Report Reveals Treatment Gap, Disparities in Osteoporosis Care

Paz Gómez Polledo, MD, PhD

February 25, 2022

The high burden of osteoporosis in several European countries contrasts starkly with suboptimal osteoporosis care, provision of treatment, and treatment uptake, according to the results of a report recently published in the Archives of Osteoporosis.

The report reviews and describes the current burden of osteoporosis in each of the 27 countries of the European Union, as well as in the United Kingdom and Switzerland (EU27+2). The authors audit key metrics in the following four domains: disease burden, policy framework, treatment, and healthcare utilization.

Osteoporosis is one of the major healthcare burdens in Europe. It causes over 4 million fragility fractures per year and is associated with over 200,000 causally related deaths. The disease costs the healthcare systems of Europe in excess of €56 billion each year.

Osteoporosis is a complex disease that can be treated and managed in several ways. Improvements in medication and diagnostic techniques in the past 25 years have provided highly effective means of reducing the risk for osteoporotic fractures. However, research has shown significant heterogeneity in the different national approaches to managing the disease in Europe.

The current report is based on the most recent results of the Scorecard for Osteoporosis in Europe (SCOPE), which was created by the International Osteoporosis Foundation (IOF) in 2010. Its aim was to develop an assessment tool and background documents to highlight gaps and inequalities in the primary and secondary prevention of fractures resulting from osteoporosis. To do this, a group of independent experts studied the information available on the burden of osteoporosis, treatment, and healthcare utilization in 27 countries of the European Union (EU27). SCOPE is based on independent research arising from regional IOF audits. It also incorporates information provided by more than 30 national osteoporosis societies throughout Europe and by the European Federation of Pharmaceutical Industries and Associations.

The SCOPE 2021 results, also published in the Archives of Osteoporosis, summarize key indicators of the burden of osteoporosis and its management in the EU27+2. They permit an in-depth comparison of the burden of osteoporosis, treatment, and prevention of fragility fractures in each of the 29 countries.

Given the significance of the findings to European healthcare policy, the IOF has compiled the key data from these two scientific publications in a new illustrated SCOPE Summary Report. The Summary Report, which includes a related slide deck, country-specific fact sheets, and infographics, is available on the IOF website. The report draws attention to the disparities in healthcare provision. It analyzes and compares the SCOPE results from 2010 with data from 2019, providing a way to compare the management of osteoporosis over time within and between the EU27+2 countries.

In a press release from the IOF, John Kanis, MD, honorary president of the IOF and lead author of the report, states, "Although we have found wide differences in service provision and uptake, all 29 European countries surveyed face an enormous osteoporosis and fragility fracture burden, with a substantial impact on current and future healthcare budgets. In aggregate, the economic burden of incident and prior fragility fractures was estimated at close to €57 billion in 2019, with an estimated 248,487 causally related deaths that year. As the numbers of women and men aged 75 years or more are expected to increase by more than 29% and 42%, respectively, between 2019 and 2034, the annual number of osteoporotic fractures will rise considerably. It is expected to increase by approximately +24.8% in that time period, reaching 5.34 million annual fragility fractures."

He concludes: "These alarming projections should spur concerted action on the part of all healthcare authorities in Europe."

Findings of the SCOPE and Country-Specific Reports

  • The countries that saw the largest absolute increases in the number of women with osteoporosis between 2010 and 2019 were Germany, Italy, and the United Kingdom. These three countries are projected to have the largest annual numbers of fragility fractures in 2034.

  • Across all countries, the lifetime probability of hip fracture for women older than 50 years was 15%, but the rates varied markedly by country, ranging from 7.0% in Romania to 25.1% in Sweden.

  • The highest cost of osteoporotic fractures per capita (in 2019) was in Switzerland (€403), followed by Denmark (€251), Sweden (€230), and Germany (€167).

  • Approximately 60% of the EU member states offered at least the minimum recommended number of 11 DXA units per million of the population. Although 5% more DXA units were available across Europe in 2019 than in 2010, this is a small increase, considering that the number of fractures rose by approximately 17% in the same period.

  • The percentage of member states offering full reimbursement of osteoporosis treatment went up from 27% in 2010 to 44% in 2019. Limitations or restrictions to reimbursement were identified in 15 countries, with marked restrictions in Belgium, Greece, and the Czech Republic.

  • Country-specific models of the fracture risk assessment tool FRAX are available for all countries except Cyprus, Latvia, Luxembourg, and Slovenia. The country with the highest online usage was Slovenia (41,894 sessions/million people, using the UK surrogate model), and the lowest was Bulgaria (49 sessions/million people).

  • On average, the treatment gap (the rate of women who exceed the intervention threshold but do not receive osteoporosis treatment) was estimated to be 71%, with the highest gaps estimated for Bulgaria (87%) and Estonia (84%). The lowest, although still considerable, gaps were found in Ireland (32%), Denmark (43%), and Greece (43%).

  • Surgery within 48 hours of a hip fracture has been shown to significantly reduce mortality and increase the proportion of patients returning to their original residence. Average waiting time between hospital admission and surgical intervention was reported as greater than 48 hours in five of the 29 countries: Cyprus, Greece, Italy, Portugal, and Spain.

"Only nine of the 29 European countries surveyed in this report recognize osteoporosis or musculoskeletal diseases as a national health priority," stated Prof Cyrus Cooper, DM, president of the IOF. "To prompt action for prevention, the IOF calls for a Europe-wide strategy and parallel national strategies to provide coordinated osteoporosis care and to reduce debilitating fractures and their impact on individual lives and healthcare systems."

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