About SCOPE
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5. Scorecard
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Acknowledgements
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Abbreviations and glossary
A letter to all Europeans
Introduction
The basis for SCOPE
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Burden of disease—including the burden of osteoporosis, fractures and forecasts for the future.
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Policy framework—such as the availability of public health programmes.
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Service provision—including assessment and treatments of osteoporosis.
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Service uptake—e.g. the proportion of men and women at high risk that do not receive treatment (the treatment gap).
Osteoporosis
Osteoporotic fractures
References
Chapter 1: Burden of disease
1a—Healthcare cost of osteoporotic fractures
Domain
Background and aims
Methods
Results
Country | Incident fracture costs | Long-term disability costs | Intervention costs | Total costs | Cost per capita (€) 2010 | Cost per capita (€) 2019 | QALYs lost (€m) 2010 | QALYs lost (€m) 2019 |
---|---|---|---|---|---|---|---|---|
Austria | 833.52 | 468.10 | 41.70 | 1343.32 | 104.84 | 151.84 | 2100 | 4111 |
Belgium | 766.36 | 321.85 | 33.97 | 1122.18 | 62.91 | 98.25 | 1914 | 3079 |
Bulgaria | 135.09 | 41.30 | 9.19 | 185.58 | 6.62 | 26.42 | 130 | 327 |
Croatia | 71.30 | 58.55 | 6.08 | 135.93 | - | 31.75 | - | 373 |
Cyprus | 64.09 | 12.71 | 8.92 | 85.73 | 51.87 | 72.08 | 86 | 95 |
Czech Republic | 260.88 | 121.34 | 14.05 | 396.27 | 28.69 | 37.29 | 695 | 1350 |
Denmark | 852.75 | 548.37 | 51.15 | 1452.27 | 209.68 | 250.50 | 1881 | 3096 |
Estonia | 18.05 | 11.89 | 1.68 | 31.62 | 24.28 | 23.94 | 65 | 106 |
Finland | 406.60 | 190.90 | 13.62 | 611.12 | 78.36 | 110.75 | 915 | 1423 |
France | 5047.97 | 1769.89 | 162.22 | 6980.07 | 84.98 | 104.20 | 9170 | 12001 |
Germany | 10235.08 | 3345.62 | 249.36 | 13830.06 | 121.40 | 166.77 | 16473 | 28232 |
Greece | 694.70 | 203.51 | 80.46 | 978.68 | 66.22 | 91.23 | 1394 | 1518 |
Hungary | 348.93 | 79.65 | 20.85 | 449.44 | 22.07 | 46.01 | 512 | 890 |
Ireland | 290.84 | 135.72 | 37.73 | 464.29 | 55.18 | 95.66 | 470 | 1456 |
Italy | 5438.79 | 3749.16 | 258.61 | 9446.55 | 129.12 | 156.32 | 9680 | 14980 |
Latvia | 28.04 | 18.75 | 1.84 | 48.63 | 18.76 | 25.24 | 79 | 170 |
Lithuania | 53.14 | 35.08 | 2.79 | 91.01 | 15.45 | 32.63 | 89 | 258 |
Luxembourg | 28.26 | 10.78 | 1.58 | 40.62 | 47.45 | 66.84 | 163 | 317 |
Malta | 18.59 | 8.41 | 2.07 | 29.06 | 45.25 | 60.10 | 26 | 65 |
Netherlands | 652.72 | 708.35 | 42.82 | 1403.88 | 55.18 | 81.47 | 2056 | 3735 |
Poland | 332.89 | 347.32 | 13.52 | 693.73 | 17.66 | 18.27 | 1094 | 2172 |
Portugal | 523.86 | 464.82 | 14.82 | 1003.51 | 59.59 | 97.60 | 640 | 720 |
Romania | 91.02 | 150.13 | 16.17 | 257.32 | 6.62 | 13.21 | 374 | 1035 |
Slovakia | 135.24 | 41.73 | 16.68 | 193.66 | 22.07 | 35.55 | 312 | 724 |
Slovenia | 60.81 | 26.74 | 8.15 | 95.69 | 30.90 | 46.29 | 185 | 302 |
Spain | 1813.37 | 2197.98 | 302.95 | 4314.30 | 69.53 | 92.34 | 3610 | 6224 |
Sweden | 1440.28 | 848.47 | 44.63 | 2333.37 | 176.58 | 229.14 | 2942 | 4457 |
Switzerland | 2624.76 | 745.65 | 59.91 | 3430.32 | 190.22 | 402.78 | 3242 | 5166 |
UK | 3031.07 | 2339.81 | 111.21 | 5482.09 | 96.01 | 82.45 | 9599 | 14465 |
EU27+2 | 36298.99 | 19002.57 | 1628.74 | 56930.30 | 85.80* | 109.12 | 69898* | 112850 |
Comment
References
1b – Economic framework
Domain
Background and aims
Methods
Results
Country | Population (thousands) | Health care spending (millions €) | Healthcare spending (% GDP) | Healthcare spending (€ per capita) | Fracture cost (% health care spending) |
---|---|---|---|---|---|
Austria | 8,847 | 38,746.40 | 10.4 | 4,379.59 | 3.4 |
Belgium | 11,422 | 45,746.49 | 10.3 | 4,005.10 | 2.4 |
Bulgaria | 7,024 | 4,214.84 | 8.1 | 600.04 | 4.2 |
Croatia | 4,089 | 3,350.71 | 6.8 | 819.36 | 3.9 |
Cyprus | 1,189 | 1,323.06 | 6.7 | 1,112.50 | 5.8 |
Czech Republic | 10,626 | 13,959.61 | 7.2 | 1,313.76 | 2.7 |
Denmark | 5,797 | 29,811.80 | 10.1 | 5,142.23 | 4.7 |
Estonia | 1,321 | 1,529.83 | 6.4 | 1,158.18 | 2.0 |
Finland | 5,518 | 20,768.83 | 9.2 | 3,763.80 | 2.9 |
France | 66,987 | 261,591.87 | 11.3 | 3,905.10 | 2.6 |
Germany | 82,928 | 371,370.83 | 11.2 | 4,478.24 | 3.7 |
Greece | 10,728 | 14,601.06 | 8.0 | 1,361.07 | 6.2 |
Hungary | 9,769 | 8,597.02 | 6.9 | 880.05 | 5.0 |
Ireland | 4,854 | 21,289.77 | 7.2 | 4,386.47 | 2.0 |
Italy | 60,431 | 153,854.16 | 8.8 | 2,545.94 | 6.0 |
Latvia | 1,927 | 1,621.85 | 5.3 | 841.85 | 2.9 |
Lithuania | 2,790 | 2,745.30 | 6.5 | 984.14 | 3.2 |
Luxembourg | 608 | 3,053.81 | 5.5 | 5,024.96 | 1.3 |
Malta | 484 | 1,064.06 | 9.3 | 2,200.61 | 2.5 |
Netherlands | 17,231 | 75,008.25 | 10.1 | 4,353.09 | 1.8 |
Poland | 37,979 | 30,787.16 | 6.5 | 810.65 | 2.2 |
Portugal | 10,282 | 17,587.68 | 9.0 | 1,710.57 | 5.6 |
Romania | 19,474 | 9,749.41 | 5.2 | 500.64 | 2.5 |
Slovakia | 5,447 | 5,764.15 | 6.7 | 1,058.22 | 3.1 |
Slovenia | 2,067 | 3,546.49 | 8.2 | 1,715.46 | 2.5 |
Spain | 46,724 | 104,267.79 | 8.9 | 2,231.58 | 3.8 |
Sweden | 10,183 | 52,765.82 | 11.0 | 5,181.67 | 4.3 |
