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

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

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.

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

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.

Date of preparation: October 2020.

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