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Differences In Osteoporosis Diagnosis And Treatment In Europe

Results of the IOF Survey

A symposium in conjunction with the 2nd International Meeting on Social and Economic Aspects of Osteoporosis and Bone Disease, Liège, Belgium, 7 December 2000

by Mary Anderson, International Osteoporosis Foundation

Despite the fact that osteoporosis affects many millions of women around the world, very few women are diagnosed and treated. An 11-country survey *, conducted by the International Osteoporosis Foundation (IOF), revealed that despite the vast progress made in osteoporosis research and education over the last decade, bone loss is still not being detected early enough to protect postmenopausal women from osteoporosis-related fractures.

In the European Union alone, at least 400,000 women suffer osteoporosis-related hip fractures each year, and that number is expected to reach 1 million women by the year 2050. The annual combined medical costs of treating 2.3 million osteoporotic fractures in both Europe and the United States is currently US$27 billion, and the disease is fast becoming a public health problem around the world.

Even though substantial progress has been made in terms of identifying risk factors, bringing new technologies to market to aid diagnosis, and developing medicines that fight osteoporosis, this survey clearly illustrates that current patient-doctor communication about osteoporosis prevention and treatment is inadequate and falls short of its goal. Although nearly 100% of doctors and women recognize that osteoporosis is a serious health threat, women appear to be leaving the doctor's office with a limited understanding of their personal risk, and as a result, are doing very little to protect their bones. Much work remains to be done by women and doctors alike.

Ironically, this common and potentially devastating disease is not taken seriously enough, even in countries where awareness is high. Although one in three postmenopausal women will be affected by osteoporosis during her lifetime, a surprising 85% do not believe they are personally at risk of developing the disease. Furthermore, while 65% of doctors reported that they routinely conduct health status reviews among their postmenopausal patients, only 20% of women recalled being tested for osteoporosis.

Among women suffering from osteoporosis, 80% admitted they were not aware of their risk factors prior to diagnosis and, disturbingly, a third of these women reported that they are not currently taking medication to prevent fractures related to the disease. When asked how the disease affected them, 81% said that osteoporosis has had a negative impact on their quality of life, causing pain and loss of mobility.

In addition, medication to prevent fractures is not being offered to women early enough, according to the survey. Doctors overwhelmingly (96%) acknowledged that osteoporosis is a serious condition that merits discussion and attention with their postmenopausal patients, with 97% stating that prevention of the first fracture was their management goal. Despite this, only 2% of women who talked about osteoporosis with their doctors recalled discussing prescription medications with their physician. The survey shows that, unfortunately, doctors often test for osteoporosis or prescribe medication only after evidence that a fracture exists. For example 80% of physicians responded that one of the strongest indicators of an ideal candidate for an osteoporosis medication is a woman who has already suffered a vertebral fracture.

Doctors identified several obstacles to effective diagnosis and prevention, including inadequate levels of access to bone mineral density testing (75%) and lack of funding for bone densitometry equipment and facilities (85%). In addition, 60% of physicians believe that postmenopausal women do not consult them early enough, and 61% of physicians say some of their patients have refused preventive and treatment medications because of concerns about the long-term safety of medication.

We also learned from the survey that a gap exists between women's and doctors' perceptions about osteoporosis medication. Physicians estimate that they prescribe preventive or treatment medications to more than 80% of postmenopausal patients, but 63% of the women surveyed said that they were not taking any medication to prevent or treat osteoporosis.

This is extremely unfortunate, because we have the means of diagnosis and treatment available and the benefits of taking osteoporosis medication outweigh the risks for most women. This highly disturbing report challenges women, their healthcare providers and government health authorities to make the identification and treatment of bone loss a top priority.

The International Osteoporosis Foundation is using this evidence in our continuing campaign to:

  • Create a greater sense of urgency among women to learn about their own risk of osteoporosis.
  • Challenge current medical attitudes and prescribing habits in osteoporosis.
  • Lobby governments for policy change on access and reimbursement for appropriate early prevention strategies and medication.

It is only by ensuring that doctors, women, and public health policy makers give the highest priority to the prevention, diagnosis and treatment of osteoporosis that we can hope to achieve our vision – a world without osteoporotic fractures.

Also see slide presentation (PDF, 86 KB)

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