What are osteoporosis and fragility fractures and what impact do they have on people’s lives?

Osteoporosis is a chronic disease which weakens bones, leaving people at risk of fragility fractures.1 Fragility fractures occur from light stresses and impacts that would not ordinarily cause breaks in healthy bones.2 While bones do weaken as we age, osteoporosis is not inevitable. Factors such as weight gain/loss, certain medications and menopause can exacerbate this natural process.3

Fragility fractures can be life-changing events with the potential to bring pain, isolation and dependence.4 The decline in quality of life following a fragility fracture may impact not only the person who has experienced the fracture,4 but also their family and other informal carers.5 The carers may find themselves needing to cut down their working hours or leave paid employment as they prioritise their care responsibilities.5-7

Having a fracture can change your life completely. People often feel they are no longer the masters of their own lives and can’t look after themselves independently. Normal, everyday activities can become very difficult and painful. In addition, you may suddenly face high costs and you cannot go to work.

ANSA HOLM, FINNISH OSTEOPOROSIS ASSOCIATION

We already know how to manage osteoporosis and prevent many fragility fractures from occurring, but people often lack access to this critical care. Even after a fracture, 60–85% of women in Europe do not receive treatment for osteoporosis, which is often the underlying cause of the fracture.6

Although women are more likely to develop osteoporosis than men, gender bias in healthcare could impede diagnosis and effective treatment of people with osteoporosis or at risk of fragility fractures. Women are often disadvantaged due to disparities in provision of care. For example, men are more likely than women to be referred to certain specialists8 and women are more often diagnosed with medically unexplained pain than men, potentially preventing appropriate diagnoses and leading to poor perceptions of healthcare.9

Osteoporosis mostly affects older women. It is an invisible disease among an invisible group. We must give it a face and demand that policymakers stop ignoring it.

PENILLA GUNTHER, FORMER MP, SWEDEN

The perception that osteoporosis affects only women, however, means men are less often screened and treated for osteoporosis following a fracture, and less evidence exists for their diagnosis and therapy.10 Ultimately, if healthcare professionals and the public keep underestimating the risk of osteoporosis in women, it is likely to be even less recognised among men.

Let’s be upfront about this: osteoporosis isn’t headline-grabbing, and because of that it gets relegated. The reality of its impact on people’s lives – mainly on older women, but older men too – is not recognised.

MARIAN HARKIN, FORMER MEP, IRELAND

The cost of inaction: the economic case for change

Osteoporosis affects an alarming number of people in the EU, including 21% of women and 6% of men aged 50–84.1 In 2010, it was estimated that there were 3.5 million new fragility fractures in the EU – nearly 10,000 each day.1 These are associated with increased risk of disability and death, and more frequent hospital admissions.11 Hip fractures have been found to at least double the risk of death for both men and women.12 13 In 2010, 43,000 deaths in the EU were causally related to fractures.14

Over the coming years, the proportion of the retired population will dramatically increase in the whole of Europe. It is imperative that we maintain the mobility and independence of older people.

PAUL MITCHELL, FRAGILITY FRACTURE NETWORK

Fragility fractures cost EU health systems an estimated €37.4 billion in 2010, equivalent to 3% of all healthcare spending.1 As the EU has one of the most rapidly ageing populations in the world,15 health expenditures will only continue to rise.16 In this context, the number of people living with osteoporosis in the EU is expected to increase by almost a quarter, from 27.5 million in 2010 to 33.9 million in 2025.1 Consequently, the number of fragility fractures in the EU per year is also expected to rise, from around 3.5 million in 2010 to nearly 4.5 million by 2025.1 We must promote health ageing to reverse these trends and avoid this catastrophic personal and societal burden.

References +
  1. Hernlund E, Svedbom A, Ivergard M, et al. 2013. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8: 136
  2. National Institute for Health and Care Excellence. 2017. Osteoporosis: assessing the risk of fragility fracture. London: NICE
  3. Hannan MT, Felson DT, Dawson-Hughes B, et al. 2000. Risk Factors for Longitudinal Bone Loss in Elderly Men and Women: The Framingham Osteoporosis Study. J Bone Miner Res 15(4): 710-20
  4. Salkeld G, Cameron ID, Cumming RG, et al. 2000. Quality of life related to fear of falling and hip fracture in older women: a time trade off study. BMJ 320(7231): 341-6
  5. Information from the experience of Nadia Kamel. Printed with permission.
  6. International Osteoporosis Foundation. 2018. Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe. Nyon: IOF
  7. Strom O, Borgstrom F, Kanis JA, et al. 2011. Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 6: 59-155
  8. Clerc Liaudat C, Vaucher P, De Francesco T, et al. 2018. Sex/gender bias in the management of chest pain in ambulatory care. Women’s Health 14: 1745506518805641
  9. Claréus B, Renström EA. 2019. Physicians’ gender bias in the diagnostic assessment of medically unexplained symptoms and its effect on patient–physician relations. Scand J Psychol 60(4): 338-47
  10. Alswat KA. 2017. Gender Disparities in Osteoporosis. J Clin Med Res 9(5): 382-87
  11. Lems WF, Raterman HG. 2017. Critical issues and current challenges in osteoporosis and fracture prevention. An overview of unmet needs. Ther Adv Musculoskel Dis 9(12): 299-316
  12. Haentjens P, Magaziner J, Colon-Emeric CS, et al. 2010. Meta-analysis: excess mortality after hip fracture among older women and men. Annals of Internal Medicine 152(6): 380-90
  13. Katsoulis M, Benetou V, Karapetyan T, et al. 2017. Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project. J Intern Med 281(3): 300-10
  14. Kanis JA, Borgstrom F, Compston J, et al. 2013. SCOPE: a scorecard for osteoporosis in Europe. Arch Osteoporos 8: 144
  15. Eurostat. 2017. People in the EU: Statistics on demographic changes. Brussels: European Commission
  16. Nerlich C, Schroth J. 2018. The economic impact of population ageing and pension reforms. ECB Econ Bulletin 2: 85-109