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Why Are So Few Women With Fractures Diagnosed And Treated In Europe?

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

Olof Johnell, MD, PhD, Professor of Medicine, Department of Orthopaedics, Malmö General Hospital, Malmö, Sweden

Approximately 400,000 women in the European Union suffer osteoporosis-related hip fractures each year, and that number is expected to reach one million women annually by the year 2050. The disease is fast becoming a major public health problem in Europe, yet women who are eligible for treatment are not being treated.

In fact, less than 20% of eligible women – including women with prior fractures who are at the highest risk – are not being diagnosed and treated. This is extremely disturbing in light of the many worldwide studies showing that osteoporosis can result in disability, reduced quality of life and increased healthcare resource utilization.

As multiple fractures occur, women with osteoporosis suffer an increasing degree of painful disability which can dramatically affect daily activities. For example, back pain associated with vertebral fractures include acute deep bone pain from the injury itself, worsening of existing chronic back pain from such causes as spinal stenosis (narrowing) and osteoarthritis, and in those with multiple severe fractures, chronic back pain from kyphosis (curvature), soft tissue strain. We also know that, left untreated, osteoporosis-related fractures can be fatal; as high as 20% of women with multiple fractures are at risk of dying within one year.

This is a perplexing dilemma, given that well-designed multi-center clinical trials in tens of thousands of women have demonstrated conclusively that pharmaceutical therapies such as alendronate effectively reduce the risk of osteoporotic fractures substantially. Drugs such as alendronate and raloxifene have been shown to reduce the risk of a first osteoporotic fracture and alendronate, raloxifene and risedronate have been proven to reduce the risk of fracture in women with existing fractures.

"For example, findings from the landmark Fracture Intervention Trial (FIT) showed that, in women with osteoporosis and with low BMD, alendronate reduced the risk of hip fractures by 63% in only 18 months and the risk of symptomatic spinal fractures by 59% in only one year, and further, reduced the risk of multiple spinal fractures by 90% over three years."

One study conducted in 34 countries demonstrated that alendronate increased bone density as early as three months and reduced the risk of non-spinal fractures by nearly half after just one year in postmenopausal women with low bone mass.

In addition, consistent treatment can have a substantial and positive impact on national healthcare resources. One randomized study of alendronate in women with low bone mass and prior fracture has shown the fracture-related health care resource utilization can be reduced by approximately 25%.

For these clinically proven therapies, relatively few women have to be treated to prevent one of them from suffering a fracture, and, when targeted for osteoporotic women – with either low bone mineral density or low bone mineral density plus prior fracture – intervention can be very cost-effective. Reducing the risk of hip, spine and other fractures leads to decreased medical costs, such as hospital emergency treatment, surgery, orthopaedic services, nursing and rehabilitation.

Because of their clinical and economic value, ideally these treatments should be made readily available and actively promoted by European health agencies. Unfortunately, the reality is far from the ideal, and many otherwise preventable fractures are occurring every day in Europe. Osteoporosis is a disease that we cannot afford to neglect any longer.

Also see slide presentation (PDF, 84 KB)

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