Osteoporosis is a process that develops gradually over many years as we age. With the first of the baby boomer generation now entering their
eighties, the next decade will see a significant increase in the number
of people living with osteoporosis and experiencing the often
devastating outcome of fragility fractures.
A newly published narrative review in 'Osteoporosis International
considers the key global challenges facing healthcare professionals and
policymakers responsible for providing care to populations in relation
to bone health and fracture prevention.
‘Key challenges which hinder efforts to improve bone health and provide optimal prevention of osteoporosis and fragility fractures, a major cause of morbidity and mortality worldwide, have been reviewed by a new study.’
Referencing key studies, guidelines and audits, the review provides
evidence of the chief care gaps, and outlines the solutions which will
need to be implemented in order to address the growing burden of
fragility fractures in the world's population.
The authors identify four distinct themes which encompass challenges
related to: (1) case finding and management of individuals at high risk
of fracture; (2) public awareness of osteoporosis and fragility
fractures; (3) reimbursement and health system policy; and (4)
epidemiology of fracture in the developing world.
Co-author Professor Eugene McCloskey, Director of the MRC ARUK
Center for Integrated Research in Musculoskeletal Ageing, Metabolic Bone
Center, Northern General Hospital, Sheffield, UK., stated, "This review
identifies, among other challenges, the current gaps in delivery of
best clinical practice, low levels of public awareness, and insufficient
access and funding for diagnosis and treatment. Sadly, these gaps are a
clear reflection of the low priority currently given to bone health and
fracture prevention in healthcare policy."
Several of the main challenges and solutions identified are:
- An urgent need for increased implementation of
systematic approaches to prevent secondary fractures. Strategies and
models of care such as Fracture Liaison Services, which improve the
identification and treatment of individuals who have already sustained a
first fragility fracture, are shown to be highly effective;
- More attention needs to be given to the
identification and management of patients who are undergoing treatment
with medicines which negatively affect bone health, and improved
management of bone health in people who have diseases where bone loss
and related fragility fractures are a common comorbidity;
- In terms of public awareness, there is a need for
greater awareness of the life-changing and life-threatening impact of
fractures due to osteoporosis. Given the extremely high rates of
non-adherence to medication, it is essential that more support be given
to patients and their doctors to have meaningful discussions concerning
the risk-benefit ratio of osteoporosis treatment;
- In contrast with other comparable chronic diseases,
osteoporosis has often not attracted an appropriate level of attention
from health providers. Access to, and reimbursement of, diagnostic
testing and treatment remain a major challenge in many countries of the
- In many parts of the developing world, robust
epidemiological data to quantify fracture incidence is still needed.
This will be a critical step towards developing fracture prevention
policies for regions such as Asia and Latin America, which have rapidly
Professor Cyrus Cooper, Chair of the International Osteoporosis
Foundation (IOF) Committee of Scientific Advisors, stated: "We cannot
afford to ignore the current and growing burden that osteoporosis and
fragility fractures impose upon societies around the world. As we now
have the knowledge and tools needed to manage bone health optimally, I
urge healthcare professionals, stakeholder organizations, and healthcare
authorities to make a concerted effort to implement these tools.
Prioritization of fragility fracture prevention must become a reality
The review "Mind the (treatment) gap: a global perspective on
current and future strategies for prevention of fragility fractures" is
an updated, referenced synopsis of the IOF illustrated report "Gaps and
Solutions in Bone Health - A Global Framework for Improvement" which was
published in nine languages on the occasion of World Osteoporosis Day.