Switzerland | 8,517 | 74,947.83 | 12.3 | 8,800.26 | 4.5 |
UK | 66,489 | 227,158.96 | 9.6 | 3,416.49 | 2.4 |
EU27+2 | 521,730 | 1,600,824.83 | 9.4 | 3,068.30 | 3.5 |
Comment
References
1c—Men and women with osteoporosis
Domain
Background and aims
Methods
Results
Country | Men with osteoporosis | Women with osteoporosis | Men and women with osteoporosis | Prevalence in male population aged 50+ (%) | Prevalence in female population aged 50+ (%) | Prevalence in total population (%) |
---|---|---|---|---|---|---|
Austria | 113,230 | 438,894 | 552,124 | 6.5 | 22.2 | 5.5 |
Belgium | 142,428 | 538,944 | 681,372 | 6.6 | 22.4 | 5.6 |
Bulgaria | 82,432 | 337,744 | 420,176 | 6.4 | 20.9 | 5.6 |
Croatia | 48,050 | 204,248 | 252,298 | 6.2 | 21.1 | 5.5 |
Cyprus | 11,346 | 38,986 | 50,332 | 6.2 | 19.3 | 3.7 |
Czech Republic | 114,600 | 457,776 | 572,376 | 6.0 | 20.4 | 5.0 |
Denmark | 72,670 | 254,888 | 327,558 | 6.5 | 21.1 | 5.1 |
Estonia | 13,082 | 68,820 | 81,902 | 6.2 | 22.2 | 5.8 |
Finland | 69,376 | 266,815 | 336,191 | 6.4 | 21.5 | 5.7 |
France | 802,660 | 3,188,700 | 3,991,360 | 6.7 | 22.5 | 5.5 |
Germany | 1,159,884 | 4,499,208 | 5,659,092 | 6.6 | 22.6 | 6.1 |
Greece | 143,796 | 539,883 | 683,679 | 6.9 | 22.3 | 5.7 |
Hungary | 99,758 | 459,347 | 559,105 | 6.2 | 21.1 | 5.5 |
Ireland | 47,120 | 162,200 | 209,320 | 6.2 | 20.0 | 3.7 |
Italy | 878,922 | 3,479,814 | 4,358,736 | 6.9 | 23.4 | 6.3 |
Latvia | 18,849 | 105,925 | 124,774 | 6.1 | 22.3 | 5.8 |
Lithuania | 28,487 | 152,117 | 180,604 | 6.1 | 21.7 | 5.3 |
Luxembourg | 6,466 | 23,100 | 29,566 | 6.1 | 21.0 | 4.3 |
Malta | 5,015 | 18,216 | 23,232 | 5.9 | 19.8 | 4.9 |
Netherlands | 215,901 | 760,240 | 976,141 | 6.3 | 20.8 | 4.9 |
Poland | 367,430 | 1,617,246 | 1,984,676 | 5.8 | 20.1 | 4.8 |
Portugal | 133,263 | 547,360 | 680,623 | 6.7 | 22.0 | 5.6 |
Romania | 207,390 | 863,870 | 1,071,260 | 6.2 | 20.5 | 4.8 |
Slovakia | 50,160 | 213,788 | 263,948 | 5.7 | 19.4 | 4.2 |
Slovenia | 24,720 | 100,190 | 124,910 | 6.0 | 21.5 | 5.4 |
Spain | 612,272 | 2,332,998 | 2,945,270 | 6.8 | 22.6 | 5.4 |
Sweden | 130,755 | 452,480 | 583,235 | 6.9 | 22.4 | 5.6 |
Switzerland | 111,210 | 412,450 | 523,660 | 6.6 | 22.6 | 6.1 |
UK | 821,152 | 2,953,653 | 3,774,805 | 6.7 | 21.9 | 5.2 |
EU27+2 | 6,532,426 | 25,511,028 | 32,043,453 | 6.6 | 22.1 | 5.6 |
Score allocation
Comment
References
1d—Epidemiology of hip fracture
Domain
Background and aims
Methods
Results
Country | Year | Sample | Incidence | F/M | Source | |
---|---|---|---|---|---|---|
Men | Women | |||||
Austria | 2001-5 | National | 298 | 608 | 2.0 | [74] |
Belgium | 2005-7 | National | 221 | 471 | 2.1 | [75–77] |
Bulgaria | 2015-7 | Regional | 188 | 411 | 2.2 | [70] |
Croatia | 2012 | National | 188 | 406 | 2.2 | [71] |
Cyprus | - | - | - | - | - | |
Czech Republic | 2008-9 | National | 248 | 457 | 1.8 | [66] |
Denmark | 2004 | National | 371 | 677 | 1.8 | [78] |
Estonia | 2010 | National | 181 | 278 | 1.5 | [72] |
Finland | 2000-6 | National | 234 | 382 | 1.6 | [79] |
France | 2004 | National | 168 | 387 | 2.3 | [80] |
Germany | 2003-4 | National | 225 | 470 | 2.1 | [66] |
Greece | 1986-92 | Regional | 236 | 503 | 2.1 | [67, 81–83] |
Hungary | 1999-2003 | National | 237 | 472 | 2.0 | [66] |
Ireland | 2009-10 | National | 228 | 431 | 1.9 | [84] |
Italy | 2008 | National | 204 | 476 | 2.3 | [85] |
Latvia | - | - | - | - | - | |
Lithuania | 2009-10 | Regional | 199 | 336 | 1.7 | [86] |
Luxembourg | - | - | - | - | - | |
Malta | 2003-07 | National | 205 | 454 | 2.2 | [66] |
Netherlands | 2005 | National | 153 | 290 | 1.9 | [87] |
Poland | 2008 | Regional | 149 | 263 | 1.8 | [88] |
Portugal | 2006-10 | National | 149 | 381 | 2.6 | [89] |
Romania | 2005-9 | National | 159 | 246 | 1.6 | [66] |
Slovakia | 2007 | National | 266 | 451 | 1.7 | [66] |
Slovenia | 2003 | National | - | 461 | - | [66] |
Spain | 1984-91 | Regional | 132 | 330 | 2.5 | [67, 90–92] |
Sweden | 1991 | Regional | 339 | 730 | 2.2 | [66] |
Switzerland | 2000 | National | 227 | 510 | 2.2 | [73, 93] |
UK | 1992–3 | Regional | 185 | 405 | 2.2 | [66] |
Score criteria
Score allocation
Comment
References
1e—Number of fragility fractures
Domain
Background and aims
Methods
Results
Fracture site | Women | Men | Women and men |
---|---|---|---|
Hip fractures | 603,967 | 222,741 | 826,708 |
Vertebral fractures | 432,479 | 230,064 | 662,544 |
Forearm fractures | 528,109 | 108,596 | 636,705 |
Other fractures | 1,293,964 | 855,626 | 2,149,591 |
All fractures | 2,858,519 | 1,417,028 | 4,275,547 |
Country | Fractures in 2010 | Fractures in 2019 | Population at risk (thousands) 2019 | Rate/1000 in 2010 | Rate/1000 in 2019 |
---|---|---|---|---|---|
Austria | 86536 | 110196 | 3719 | 28.5 | 29.6 |
Belgium | 79893 | 100188 | 4564 | 20.2 | 22.0 |
Bulgaria | 38198 | 56187 | 2904 | 13.3 | 19.3 |
Croatia | - | 34864 | 1743 | - | 20.0 |
Cyprus | 5129 | 6602 | 385 | 16.5 | 17.1 |
Czech Republic | 72195 | 91349 | 4154 | 19 | 22.0 |
Denmark | 66358 | 86153 | 2326 | 33.1 | 37.0 |
Estonia | 8688 | 7870 | 521 | 17.9 | 15.1 |
Finland | 36405 | 45254 | 2325 | 17.4 | 19.5 |
France | 376774 | 483654 | 26152 | 16.6 | 18.5 |
Germany | 724774 | 830848 | 37482 | 22 | 22.2 |
Greece | 85518 | 99242 | 4505 | 20.2 | 22.0 |
Hungary | 102457 | 86281 | 3786 | 27.8 | 22.8 |
