporosis, low body weight and /or unhealthy lifestyle such as low physical activity, smoking, excessive alcohol, lack of calcium and vitamin D.

Dual-energy x-ray absorptiometry (DXA)can be used to measure the mineral content of bone (bone strength) to determine which category the patient falls in based on their T-score: normal (above -1), osteopenia (-1 to -2.5) or osteoporosis (<-2.5).

It would be ideal if tests for osteoporosis were embedded into the assessment of all patients over the age of 50 years in the same way that blood pressure is assessed and treated with a target in mind.  This way treatment measures would be in place to minimise the loss of bone and identify both osteoporosis and osteopenia earlier.

Our survey results show that still more needs to be done to educate and support GPs and patients on osteoporosis particularly the importance of timely referral and effective management.

The importance of Fracture Liaison Services

Before a fracture, osteoporosis can be a silent condition. The first fracture is usually the turning point for a patient and in recent years there has been a big focus on hip fractures as these greatly impact autonomy – 40% of patients who suffer a hip fracture are not able to walk independently again² and up to a quarter die in the first year through complications.^9,10

The hospital costs of hip fractures alone are estimated at £1.1 billion. This figure excludes the high cost of social care, which can add significantly to this cost.¹¹

Vertebral fractures are also very damaging fractures because they are very painful and can impair a patient’s everyday activities.¹²

The aim would be to prevent the first fracture, but co-ordinated post-fracture care services like the Fracture Liaison Service (FLS) have proven to improve diagnosis, improve long-term treatment and to decrease morbidity in patients with osteoporosis.¹³ The role of the surgeon is to fix the broken bone but if there are good links and collaboration with osteoporosis specialists then the management of the patient is optimised and the burden of further fractures can be significantly reduced.

Dr Pascale Richetta, Executive Vice President and Head of the Bone Patient Value Unit at UCB (Brussels, Belgium), was interviewed by Alison Bloomer, Managing Editor, GM Journal.

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