Closing the gap in osteoporosis: It’s make or break for post-fracture care

We can’t escape the facts. Around the world, the treatment gap in osteoporosis continues to be as pervasive as it is affecting; in an international survey last year, the International Osteoporosis Foundation (IOF) revealed that almost one in two women after the age of 50 and over experienced a fracture. Paradoxically, bone health – and the chance to identify and treat the underlying osteoporosis – was neglected during medical check-ups. The ramifications of this missed opportunity are huge.

Why does this matter? The impact on daily life for women with osteoporosis should not be underestimated, with fractures marked by excruciating pain, immobilization, and prolonged hospitalization, robbing them of their independence. This can have a significant impact on their well-being, leaving women feeling anxious and isolated. The lack of appropriate intervention at this crucial trigger point of the patient journey places a staggering burden on healthcare systems, with the cost of fractures in the EU anticipated to hit 77 billion EUR by 2050.  

In the past year, we have made great progress in elevating secondary fracture prevention on government agendas – for example, the success in Japan following its reimbursement scheme for Fracture Liaison Services (FLSs) and last year’s announcement of a government-funded osteoporosis knowledge center in Stockholm, Sweden – however, global efforts to tackle the treatment gap fall short of what is truly necessary. And, with the global population aging at a phenomenal rate, it is rapidly becoming a challenge we can no longer afford to ignore.

Closing the gaps in osteoporosis

As global leaders of the bone health community gather in London this week for the World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases, we have a unique opportunity to confront some of the barriers that prevent us from the delivery of optimal patient care:

Knowledge gap: IOF’s survey highlighted a disconnect between the occurrence of fractures amongst women at high-risk of osteoporosis and the decision by healthcare professionals to perform a diagnostic scan. And, as described by Kassim Javaid in the latest episode of the UCB podcast, Fragility Fractures in Focus, the lack of a recognized ‘bone specialism’ has resulted in a lack of clarity around which practitioners ‘own’ this area of medicine, and consequently, how it should be delivered effectively. How can we therefore equip ALL healthcare practitioners with the knowledge and the tools they need to ensure everyone with osteoporosis receives appropriate investigation and intervention after experiencing a fracture?

Fragmented pathways: In most healthcare systems, patients who experience a fracture are often faced with disjointed pathways that are unable to deliver the necessary assessment for osteoporosis, once again, leading to missed opportunities for timely diagnosis, initiation of appropriate treatments and implementation of preventive measures to reduce the risk of subsequent fractures.

Patient education and empowerment: Empowering patients with accurate information, clear guidance in treatment regimens and supporting resources can enable them to make informed decisions and take an active role in their care by having effective conversations with their doctors.

Post-fracture care – make or break?

Fortunately, a means to bridge these gaps already exists. Coordinated, multidisciplinary services such as FLSs enable rapid referral, facilitate early intervention and improve secondary fracture prevention. These services provide a seamless pathway post-fracture by systematically identifying patients, assessing their fall and fracture risk, and carefully evaluating the most effective intervention, placing the individual’s needs at the center of care. FLSs have been shown to be both clinically and cost-effective , and are described as the single most important step in directly improving patient care and reducing spiraling fracture-related healthcare costs worldwide.

But having a solution is only half the challenge. Global implementation of coordinated post-fracture services is dependent on the close collaboration between policymakers, payers, healthcare professionals and the pharmaceutical industry, and a unified commitment to elevate secondary fracture prevention as a healthcare priority.

We are proud to work closely with partners such as the Fragility Fracture Network and IOF, which look to make this vision a reality – IOF’s Capture the Fracture® program recently celebrated a tremendous milestone of 900 registered FLSs worldwide, doubling the number of services since 2019.  To support those looking to start a new FLS or improve the performance of an existing service, we and our partners at Amgen established the FLS Academy and Network (FAN), an educational program led by a Scientific Steering Committee of international experts. FAN offers healthcare professionals practical resources, expert guidance and access to knowledge-sharing events designed to help overcome the challenges faced by those on the ground.

The evidence is in front of us – we already have the tools at our disposal to close the treatment gap in osteoporosis. Through a multidisciplinary approach and the prioritization of secondary fracture prevention on a national, regional, and global level, we can create a world free of fragility fractures.

To hear more on how we can close the treatment gap in osteoporosis, listen to the latest episode of Fragility in Fractures Focus here https://open.spotify.com/episode/7DZrvyPpQfQktd3OVFZj5y?si=2dee74488a4849b7.