Ireland | 18085 | 32367 | 1571 | 14.5 | 20.6 |
Italy | 465400 | 568424 | 27609 | 19.6 | 20.6 |
Latvia | 14305 | 15752 | 784 | 17.6 | 20.1 |
Lithuania | 15074 | 23148 | 1168 | 13.4 | 19.8 |
Luxembourg | 2700 | 4053 | 216 | 17.1 | 18.8 |
Malta | 2641 | 3232 | 177 | 17.4 | 18.3 |
Netherlands | 75947 | 99610 | 7082 | 12.9 | 14.1 |
Poland | 167664 | 205668 | 14381 | 12.6 | 14.3 |
Portugal | 51821 | 70730 | 4477 | 13.2 | 15.8 |
Romania | 94282 | 103035 | 7559 | 12.9 | 13.6 |
Slovakia | 38634** | 75722 | 1982 | 22.3 | 38.2 |
Slovenia | 15510 | 16637 | 878 | 20.4 | 18.9 |
Spain | 204151 | 285494 | 19327 | 12.8 | 14.8 |
Sweden | 107046 | 123523 | 3915 | 30.7 | 31.6 |
Switzerland | 74192 | 82488 | 3510 | 24.4 | 23.5 |
UK | 447972* | 526974 | 25743 | 20.7 | 20.5 |
EU27+2 | - | 4275547 | 214945 | 19.0 | 19.9 |
Score criteria
Score allocation
Comment
References
1f—Lifetime hip fracture probability
Domain
Background and aims
Methods
Results
Country | Lifetime probability (%) | |||
---|---|---|---|---|
At age 50 years | At age 70 years | |||
Men | Women | Men | Women | |
Austria | 8.3 | 19.7 | 8.8 | 20.7 |
Belgium | 7.8 | 18.2 | 8.3 | 18.9 |
Bulgaria | 4.4 | 11.2 | 4.3 | 11.5 |
Croatia | 5.1 | 11.4 | 5.1 | 11.3 |
Cyprus | - | - | - | - |
Czech Republic | 6.9 | 14.8 | 7.5 | 15.6 |
Denmark | 10.6 | 22.1 | 11.1 | 23.6 |
Estonia | 4.4 | 9.1 | 4.9 | 9.6 |
Finland | 5.8 | 12.4 | 6.1 | 12.8 |
France | 5.6 | 18.4 | 6.3 | 19.4 |
Germany | 5.3 | 14.2 | 5.6 | 15.0 |
Greece | 8 | 15.8 | 8.6 | 15.2 |
Hungary | 4.1 | 10.6 | 5.2 | 12.0 |
Ireland | 7.8 | 18.2 | 8.0 | 18.7 |
Italy | 7.7 | 19.2 | 7.8 | 19.3 |
Latvia | - | - | - | - |
Lithuania | 4.4 | 11.3 | 5.3 | 11.9 |
Luxembourg | - | - | - | - |
Malta | 5.8 | 14.2 | 5.8 | 14.2 |
Netherlands | 5.4 | 12.5 | 5.6 | 12.8 |
Poland | 4.0 | 9.7 | 3.9 | 10.1 |
Portugal | 4.8 | 14.4 | 5.3 | 14.9 |
Romania | 3.8 | 7.0 | 3.7 | 7.2 |
Slovakia | 9.5 | 20.3 | 9.9 | 20.3 |
Slovenia | - | 11.6 | - | 12.0 |
Spain | 4.0 | 12.1 | 4.3 | 12.6 |
Sweden | 10.9 | 25.1 | 11.0 | 25.4 |
Switzerland | 7.1 | 22.5 | 6.9 | 23.5 |
UK | 4.8 | 13.8 | 5.0 | 14.6 |
EU27+2* | 5.7 | 15.0 | 6.0 | 15.6 |
Score criteria
Score allocation
Comment
References
1g—Men and women at high fracture risk
Domain
Background and aims
Methods
Results
Country | Number of men and women (000) | Proportion of population age 50–89 years (%) | ||||||
---|---|---|---|---|---|---|---|---|
>20% | >10% | >High risk | >Very high risk | >20% | >10% | >High risk | >Very high risk | |
Austria | 469 | 1297 | 386 | 234 | 13 | 36 | 11 | 6 |
Belgium | 384 | 1185 | 512 | 315 | 9 | 27 | 12 | 7 |
Bulgaria | 165 | 622 | 325 | 200 | 6 | 22 | 11 | 7 |
Croatia | 103 | 371 | 196 | 120 | 6 | 22 | 11 | 7 |
Cyprus* | 26 | 91 | 44 | 28 | 7 | 24 | 12 | 7 |
Czech | 361 | 1144 | 471 | 288 | 9 | 28 | 12 | 7 |
Denmark | 470 | 1116 | 252 | 148 | 21 | 49 | 11 | 6 |
Estonia | 17 | 72 | 60 | 38 | 3 | 14 | 12 | 7 |
Finland | 133 | 493 | 261 | 153 | 6 | 22 | 11 | 7 |
France | 1856 | 5259 | 2892 | 1803 | 7 | 21 | 11 | 7 |
Germany | 2719 | 8457 | 3846 | 2390 | 7 | 23 | 11 | 7 |
Greece | 352 | 1158 | 534 | 336 | 8 | 26 | 12 | 8 |
Hungary | 259 | 925 | 431 | 260 | 7 | 25 | 12 | 7 |
Ireland | 145 | 446 | 179 | 109 | 9 | 29 | 12 | 7 |
Italy | 2452 | 7024 | 3278 | 2073 | 9 | 26 | 12 | 8 |
Latvia* | 39 | 151 | 94 | 58 | 5 | 20 | 12 | 8 |
Lithuania | 58 | 223 | 138 | 86 | 5 | 20 | 12 | 8 |
Luxembourg* | 15 | 49 | 24 | 14 | 7 | 23 | 11 | 7 |
Malta | 14 | 47 | 20 | 13 | 8 | 27 | 12 | 8 |
Netherlands | 277 | 1115 | 801 | 501 | 4 | 16 | 12 | 7 |
Poland | 436 | 1820 | 1633 | 1018 | 3 | 13 | 12 | 7 |
Portugal | 252 | 786 | 537 | 346 | 6 | 18 | 12 | 8 |
Romania | 135 | 822 | 841 | 525 | 2 | 11 | 11 | 7 |
Slovakia | 170 | 642 | 217 | 131 | 9 | 33 | 11 | 7 |
Slovenia* | 56 | 202 | 93 | 56 | 7 | 23 | 11 | 6 |
Spain | 753 | 2626 | 2113 | 1337 | 4 | 14 | 11 | 7 |
Sweden | 616 | 1643 | 441 | 268 | 16 | 43 | 12 | 7 |
Switzerland | 554 | 1397 | 375 | 215 | 16 | 41 | 11 | 6 |
UK | 2280 | 7419 | 2858 | 1723 | 9 | 30 | 11 | 7 |
EU27+2 | 15566 | 48602 | 23852 | 14786 | 7 | 23 | 11 | 7 |
Probability | 2010 | 2019 | Difference | % |
---|---|---|---|---|
>20% | 12,915 | 16,934 | 4,019 | +31 |
>10% | 41,238 | 48,899 | 7,661 | +18 |
High risk threshold | 21,339 | 23,721 | 2,382 | +11 |
Score criteria
Score allocation
References
1h— Population projections
Domain
Background and aims
Methods
Results
Country | Women (%) | Men (%) | Both (%) | ||
---|---|---|---|---|---|
Age 50–74 | Age 75+ | Age 50–74 | Age 75+ | Age 50+ | |
Austria | 6.0 | 22.0 | 7.5 | 38.0 | 11.8 |
Belgium | 3.0 | 32.8 | 5.0 | 55.5 | 12.6 |
Bulgaria | −8.4 | 19.7 | −1.8 | 20.1 | −0.1 |
Croatia | -5.2 | 17.3 | −2.2 | 41.0 | 2.8 |
Cyprus | 28.2 | 59.4 | 25.3 | 71.0 | 33.8 |
Czech Republic | 7.1 | 41.1 | 14.4 | 60.9 | 18.5 |
Denmark | −2.6 | 38.8 | −3.4 | 48.2 | 7.0 |
Estonia | −3.3 | 11.6 | 10.8 | 41.0 | 7.3 |
Finland | −8.9 | 47.8 | −6.3 | 66.7 | 6.9 |
France | 0.3 | 41.8 | 0.9 | 57.0 | 11.8 |
Germany | −2.1 | 13.1 | −0.8 | 25.0 | 3.5 |
Greece | 6.1 | 21.0 | 10.5 | 23.7 | 11.9 |
Hungary | −1.6 | 32.1 | 7.0 | 49.3 | 9.8 |
Ireland | 31.1 | 69.0 | 28.8 | 78.9 | 38.0 |
Italy | 3.6 | 20.3 | 6.2 | 31.8 | 10.1 |
Latvia | −9.9 | 6.1 | −4.1 | 18.9 | −3.1 |
Lithuania | −11.6 | 11.9 | −7.7 | 17.2 | −4.2 |
