Top 10 solutions to reduce the global burden of fragility fractures

policy landscape assessment

On the occasion of World Osteoporosis Day, the International Osteoporosis Foundation (IOF) urges healthcare authorities to take action to prevent fragility fractures and outlines 10 key solutions as identified by osteoporosis experts.

National healthcare landscapes vary worldwide, but most share one common failing: osteoporosis and fracture prevention are under-prioritized within the healthcare system. 

Osteoporosis is a progressive, chronic disease that causes bones to become weak and fragile, resulting in a high risk of broken bones, known as ‘fragility fractures’. In people with osteoporosis, a bone can break following a minor fall from standing height, a bump or even a sneeze. Globally, approximately one in three women and one in five men aged over fifty will sustain an osteoporosis-related fracture – often at the spine, wrist or hip. 

Fragility fractures lead to costly surgeries, hospitalization, and rehabilitation and in many cases, place a heavy burden on family caregivers or result in the need for long-term nursing home care. For the patient, there is an enormous impact on quality of life, mobility, and independence, and an increased risk of death: approximately 24% of hip fracture patients die within the year following their fracture. In Europe alone, more than 4.3 million fragility fractures occurred in 2019, at a cost of close to €57 billion.

Dr Philippe Halbout, CEO of the International Osteoporosis Foundation (IOF) stated: 

“As populations age worldwide, we can expect a surge in the numbers of fragility fractures. By 2050, the global incidence of hip fracture is projected to increase by 310% in men and by 240% in women, compared to rates in 1990. For this reason, osteoporosis and fracture prevention must be urgently prioritized within healthcare systems.” 

Without treatment for osteoporosis, patients who have already suffered a fracture are at substantial risk of sustaining additional fractures within the next one to two years. In fact, up to half of the patients who present to hospital with a hip fracture have broken another bone in the months or years before breaking their hip.

Professor Maria Luisa Brandi, Chair of the IOF Capture the Fracture® programme, also noted:

“It is critically important that all patients who have had a prior fracture receive timely intervention and treatment for osteoporosis to prevent further fractures. Unfortunately, the vast majority of people who have experienced a first fracture are not evaluated for osteoporosis. Indeed, studies have shown that approximately 80% of fracture patients worldwide are neither assessed nor treated for osteoporosis, the underlying disease. This is despite the availability of safe and effective medications, and clear medical management guidance that calls for treatment and follow-up.”

IOF experts in collaboration with national osteoporosis experts have identified many key actions that healthcare systems can take to help prevent fragility fractures in the population. These have been outlined in recent IOF publications including Capture the Fracture® policy reports and audits, the major report Capture the Fracture Partnership Guidance for Policy Shaping and the landmark SCOPE: Scorecard for Osteoporosis in Europe Summary Report. Although each country has its own specific healthcare landscape, priorities and challenges, there are a number of universally important components of any effective strategy to address the fragility fracture crisis.

Top 10’ policy actions include: 

  1. Mandate osteoporosis as a National Health Priority with the implementation of a national and/or regional action plan.
  2. Widely implement Fracture Liaison Services for the routine assessment, management and follow-up of all individuals who have sustained a low trauma fracture.
  3. Ensure high-quality information about the burden of disease through a national fracture registry, which includes hip and clinical vertebral fractures.
  4. Provide reimbursement for approved treatments to ensure accessibility for all those at high risk of fractures.
  5. Ensure accurate identification of patients at risk of fracture through accessibility and adequate provision of DXA services and emerging technologies, as well as FRAX.
  6. Develop and disseminate high-quality management guidelines for osteoporosis, including guidance on the use of risk assessment tools, and ensure that they are widely used in clinical practice. 
  7. Reduce waiting time for surgery after hip fracture, as this has been associated with a significant reduction in mortality and better patient outcomes.
  8. Provide high-quality training in osteoporosis, including for primary care of osteoporosis patients, and ensure that osteoporosis is a recognized and established component of specialty training.
  9. Support strong and effective patient organizations that can advocate on behalf of patients, work to raise public awareness, and collaborate closely with medical and research associations.
  10. Implement systems to measure and audit the quality of care provided to people with osteoporosis and associated fractures.

IOF President Professor Cyrus Cooper stated: 

“Against the backdrop of World Osteoporosis Day, I strongly urge all health authorities to make osteoporosis and fracture prevention a healthcare priority. We must address this paradox: an explosion of fragility fractures as populations age, versus an unacceptable osteoporosis treatment gap that leads to immense human and socioeconomic costs. Furthermore, although the implementation of post-fracture care programmes such as fracture liaison services is growing, we simply must increase the provision of these essential services which are still rare in most countries. 

“Given the projected increase in fracture burden, we absolutely must do better. The 10 key actions we have identified can help save lives, reduce costs and improve the quality of life of older adults in countries around the world.” 

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About Osteoporosis
Osteoporosis is a condition where bones become thin and lose their strength as they become less dense and their quality is reduced. This leads to a high risk of broken bones or ‘fragility fractures’ which occur after a minor slip from standing height or simply as a result of a bump or sudden movement. Osteoporosis is often called a “silent” disease because there are no apparent symptoms, until a bone breaks. 
•    Osteoporosis is the major cause of fractures in postmenopausal women and in older men. Osteoporosis-related fractures happen most often in bones of the hip, vertebrae in the spine, and wrist. 
•    Many effective drugs have been approved for the treatment of osteoporosis worldwide. These medications are most often used in conjunction with calcium and vitamin D supplements, as well as with recommended lifestyle changes, adequate nutrition, and targeted exercise.
•    Using the WHO definition of osteoporosis, the disease affects approximately 21.2% of women and 6.3% of men over the age of 50 and over the same age range globally. Based on the world population, this suggests that approximately 500 million women and men may be affected globally. 

More information, as well as facts and statistics about osteoporosis, are available on the IOF website.

About IOF

The International Osteoporosis Foundation (IOF) is the world's largest nongovernmental organization dedicated to the prevention, diagnosis, and treatment of osteoporosis and related musculoskeletal diseases. IOF members, including committees of scientific researchers as well as 325 patient, medical and research organizations, work together to make fracture prevention and healthy mobility a worldwide healthcare priority. www.osteoporosis.foundation @iofbonehealth

World Osteoporosis Day is marked on October 20th each year: www.worldosteoporosisday.org 

About Capture the Fracture®

Capture the Fracture® (CTF) is a multi-stakeholder initiative, led by the International Osteoporosis Foundation, to facilitate the implementation of Post-Fracture Care (PFC) Coordination Programs, such as Fracture Liaison Services (FLS), for secondary fracture prevention. The CTF initiative aims to drive changes at local and regional levels to prioritize secondary fracture prevention. It sets global best practice standards and offers recognition for Fracture Liaison Services (FLS) through its Best Practice Framework. CTF also provides essential resources and documentation to build the case for prioritization of secondary fracture prevention and to help drive the implementation and quality improvement of FLS. Mentorship programs that support the development of FLS at the local level are also offered. Currently, the CTF network includes more than 875 FLS in 55 countries worldwide. FLS are invited to apply for free assessment and recognition via the CTF website’s online Best Practice Framework Questionnaire platform. www.capturethefracture.org    #CaptureTheFracture