Introduction
Osteoporosis
Epidemiology of fragility fractures
Prevalence of osteoporosis
Number of fractures
Fracture site | Women | Men | Men and women |
---|---|---|---|
Hip | 381,732 | 144,738 | 526,470 |
Spine | 267,194 | 148,089 | 415,283 |
Proximal humerus/distal forearm | 303,021 | 175,020 | 478,041 |
Other | 819,029 | 437,397 | 1,256,426 |
All | 1,770,976 | 905,244 | 2676,220 |
Country | New fractures (000) | Population at risk (000) | Rate/1000 |
---|---|---|---|
France | 381.6 | 24,672 | 15 |
Germany | 764.9 | 33,399 | 23 |
Italy | 563.4 | 26,282 | 21 |
Spain | 327.6 | 16,510 | 20 |
UK | 519.0 | 24,048 | 22 |
Sweden | 119.7 | 3787 | 32 |
EU6 | 2676.2 | 128,699 | 21 |
Lifetime risk of fragility fracture
Fracture projections
Imminent risk of fracture
10-year probability of MOF | |||
---|---|---|---|
Age | Cohort with clinical vertebral fracture 0–2 years ago | Cohort with any previous fracture in adult life | Ratio |
50 | 29.0 | 11.7 | 2.47 |
60 | 36.1 | 19.4 | 1.86 |
70 | 41.9 | 27.6 | 1.52 |
80 | 42.5 | 34.2 | 1.24 |
90 | 34.7 | 33.3 | 1.04 |
Probability MOF (%) | ||
---|---|---|
Country | Undetermined time | Within the past 2 years |
France | 9.4 | 17 |
Germany | 12 | 22 |
Italy | 12 | 22 |
Spain | 7.0 | 13 |
Sweden | 21 | 39 |
UK | 16 | 30 |
Economic cost of fragility fractures
Fracture costs and length of hospital stay
Country | Hip | Vertebral | Distal forearm |
---|---|---|---|
France | 12,856 | 3205 | 1468 |
Germany | 20,884 | 11,080 | 1275 |
Italy | 21,307 | 4713 | 1301 |
Spain | 9724 | 1928 | 533 |
Sweden | 16,406 | 14,474 | 4028 |
UK | 20,650 | 4028 | 2568 |
Annual fracture-related costs
Country | Incident fractures | Prior fractures | Institutional care | Total |
---|---|---|---|---|
France | 3748 | 219 | 1404 | 5371 |
Germany | 8176 | 414 | 2680 | 11,270 |
Italy | 5951 | 299 | 3179 | 9429 |
Spain | 2150 | 137 | 1915 | 4202 |
UK | 2955 | 372 | 1919 | 5246 |
Sweden | 1199 | 81 | 690 | 1970 |
Patient burden
Quality-adjusted life years
Disability-adjusted life years
Loss of productivity
Caregiver burden
Independent living
Fracture prevention
Pharmacological treatment gap
Post-fracture treatment gap
Fracture risk assessment
Fracture liaison services
Outcome measure | Effect of FLS (absolute change) | 95% CI | Duration of follow-up (months) | Number of studies |
---|---|---|---|---|
BMD testing | + 24% | (0.18 to 0.29) | 3–26 | 37 |
Treatment initiation | + 20% | (0.16 to 0.25) | 3–72 | 46 |
Adherence | + 22% | (0.13 to 0.31) | 3–48 | 9 |
Refracture | − 5% | (− 0.08 to − 0.03) | 6–72 | 11 |
Capture the Fracture®
Country | Total | Gold | Silver | Bronze | Other | Score | Score/FLS |
---|---|---|---|---|---|---|---|
France | 20 | 0 | 3 | 9 | 8 | 35 | 1.75 |
Germany | 2 | 0 | 1 | 0 | 1 | 4 | 2.0 |
Italy | 13 | 1 | 3 | 2 | 7 | 24 | 1.8 |
Spain | 65 | 13 | 13 | 22 | 17 | 152 | 2.3 |
Sweden | 5 | 0 | 4 | 1 | 0 | 14 | 2.8 |
UK | 25 | 6 | 11 | 1 | 7 | 66 | 2.6 |
EU6 | 130 | 20 | 35 | 35 | 40 | 285 | 2.2 |
Closing the FLS gap
Country | Fractures avoided (per year) | Fractures avoided per 1000 FLS patients | Reduction in annual fracture-related cost (million €) | Net impact on annual burden (million €) | Net impact per patient (€) | Reduction in annual burden (QALYs) |
---|---|---|---|---|---|---|
France | 2665 | 10.0 | −38.0 | 20.0 | 75.0 | 1036 |
Germany | 5423 | 13.9 | −75.4 | 8.2 | 21.0 | 2335 |
Italy | 2868 | 7.2 | −55.7 | −4.8 | −12.0 | 1602 |
Spain | 1249 | 5.4 | −18.4 | 20.0 | 86.0 | 584 |
Sweden | 1371 | 22.7 | −22.4 | −2.3 | −38.0 | 596 |
UK | 5686 | 16.2 | −75.5 | −1.4 | −4.0 | 2705 |
EU6 | 19,262 | 11.3 | −285.4 | 39.7 | 16.2 | 8858 |
Executive summary
Key findings
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The total number of fragility fractures in the EU6 is estimated to increase from 2.7 million in 2017 to 3.3 million in 2030; an increase of 23.3%.
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The annual fracture-related costs in the EU6 are projected to increase from a total €37.5 billion 2017 to €47.4 billion in 2030; an increase of 27%.
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The number of disability-adjusted life years (DALYs) per 1000 individuals’ age 50 years or more in EU6 due to fragility fractures was estimated at 21 years. This is a higher estimate compared to some other chronic diseases such as stroke (13 DALYs per 1000) and chronic obstructive pulmonary disease (COPD) (15 DALYs per 1000).
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The risk of refracture is highest immediately after a fracture. This has been referred to as the period of imminent risk; this phenomenon suggests that there is an opportunity to optimize the benefits of fracture prevention by treating patients as soon as possible after occurrence of a fracture.
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The treatment gap (defined as the percent eligible individuals not receiving treatment with osteoporosis drugs) in EU6 in year 2017 is estimated to be 73% for women and 63% for men. Compared to analysis from the year 2010, this is a marked increase from 56% in women and 47% in men.
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The proportion of patients starting a pharmacological treatment in the year after a fracture is low. In France, Sweden and Spain, 85%, 84% and 72% of fracture patients remained untreated 1 year after fracture, respectively.
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A fracture liaison service (FLS) is a multi-disciplinary health care delivery model for secondary fracture prevention. This health care delivery model has become more common in recent years, but its coverage is still low.
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A growing body of evidence suggests that FLS are cost-effective care delivery models that have the potential to increase the number of high-risk patients being treated, improve adherence to treatment and reduce the risk of refracture.
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A FLS provides an opportunity to improve early post-fracture patient identification and reduce the treatment gap.
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If FLS could be further expanded to reach all fracture patients in the EU6, 19,262 additional fractures every year would be avoided, and fracture-related costs would be reduced by €285.5 million.