Luxembourg | 24.9 | 45.0 | 22.4 | 81.2 | 30.3 |
Malta | −1.7 | 57.3 | 3.5 | 76.2 | 14.7 |
Netherlands | −2.7 | 49.1 | −3.3 | 67.0 | 9.5 |
Poland | 0.0 | 60.8 | 7.2 | 92.4 | 16.6 |
Portugal | 4.7 | 26.1 | 5.9 | 33.9 | 11.3 |
Romania | −2.8 | 29.6 | 2.8 | 38.5 | 6.4 |
Slovakia | 6.8 | 58.8 | 14.1 | 88.8 | 20.2 |
Slovenia | 1.9 | 33.3 | 6.1 | 64.9 | 13.1 |
Spain | 17.9 | 28.6 | 20.3 | 37.7 | 22.3 |
Sweden | 3.0 | 32.0 | 4.8 | 43.0 | 12.0 |
Switzerland | 10.5 | 39.1 | 10.8 | 57.0 | 18.7 |
UK | 6.3 | 31.0 | 6.7 | 42.2 | 13.2 |
EU27+2 | 3.0 | 29.6 | 5.4 | 42.6 | 11.4 |
Score criteria
Comment
References
1i—Fracture projections
Domain
Background and aims
Methods
Results
Country | Number fractures 2019 | Number fractures 2034 | Difference 2019-2034 | Increase in fractures 2019-2034 (%) | Share of EU27+2 increase (%) |
---|---|---|---|---|---|
Austria | 110,196 | 140,275 | 30,079 | 27.3 | 2.8 |
Belgium | 100,188 | 123,560 | 23,372 | 23.3 | 2.2 |
Bulgaria | 56,187 | 60,855 | 4,668 | 8.3 | 0.4 |
Croatia | 34,864 | 38,716 | 3,852 | 11.0 | 0.4 |
Cyprus | 6,602 | 9,801 | 3,199 | 48.5 | 0.3 |
Czech Republic | 91,349 | 123,122 | 31,773 | 34.8 | 3.0 |
Denmark | 86,153 | 114,232 | 28,079 | 32.6 | 2.6 |
Estonia | 7,870 | 9,459 | 1,589 | 20.2 | 0.1 |
Finland | 45,254 | 60,196 | 14,942 | 33.0 | 1.4 |
France | 483,654 | 609,568 | 125,914 | 26.0 | 11.9 |
Germany | 830,848 | 966,792 | 135,945 | 16.4 | 12.8 |
Greece | 99,242 | 120,954 | 21,712 | 21.9 | 2.0 |
Hungary | 86,281 | 108,489 | 22,208 | 25.7 | 2.1 |
Ireland | 32,367 | 51,278 | 18,911 | 58.4 | 1.8 |
Italy | 568,424 | 701,629 | 133,205 | 23.4 | 12.5 |
Latvia | 15,752 | 17,049 | 1,297 | 8.2 | 0.1 |
Lithuania | 23,148 | 26,925 | 3,777 | 16.3 | 0.4 |
Luxembourg | 4,053 | 5,840 | 1,787 | 44.1 | 0.2 |
Malta | 3,232 | 4,775 | 1,542 | 47.7 | 0.1 |
Netherlands | 99,610 | 136,821 | 37,211 | 37.4 | 3.5 |
Poland | 205,668 | 266,653 | 60,985 | 29.7 | 5.7 |
Portugal | 70,730 | 91,203 | 20,473 | 28.9 | 1.9 |
Romania | 103,035 | 118,297 | 15,261 | 14.8 | 1.4 |
Slovakia | 75,722 | 100,785 | 25,063 | 33.1 | 2.4 |
Slovenia | 16,637 | 21,564 | 4,926 | 29.6 | 0.5 |
Spain | 285,494 | 369,896 | 84,402 | 29.6 | 7.9 |
Sweden | 123,523 | 160,647 | 37,124 | 30.1 | 3.5 |
Switzerland | 82,488 | 113,458 | 30,970 | 37.5 | 2.9 |
UK | 526,974 | 664,850 | 137,876 | 26.2 | 13.0 |
EU27+2 | 4,275,547 | 5,337,690 | 1,062,143 | 24.8 | 100.0 |
Score criteria
Score allocation
Comment
References
Chapter 2 Policy framework
2a—Quality of existing information
Domain
Background and aims
Methods
Results
Country | Incidence of hip fracture | Established National Fracture Registries | 2010 Score | 2019 Score | ||
---|---|---|---|---|---|---|
Qualitya | Sample | Present | Datab | |||
Austria | G | National | Yes | Hip+ | 3 | 3 |
Belgium | G | National | No | 3 | 2 | |
Bulgaria | G | Regional | Yes | Hip+ | 0 | 3 |
Croatia | G | National | No | - | 2 | |
Cyprus | - | - | No | 0 | 1 | |
Czech Republic | G | National | No | 2 | 2 | |
Denmark | G | National | No | 3 | 2 | |
Estonia | G | National | No | 1 | 2 | |
Finland | G | National | Yes | Hip+ | 3 | 3 |
France | G | National | Yes | Hip | 2 | 3 |
Germany | G | National | No | 2 | 2 | |
Greece | P/F/G | Regional | No | 1 | 1 | |
Hungary | G | National | Yes | Hip+ | 3 | 3 |
Ireland | G | National | Yes | Hip | 3 | 3 |
Italy | G | National | Yes | Hip+ | 2 | 3 |
Latvia | - | - | Yes | Hip+ | 3 | 3 |
Lithuania | F | Regional | Yes | Hip+ | 1 | 3 |
Luxembourg | - | - | - | 0 | - | |
Malta | G | National | No | 2 | 2 | |
Netherlands | G | National | Yes | Hip | 3 | 3 |
Poland | F | Regional | No | 1 | 1 | |
Portugal | G | National | No | 3 | 2 | |
Romania | G | National | No | 2 | 2 | |
Slovakia | G | National | Yes | Hip | 3 | 3 |
Slovenia | F | National | No | 2 | 1 | |
Spain | F/G | Regional | Yes | Hip+ | 1 | 3 |
Sweden | G | National | Yes | Hip+ | 3 | 3 |
Switzerland | G | National | No | - | 2 | |
UK | G | Regional | Yes | Hip+ | 3 | 3 |
Score criteria
Score allocation
Comment
References
2b—National health priority
Domain
Background and aims
Methods
Results
Country | NHP and date | Government support | Scopea | Action plan | Score 2010 | Score 2019 |
---|---|---|---|---|---|---|
Austria | No | 1 | 1 | |||
Belgium | No | 1 | 1 | |||
Bulgaria | Yes 2006 | Yes | No | 3 | 2 | |
Croatia | No | No | 1 | |||
Cyprus | No | 1 | 1 | |||
Czech Republic | No | 1 | 1 | |||
Denmark | No | 1 | 1 | |||
Estonia | No | 1 | 1 | |||
Finland | Yes 2017 | Yes | N, E, F | Yes | 2 | 3 |
France | Yes 2018 | Yes | F, P | Yes | 2 | 3 |
Germany | Yes 2020 | Yes | N, E, F | No | 1 | 2 |
Greece | No | 1 | 1 | |||
Hungary | No | N, E, F, P | No | 1 | 1 | |
Ireland | No | 1 | 1 | |||
Italy | Yes 2010 | Yes | Yes | 2 | 3 | |
Latvia | No | N, E | 1 | 1 | ||
Lithuania | No | 1 | 1 | |||
Luxembourg | - | 3 | 0 | |||
Malta | No | 1 | 1 | |||
Netherlands | No | 1 | 1 | |||
Poland | Yes | Yes | N | Yes | 1 | 3 |
Portugal | No | 2 | 1 | |||
Romania | Yes 2005 | Yes | Yes | 3 | 3 | |
Slovakia | No | 1 | 1 | |||
Slovenia | No | 1 | 1 | |||
Spain | Yes | Yes | No | 1 | 2 | |
Sweden | Yes 2012 | Yes | F, P | Yes | 2 | 3 |
Switzerland | No | 1 | ||||
UK | No | 3 | 1 |
Score criteria
Score allocation
Comment
References
2c—Who manages osteoporosis?
