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IOF International Survey

In 1998 and 1999 IOF carried out a survey among its member societies to evaluate international awareness of osteoporosis and availability of diagnostic tools and therapy.

Nineteen countries, mostly from Europe but including Lebanon, China and Argentina, took part. Using a standardized questionnaire, societies were asked to detail their national experience of fracture rate, proportion of osteoporosis patients receiving regular treatment, awareness of osteoporosis in the general population and among physicians, treatments available, and the availability and reimbursement of bone densitometry and X-ray for vertebral fractures.

The results were presented at the meeting of the Committee of National Societies in Brussels on November 19th 1999 – and are a cause for concern. See detailed survey results (PDF, 135 KB; Acrobat Reader required)

  • Overall awareness of osteoporosis in the general population is low in most countries. Even more worrying is the low awareness among physicians, reported by 12 out of 16 European countries. Awareness seems to be unrelated to a country's economic condition – a high level of awareness is reported by Portugal and Lebanon, a low level by Belgium and Germany.
     
  • Regular treatment of patients is still the exception throughout Europe. In most countries the proportion of osteoporosis patients receiving pharmaceutical treatment is under 20%. This might be expected of countries with low awareness of osteoporosis, but sadly it seems to be equally true of countries claiming a high awareness among physicians and the general public, such as Norway, the UK and Holland.
     
  • It is a particular scandal that in the overwhelming majority of countries surveyed, patients who have had a hip fracture are not provided with pharmaceutical treatment during follow up – even though this is known to minimize the risk of new fractures. Exceptions here are Lebanon and (in some cases) Germany.
     
  • HRT in osteoporosis prevention is accepted by physicians in 9 out of 16 countries, but in most countries the women themselves are more negative towards it. Substantially more women accept the role of calcium and of exercise in preventing osteoporosis, while the importance of vitamin D remains disputed by physicians in 8 out of 16 countries surveyed.
     
  • Although bone mass measurement is available in all 16 European countries surveyed and is in routine use in 13 of them, 7 of these offer no or only restricted reimbursement for bone densitometry. In addition the number of densitometers varies enormously, from less than 1 per million population (China, Lithuania) to more than 10 (e.g. Belgium, Germany, Portugal); Lebanon is again exceptional with as much as 25 machines per million. Documentation of vertebral fractures by X-ray is performed occasionally in most countries, but Slovenia is the only country where it is done on a regular basis.

The conclusions are clear:

  • Awareness of osteoporosis is still unacceptably low, as is the proportion of patients who receive appropriate treatment.
     
  • Although diagnostic tools are widely available, countries still experience problems in their use.
     
  • Programs that will effectively increase osteoporosis awareness, appropriate use of diagnostic tools and availability of therapy, are urgently needed.
     
  • Our actions so far, although valuable, have been of limited success. Some changes are needed to achieve our goals more effectively.

Proportion of patients with osteoporosis receiving pharmaceutical treatment

Fig 1: Proportion of patients with osteoporosis receiving pharmaceutical treatment

Awareness among public and physicians

Fig 2: Awareness among public and physicians

Number of DXA bone mass densitometers per million

Fig 3: Number of DXA bone mass densitometers per million.

We invite IOF Members societies that did not participate in the survey to do so. Please see IOF Members Only for further information.

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