Domain
Background and aims
Methods
Results
Country | Primarily devolved to primary care | Lead specialty | Score 2010 | Score 2019 |
---|---|---|---|---|
Austria | Yes | 3 | 3 | |
Belgium | Yes | 3 | 3 | |
Bulgaria | No | Rheumatology | 1 | 2 |
Croatia | No | Endocrinology | 2 | |
Cyprus | No | Endocrinology | 3 | 2 |
Czech Republic | No | Osteology Rheumatology Endocrinology, Internal medicine | 1 | 1 |
Denmark | Yes | 1 | 3 | |
Estonia | Yes | 3 | 3 | |
Finland | Yes | 3 | 3 | |
France | Yes | 3 | 3 | |
Germany | Yes | 3 | ||
Greece | No | Orthopaedic surgery | 2 | 2 |
Hungary | No | Rheumatology Endocrinology | 2 | 1 |
Ireland | Yes | 1 | 3 | |
Italy | Yes | 1 | 3 | |
Latvia | Yes | 3 | 3 | |
Lithuania | Yes | 3 | 3 | |
Luxembourg | - | 3 | 0 | |
Malta | No | Rheumatology | 1 | 2 |
Netherlands | No | Endocrinology | 3 | 2 |
Poland | No | Rheumatology Endocrinology Geriatrics | 1 | 1 |
Portugal | Yes | 3 | 3 | |
Romania | No | Endocrinology | 1 | 2 |
Slovakia | No | Rheumatology | 1 | 2 |
Slovenia | Yes | 3 | 3 | |
Spain | Yes | 3 | 3 | |
Sweden | Yes | 3 | 3 | |
Switzerland | No | Rheumatology Gynaecology Endocrinology Geriatrics Internal medicine | 1 | |
UK | Yes | 3 | 3 |
Score criteria
Score allocation
Comment
References
2d—Is osteoporosis a component of specialty training?
Domain
Background and aims
Methods
Results
Country | OP recognized as a specialty | Principal specialties | OP recognized as a component of specialty training | Score |
---|---|---|---|---|
Austria | No | Endo, Rh, Gyn, Orth | Yes | 2 |
Belgium | No | Rehab | Yes | 2 |
Bulgaria | No | Int, Orth, Endo, Rh | Yes | 2 |
Croatia | No | Endo, Rehab, Orth, Gyn | Yes | 2 |
Cyprus | No | Endo, | No | 1 |
Czech Republic | Yes | Int, Orth, Gyn, Endo, Rh, Ost | Yes | 3 |
Denmark | No | Endo | Yes | 2 |
Estonia | No | Orth, Gyn, Endo, Rh | Yes | 2 |
Finland | No | Endo, Int, Ger, Orth, Gyn | Yes | 2 |
France | No | Rh, Ger, Endo, Prim, Gyn, Orth, Int | Yes | 2 |
Germany | No | Ost, Orth, Gyn, Rh, Endo | Yes | 2 |
Greece | No | Orth, Endo, Rh | Yes | 2 |
Hungary | No | Endo, Rh | Yes | 2 |
Ireland | Yes | Ger, Rh, Orth | Yes | 3 |
Italy | No | Rh, Endo, Int, Rehab, Orth | Yes | 2 |
Latvia | No | No | 1 | |
Lithuania | Yes | Int, Ger, Endo, Rh, Orth, Prim | Yes | 3 |
Luxembourg | - | 0 | ||
Malta | No | Orth, Gyn, Rehab, Rh, Endo, Ger | Yes | 2 |
Netherlands | No | Int, Orth, Gyn, Endo, Rh, Trau | Yes | 2 |
Poland | No | Int, Orth, Rh, Endo, Ger, Gyn | Yes | 2 |
Portugal | No | Int, Orth, Gyn, Endo, Rh, Prim, Rehab, Neuro | Yes | 2 |
Romania | No | Endo, Rh, Rehab | Yes | 2 |
Slovakia | Yes | Orth, Endo, Rh | Yesb | 3 |
Slovenia | No | Prim, Int, Orth, Gyn, Endo | Yes | 2 |
Spain | No | Int, Orth, Gyn, Endo, Rh | Yes | 2 |
Sweden | No | Orth, Endo, Ger, Prim | Yes | 2 |
Switzerland | No | Endo, Rh, gyn, Ger, Int | Yes | 2 |
UK | No | Rh, Endo | Yes | 2 |
Score criteria
Score allocation
Comment
2e—Patient organisations
Domain
Background and aims
Methods
-
Policy: Work on promoting the interest of patient during all stages of policy development
-
Capacity building and education: Invest in capacity building and educational initiatives for policy makers, industry, academia and media
-
Peer support: Provide peer mentoring and counselling services and legal and financial support to patients
-
Research and Development: Active research collaborators
Results
Country | Presence of patient organisations | Patient advocacy areas | Score 2019 | |||
---|---|---|---|---|---|---|
Policy | Capacity | Peer support | Research and development | |||
Austria | Yes | x | x | x | x | 3 |
Belgium | Yes | 2 | ||||
Bulgaria | Yes | 2 | ||||
Croatia | Yes | x | x | x | 2 | |
Cyprus | Yes | x | x | 2 | ||
Czech Republic | Yes | x | 2 | |||
Denmark | Yes | x | x | x | 2 | |
Estonia | No | 1 | ||||
Finland | Yes | x | x | x | x | 3 |
France | Yes | x | x | x | x | 3 |
Germany | Yes | x | x | x | 2 | |
Greece | Yes | x | x | x | 2 | |
Hungary | Yes | 2 | ||||
Ireland | Yes | x | x | x | x | 3 |
Italy | Yes | x | x | x | x | 3 |
Latvia | Yes | x | x | x | x | 3 |
Lithuania | Yes | x | x | x | x | 3 |
Luxembourg | 0 | |||||
Malta | Yes | x | x | x | 2 | |
Netherlands | Yes | x | x | x | 2 | |
Poland | No | 1 | ||||
Portugal | Yes | x | x | x | x | 3 |
Romania | Yes | x | x | x | x | 3 |
Slovakia | Yes | x | x | x | 2 | |
Slovenia | Yes | x | x | x | 2 | |
Spain | Yes | x | x | x | 2 | |
Sweden | Yes | x | x | x | 2 | |
Switzerland | Yes | x | 2 | |||
UK | Yes | x | x | x | x | 3 |
Score criteria
Score allocation
Comment
Reference
Chapter 3 Service provision
3a—Treatments for osteoporosis
Domain
Background and aims
Methods
Results
Country | Reimbursed 2019 (%) | Score 2012 | Score 2019 | Patient or professional impediment | First-line drugs identified | Average cost (€/year) | Generic alendronate (€/year) |
---|---|---|---|---|---|---|---|
Austria | 100 | 3 | 3 | No | Yes | 230 | 124 |
Belgium | 61-98 | 1 | 1 | Yes | Yes | 193 | 65 |
Bulgaria | 50 | 1 | 2 | No | Yes | 235 | 163 |
Croatia | 100 | nr | 3 | Yes | Yes | 187 | 99 |
Cyprus | 100 | 3 | 3 | Yes | Yes | - | - |
Czech Republic | 90-100 | 2 | 1 | Yes | Yes | 161 | 66 |
Denmark | 100 | 2 | 3 | No | Yes | 173 | 49 |
Estonia | 50-100 | 1 | 2 | No | No | 133 | 84 |
Finland | 40 | 2 | 2 | No | No | 226 | 75 |
France | 65 | 1 | 2 | Yes | Yes | 225 | 100 |
Germany | 100 | 3 | 3 | Yes | Yes | 278 | 91 |
Greece | 75 | 1 | 1 | Yes | Yes | 239 | 101 |
Hungary | 70-90 | 1 | 2 | No | Yes | 125 | 16 |
Ireland | * | 3 | 2 | No | No | 285 | 79 |
Italy | 100 | 3 | 3 | Yes | Yes | 231 | 118 |
Latvia | 50 | 0 | 2 | No | Yes | 103 | 125 |
Lithuania | 100 | 1 | 3 | No | Yes | 142 | 70 |
Luxembourg | nr | 2 | 0 | 249 | 67 | ||
Malta | nr | 2 | 0 | No | No | - | - |
Netherlands | 100 | 3 | 3 | No | No | 84 | 19 |
Poland | 30 | 1 | 2 | No | Yes | 47 | 23 |
Portugal | 69 | 2 | 2 | No | Yes | 133 | 101 |
Romania | 50-100 | 1 | 2 | No | Yes | 102 | 58 |
Slovakia | 90 | 2 | 2 | No | Yes | 194 | |
Slovenia | 100 | 3 | 3 | Yes | Yes | 233 | 130 |
Spain | 90 | 1 | 2 | No | No | 329 | 101 |
Sweden | 100 | 3 | 3 | No | Yes | 120 | 16 |
Switzerland | 100 | nr | 3 | No | Yes | 374 | 217 |
UK | 100 | 3 | 3 | Yes | Yes | 60 | 15 |
Treatment | Countries where reimbursement is not offered for osteoporosis* |
---|---|
Risedronate | Malta |
Alendronate | Malta, Slovakia |
Ibandronate | Cyprus, Malta |
Zoledronate | Bulgaria, Ireland, Malta, Poland |
Raloxifene | Czech Republic, Estonia, Finland, Hungary, Latvia, Lithuania, Malta, Poland |
Denosumab | Cyprus, Ireland, Malta |
Strontium Ranelate | Only markets with reimbursement: Cyprus, Italy, Lithuania, the Netherlands, Romania, Spain, UK [removed from several markets] |
Teriparatide and PTH | Estonia, Ireland, Latvia, Malta, Poland, Romania |
Alfacalcidol/calcitriol/calcidiol | Finland, Ireland, Lithuania, Malta, Poland, Romania |
Score criteria
Score allocation
Comment
References
3b—Availability of DXA
Domain
Background and aims
Methods
Results
Country | DXA units/million | Country | DXA units/million | Country | DXA units/million |
---|---|---|---|---|---|
Austria | 29.7 | Germany | 21.5 | Netherlands | 12.3 |
Belgium | 28.9 | Greece | 51.4 | Poland | 7.1 |
Bulgaria | 3.6 | Hungary | 6.9 | Portugal | 25.4 |
Croatia | 10.8 | Ireland | 20.5 | Romania | 9.9 |
Cyprus | 19.7 | Italy | 23.5 | Slovakia | 30.2 |
Czech Republic | 8.1 | Latvia | 6.7 | Slovenia | 18.0 |
Denmark | 17.4 | Lithuania | 8.0 | Spain | 15.5 |
Estonia | 12.7 | Luxemburg | 1.7 | Sweden | 7.4 |
Finland | 11.6 | Malta | 24.6 | Switzerland | 26.9 |
France | 23.8 | UK | 7.5 |
Score criteria
Score allocation
Comment
References
3c—Access to DXA
Domain
Background and aims
Methods
Results
Country | Waiting time 2019 (d) | Waiting time 2012(d) | Cost (€) | Reimbursement | Barriers to clinical practice |
---|---|---|---|---|---|
Austria | 14 | 14 | 50 | Yes (conditional) | Reimbursement depending on public/private delivery |
Belgium | 7 | 14 | 93 | Yes (conditional) | Reimbursement depending on condition |
Bulgaria | 5 | 0 | 50 | No | |
Croatia | 21 | 25 | Yes | ||
Cyprus | 120 | 20 | 70 | Yes (conditional) | Reimbursement depending on patient income |
Czech Republic | 30 | 40 | 30 | Yes (conditional) | Reimbursement depending on condition |
Denmark | 90 | 30 | 100 | Yes | |
Estonia | 14 | 14 | 25 | Yes | |
Finland | 30 | 1 | 200 | Yes | |
France | 30 | 14 | 40 | Yes (conditional) | Reimbursement depending on condition |
Germany | 0 | 0 | 45 | Yes | |
Greece | 5 | 11 | 55 | Yes (conditional) | Reimbursement depending on condition |
Hungary | 14 | 15 | 20 | Yes | |
Italy | 90 | 140 | 90 | Yes (conditional) | Reimbursement depending on condition |
Ireland | 7 | 83 | 120 | Yes (conditional) | Reimbursement depending on listing with caregiver |
Latvia | 17 | 10 | 3 | Yes | |
Lithuania | 7 | 6 | 30 | Yes (conditional) | Reimbursement depending on condition |
Luxembourg | 30 | ||||
Malta | 30 | 105 | 0 | Yes | Full reimbursement in public practice |
Netherlands | 14 | 14 | 100 | Yes | |
Poland | 42 | 1 | 22 | Yes (conditional) | |
Portugal | 7 | 8 | 35 | Yes | |
Romania | 0 | 7 | Yes | ||
Spain | 180 | 18 | 90 | Yes | |
Slovakia | 18 | 11 | 32 | Yes | |
Slovenia | 7 | 105 | 50 | Yes (conditional) | |
Sweden | 90 | 60 | 85 | Yes | |
Switzerland | 14 | 70 | Yes (conditional) | ||
UK | 42 | 11 | 45 | Yes |
Score criteria
Score allocation
Comment
Reference
3d—Access to risk assessment algorithms
Domain
Background and aims
Methods
Results
Country | FRAX model available | Other models | Guidance b |
---|---|---|---|
Austria | ✓ | DVO [175] | ✓ |
Belgium | ✓ | ✓ | |
Bulgaria | - a | ||
Croatia | ✓ | ||
Cyprus | |||
Czech Republic | ✓ | ||
Denmark | ✓ | ✓ | |
Estonia | ✓ | ||
Finland | ✓ | ✓ | |
France | ✓ | ✓ | |
Germany | ✓ | DVO [175] | ✓ |
Greece | ✓ | ✓ | |
Hungary | ✓ | ✓ | |
Italy | ✓ | DeFRA [182] | ✓ |
Ireland | ✓ | ✓ | |
Latvia | |||
Lithuania | ✓ | ✓ | |
Luxembourg | |||
Malta | ✓ | ||
Netherlands | ✓ | CBO [173] | ✓ |
Poland | ✓ | ✓ | |
Portugal | ✓ | ✓ | |
Romania | ✓ | ✓ | |
Spain | ✓ | ✓ | |
Slovakia | ✓ | ✓ | |
Slovenia | ✓ | ||
Sweden | ✓ | ✓ | |
Switzerland | ✓ | TOP [183] | ✓ |
UK | ✓ | QFracture [174] | ✓ |
Score criteria
Score allocation
Comment
References
3e—Quality of guidelines for assessment and treatment
Domain
Background and aims
Methods
Results
Country | Developed or updated (year) | Scopea | AGREE criteria | Score |
---|---|---|---|---|
Austria | 2010-2017 | PMW, men, GIOP | 7 | 10 |
Belgium | 2020 | PMW, men, GIOP | 4 | 7 |
Bulgaria | 2019 | PMW, men, GIOP | 5 | 8 |
Croatia | 2013 | PMW, men, GIOP | 3 | 6 |
Cyprus | 0 | 0 | ||
Czech Republic | 2015-2018 | PMW, men, GIOP | 3 | 6 |
Denmark | 2019 | PMW, men, GIOP | 2 | 5 |
Estonia | 2007 | PMW, men | 4 | 6 |
Finlandb | 2013 | PMW, men, GIOP | 6 | 9 |
France | 2018-2020 | PMW, men, GIOP | 6 | 9 |
Germany | 2017 | PMW, men, GIOP | 7 | 10 |
Greece | 2019 | PMW, men | 6 | 8 |
Hungary | 2010 | PMW, men, GIOP | 7 | 10 |
Italy | 2016 | PMW, men, GIOP | 7 | 10 |
Ireland | 2011 | PMW, men, GIOP | 2 | 5 |
Latvia | 2012 | PMW, men, GIOP | 7 | 10 |
Lithuania | 2011 | PMW | 6 | 7 |
Luxembourgc | 2010 | PMW | 0 | 0 |
Malta | 0 | 0 | ||
Netherlands | 2012 | PMW, men, GIOP | 7 | 10 |
Poland | 2018 | PMW, men, GIOP | 5 | 8 |
Portugal | 2018 | PMW, men, GIOP | 7 | 10 |
Romania | 2010 | PMW, men, GIOP | 6 | 9 |
Spain | 2015 | PMW, men, GIOP | 6 | 9 |
Slovakiab | 2010 | PMW, men, GIOP | 7 | 10 |
Slovenia | 2018 | PMW, men, GIOP | 3 | 6 |
Sweden | 2020 | PMW, men, GIOP | 6 | 9 |
Switzerland | 2019 | PMW, men, GIOP | 4 | 7 |
UK | 2019 (Scotland) | PMW, men, GIOP | 7 | 10 |
Score criteria
Score allocation
Comment
References
3f—Guideline criteria for assessment and treatment
Domain
Background and aims
Methods
Results
Country | Developed or updated (year) | Assessment | Compatible/consistent | Treatment | Compatible/consistent |
---|---|---|---|---|---|
Austria | 2010 | Yes | Yes | Yes | Yes |
Belgium | 2020 | Yes | No | Yes | No |
Bulgaria | 2019 | Yes | No | Yes | Yes |
Croatia | 2013 | No | Yes | Yes | Yes |
Cyprus | na | - | - | - | - |
Czech Republic | 2015-2018 | Yes | No | Yes | Yes |
Denmark | 2019 | No | Yes | Yes | Yes |
Estonia | 2007 | Yes | Yes | Yes | |
Finland | 2013 | Yes | Yes/No | Yes | Yes |
France | 2018 | Yes | Yes | Yes | Yes |
Germany | 2017 | Yes | Yes | Yes | Yes |
Greece | 2019 | Yes | Yes | Yes | Yes |
Hungary | 2010 | Yes | Yes | Yes | Yes |
Italy | 2016 | Yes | Yes | Yes | Yes |
Ireland | 2011 | Yes | Yes | Yes | Yes |
Latvia | 2012 | Yes | Yes | Yes | No |
Lithuania | 2011 | Yes | Yes | Yes | Yes |
Luxembourg | 2010 | nr | nr | nr | nr |
Malta | na | - | - | - | - |
Netherlands | 2012 | No | Yes | Yes | Yes |
Poland | 2018 | Yes | |||
Portugal | 2018 | Yes | Yes | Yes | Yes |
Romania | 2010 | ||||
Spain | 2015 | No | Yes | Yes | Yes |
Slovakia | 2010 | Yes | Yes | Yes | Yes |
Slovenia | 2018 | Yes | Yes | Yes | |
Sweden | 2020 | Yes | Yes | Yes | |
Switzerland | 2019 | Yes | Yes | Yes | Yes |
UK | 2019 (Scotland) | Yes | Yes | Yes | Yes |
Score criteria and score allocation
Comment
References
3g – Fracture liaison services
Domain
Background and aims
Methods
Results
Score criteria
Score allocation
Comment
References
3h—Use of quality indicators
Domain
Background and aims
Methods
Results
Country | Quality indicator score (2019) | Quality indicator score (2012) | Systems in place | Targets |
---|---|---|---|---|
Austria | 1 | 1 | No | |
Belgium | 1 | 1 | No | |
Bulgaria | 1 | 2 | No | |
Croatia | 1 | 0 | No | |
Cyprus | 1 | 1 | No | |
Czech Republic | 1 | 1 | No | |
Denmark | 3 | 3 | Yes | Hip fractures |
Estonia | 1 | 1 | No | |
Finland | 3 | 2 | Yes | Hip fractures, other fractures |
France | 1 | 1 | No | |
Germany | 3 | 3 | Yes | Hip fractures, osteoporosis |
Greece | 1 | 2 | No | |
Hungary | 1 | 2 | No | |
Italy | 3 | 1 | Yes | Pharmacological treatment |
Ireland | 3 | 1 | Yes | Hip fractures |
Latvia | 1 | 1 | No | |
Lithuania | 1 | 1 | No | |
Luxembourg | 0 | 1 | - | |
Malta | 1 | 1 | No | |
Netherlands | 3 | 3 | Yes | All fractures |
Poland | 1 | 1 | No | |
Portugal | 1 | 1 | No | |
Romania | 1 | 1 | No | |
Spain | 1 | 1 | No | |
Slovakia | 3 | 2 | Yes | Osteoporosis, fragility fractures, falls |
Slovenia | 3 | 1 | Yes | Hip fractures |
Sweden | 3 | 2 | Yes | Hip fracture, pharmacological treatment |
Switzerland | 1 | 0 | No | |
UK | 3 | 3 | Yes | Hip fractures, osteoporosis, fragility fractures |
Score criteria
Score allocation
Comment
References
Chapter 4: Service uptake
4a—Uptake of DXA
Domain
Background and aims
Methods
Results
Score allocation
Comment
References
4b—Uptake of risk assessment algorithms
Domain
Background and aims
Methods
Results
Country | Sessions/million | Country | Sessions/million | ||
---|---|---|---|---|---|
2011 | 2019 | 2011 | 2019 | ||
Austria | 1,534 | 2,439 | Italy | 518 | 414 |
Belgium | 5,003 | 2,144 | Latvia | 57.7 | 218 |
Bulgaria | 112 | 49 | Lithuania | 28.5 | 131 |
Croatia | - | 629 | Luxembourg | 2,293 | 507 |
Cyprus | 272 | 1,058 | Malta | 16,988 | 1,541 |
Czech Rep. | 175 | 344 | Netherlands | 526 | 609 |
Denmark | 942 | 319 | Poland | 338 | 513 |
Estonia | 207 | 916 | Portugal | 1,039 | 2,662 |
Finland | 444 | 4,343 | Romania | 230 | 463 |
France | 314 | 676 | Slovakia | 372 | 504 |
Germany | 83.5 | 93 | Slovenia | 1,322 | 41,874 |
Greece | 502 | 4,566 | Spain | 1,115 | 1,527 |
Hungary | 1,205 | 2,832 | Sweden | 1,911 | 5,306 |
Ireland | 1,643 | 2,623 | Switzerland | - | 3,702 |
UK | 2,293 | 5,443 |
Score criteria
Score allocation
Comment
References
4c—Treatment uptake and treatment gap
Domain
Background and aims
Methods
Results
Country | Number potentially treated (000) | Number exceeding fracture risk threshold (000) | Difference (000) | Treatment gap (%) |
---|---|---|---|---|
Austria | 157 | 325 | 168 | 52 |
Belgium | 150 | 441 | 291 | 66 |
Bulgaria | 35 | 273 | 239 | 87 |
Croatia | 31 | 169 | 138 | 82 |
Cyprus | - | - | - | - |
Czech Republic | 74 | 360 | 285 | 79 |
Denmark | 125 | 218 | 93 | 43 |
Estonia | 7 | 42 | 35 | 84 |
Finland | 39 | 193 | 154 | 80 |
France | 550 | 2 569 | 2 019 | 79 |
Germany | 761 | 3 238 | 2 477 | 76 |
Greece | 275 | 485 | 211 | 43 |
Hungary | 125 | 361 | 236 | 65 |
Ireland | 104 | 153 | 49 | 32 |
Italy | 834 | 2 889 | 2 055 | 71 |
Latvia | 16 | 74 | 57 | 78 |
Lithuania | 19 | 107 | 88 | 82 |
Luxembourg | 5 | 19 | 14 | 74 |
Malta | - | - | - | - |
Netherlands | 308 | 696 | 388 | 56 |
Poland | 205 | 1 236 | 1 031 | 83 |
Portugal | 118 | 474 | 356 | 75 |
Romania | 130 | 599 | 469 | 78 |
Slovakia | 75 | 165 | 90 | 54 |
Slovenia | 32 | 74 | 42 | 57 |
Spain | 656 | 1 827 | 1 171 | 64 |
Sweden | 128 | 389 | 261 | 67 |
Switzerland | 143 | 827 | 684 | 83 |
UK | 918 | 2 679 | 1 761 | 66 |
EU27+2 | 6 017 | 20 882 | 14 862 | 71 |
Score criteria (1)
Score allocation (1)
Score criteria (2)
Score allocation (2)
Comments
References
4d—Treatment gap and treatment needed
Domain
Background and aims
Methods
Results
Country | Hip fracture | Vertebral fracture | A + B (%) | ||
---|---|---|---|---|---|
Number | % Population (A) | Number | % Population (B) | ||
Austria | 85,557 | 2.3 | 96,403 | 2.6 | 4.9 |
Belgium | 79,976 | 1.8 | 88,082 | 1.9 | 3.7 |
Bulgaria | 33,211 | 1.1 | 41,111 | 1.4 | 2.6 |
Croatia | 26,607 | 1.5 | 31,454 | 1.8 | 3.3 |
Cyprus | 4,593 | 1.2 | 5,598 | 1.5 | 2.6 |
Czech Republic | 57,421 | 1.4 | 70,624 | 1.7 | 3.1 |
Denmark | 55,373 | 2.4 | 65,777 | 2.8 | 5.2 |
Estonia | 5,668 | 1.1 | 6,800 | 1.3 | 2.4 |
Finland | 34,368 | 1.5 | 39,894 | 1.7 | 3.2 |
France | 332,839 | 1.3 | 340,740 | 1.3 | 2.6 |
Germany | 606,853 | 1.6 | 670,385 | 1.8 | 3.4 |
Greece | 79,807 | 1.8 | 88,952 | 2.0 | 3.7 |
Hungary | 53,985 | 1.4 | 66,593 | 1.8 | 3.2 |
Ireland | 21,825 | 1.4 | 27,003 | 1.7 | 3.1 |
Italy | 483,093 | 1.7 | 516,946 | 1.9 | 3.6 |
Latvia | 12,348 | 1.6 | 14,387 | 1.8 | 3.4 |
Lithuania | 16,555 | 1.4 | 19,628 | 1.7 | 3.1 |
Luxembourg | 2,896 | 1.3 | 3,346 | 1.5 | 2.9 |
Malta | 2,200 | 1.2 | 2,714 | 1.5 | 2.8 |
Netherlands | 72,719 | 1.0 | 85,471 | 1.2 | 2.2 |
Poland | 142,035 | 1.0 | 175,697 | 1.2 | 2.2 |
Portugal | 56,832 | 1.3 | 62,486 | 1.4 | 2.7 |
Romania | 101,466 | 1.3 | 124,460 | 1.6 | 3.0 |
Slovakia | 23,636 | 1.2 | 30,212 | 1.5 | 2.7 |
Slovenia | 12,046 | 1.4 | 14,335 | 1.6 | 3.0 |
Spain | 258,560 | 1.3 | 256,549 | 1.3 | 2.7 |
Sweden | 94,818 | 2.4 | 108,202 | 2.8 | 5.2 |
Switzerland | 62,528 | 1.8 | 70,914 | 2.0 | 3.8 |
UK | 400,366 | 1.6 | 430,254 | 1.7 | 3.2 |
EU27+2 | 3,220,181 | 1.5 | 3,555,016 | 1.7 | 3.2 |
Country | Author | Prevalence (%) | EU/ Comparator (%) | |
---|---|---|---|---|
Comparator | EU27+2 | |||
France | Cawston 2012 [241] | 11.2 | 2.6 | 23 |
Germany | Gauthier 2012 [242] | 14.1 | 3.4 | 24 |
Italy | Piscitelli 2012 [243] | 16.2 | 3.6 | 22 |
Spain | Gauthier 2012 [244] | 8.9 | 2.7 | 30 |
Sweden | Gauthier 2011 [240] | 22.6 | 5.2 | 23 |
UK | Gauthier 2011[245] | 10.3 | 3.2 | 31 |
Average (weighted) | 26 |
Score allocation
Comment
References
4e – Waiting time for hip surgery
Domain
Background and aims
Methods
Results
Country | Waiting time (days) 2010 | Waiting time (days) 2019 | Score 2019 | Surgical management (%) 2019 |
---|---|---|---|---|
Austria | 1-2 | <1 | 3 | >90 |
Belgium | <1 | 1-2 | 2 | >90 |
Bulgaria | 1-2 | <1 | 3 | 75-90 |
Croatia | nr | <1 | 3 | >90 |
Cyprus | 2-3 | 2-3 | 1 | 75-90 |
Czech Republic | 1-2 | 1-2 | 2 | 67.2 |
Denmark | 1-2 | 1-2 | 2 | >90 |
Estonia | <1 | nr | nr | nr |
Finland | 1-2 | 1-2 | 2 | >90 |
France | 1-2 | 1-2 | 2 | >90 |
Germany | <1 | <1 | 3 | >90 |
Greece | 2-3 | 2-3 | 1 | >90 |
Hungary | <1 | <1 | 3 | 75-90 |
Ireland | 2-3 | 1-2 | 2 | >90 |
Italy | 2-3 | 2-3 | 1 | >90 |
Latvia | <1 | <1 | 3 | >90 |
Lithuania | <1 | <1 | 3 | >90 |
Luxembourg | 1-2 | nr | nr | nr |
Malta | nr | 1-2 | nr | nr |
Netherlands | 1-2 | <1 | 3 | >90 |
Poland | 1-2 | <1 | 3 | >90 |
Portugal | 2-3 | >3 | 1 | >90 |
Romania | 1-2 | <1 | 3 | nr |
Slovakia | 1-2 | 1-2 | 2 | >90 |
Slovenia | 1-2 | 1-2 | 2 | >90 |
Spain | 2-3 | >3 | 1 | 75-90 |
Sweden | <1 | <1 | 3 | >90 |
Switzerland | N/A | 1-2 | 2 | >90 |
UK | 1-2 | 1-2 | 2 | >90 |
Score criteria
Comment
References
Chapter 5: Scores and scorecard
The scorecard
Domain Summaries
Time trends
Country | Score 2019 | Score 2010 | 2019–2010 | Incomplete data | Category |
---|---|---|---|---|---|
Slovakia | 35 | 26 | 9 | Marked improvement | |
Ireland | 37 | 29 | 8 | ||
Italy | 37 | 31 | 6 | ||
Lithuania | 31 | 25 | 6 | ||
France | 35 | 30 | 5 | Much improved | |
Germany | 37 | 32 | 5 | ||
Poland | 27 | 22 | 5 | ||
Romania | 30 | 25 | 5 | ||
Finland | 39 | 35 | 4 | ||
Malta | 23 | 19 | 4 | √ | |
Spain | 32 | 28 | 4 | ||
Cyprus | 24 | 21 | 3 | √ | Improved |
Bulgaria | 25 | 23 | 2 | √ | |
Denmark | 33 | 31 | 2 | ||
Austria | 37 | 35 | 1 | ||
Netherlands | 38 | 37 | 1 | Unchanged or marginal change | |
Portugal | 34 | 33 | 1 | ||
Estonia | 24 | 24 | 0 | √ | |
Greece | 29 | 29 | 0 | ||
UK | 38 | 38 | 0 | ||
Hungary | 32 | 33 | -1 | ||
Latvia | 28 | 29 | -1 | √ | |
Sweden | 38 | 39 | -1 | ||
Czech Republic | 23 | 25 | -2 | Worse score | |
Slovenia | 30 | 32 | -2 | ||
Belgium | 28 | 33 | -5 |