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Open Access 01-12-2013 | Position Paper

SCOPE: a scorecard for osteoporosis in Europe

Authors: J. A. Kanis, F. Borgström, J. Compston, K. Dreinhöfer, E. Nolte, L. Jonsson, W. F. Lems, E. V. McCloskey, R. Rizzoli, J. Stenmark

Published in: Archives of Osteoporosis | Issue 1-2/2013

Abstract

Summary

The scorecard summarises key indicators of the burden of osteoporosis and its management in each of the member states of the European Union. The resulting scorecard elements were then assembled on a single sheet to provide a unique overview of osteoporosis in Europe.

Introduction

The scorecard for osteoporosis in Europe (SCOPE) is an independent project that seeks to raise awareness of osteoporosis care in Europe. The aim of this project was to develop a scorecard and background documents to draw attention to gaps and inequalities in the provision of primary and secondary prevention of fractures due to osteoporosis.

Methods

The SCOPE panel reviewed the information available on osteoporosis and the resulting fractures for each of the 27 countries of the European Union (EU27). The information researched covered four domains: background information (e.g. the burden of osteoporosis and fractures), policy framework, service provision and service uptake e.g. the proportion of men and women at high risk that do not receive treatment (the treatment gap).

Results

There was a marked difference in fracture risk among the EU27. Of concern was the marked heterogeneity in the policy framework, service provision and service uptake for osteoporotic fracture that bore little relation to the fracture burden. For example, despite the wide availability of treatments to prevent fractures, in the majority of the EU27, only a minority of patients at high risk receive treatment for osteoporosis even after their first fracture. The elements of each domain in each country were scored and coded using a traffic light system (red, orange, green) and used to synthesise a scorecard. The resulting scorecard elements were then assembled on a single sheet to provide a unique overview of osteoporosis in Europe.

Conclusions

The scorecard will enable healthcare professionals and policy makers to assess their country’s general approach to the disease and provide indicators to inform future provision of healthcare.

BMD

Bone mineral density, usually measured as the amount of calcium in bone per unit area.

BMI

Body mass index, an index of leanness or obesity measured from height and weight

Confidence interval

CRF

Clinical risk factor, in this context for fracture

DALY

Disability-adjusted life year, a product of years of life lost and the remaining years of life disabled (i.e., disutility).

DDD

Defined daily dosage

Direct costs

Used in health technology assessment to describe direct healthcare costs (e.g., hospital admissions, medical examinations, drug therapy, etc.), the indirect costs (e.g., losses in productivity resulting from absence to work) and intangible costs (e.g. pain and suffering, poor quality of life).

DXA

Dual-energy X-ray absorptiometry, a method for measuring BMD

EFPIA

European Federation of Pharmaceutical Industries Association

EU27

The 27 member states of the European Union

FRAX

Fracture risk assessment tool developed by the WHO Collaborating Centre, University of Sheffield Medical School, UK. FRAX calculates the 10-year probability of a major osteoporotic fracture and hip fracture in individuals from clinical risk factors and BMD

GDP

Gross domestic product, the total value of goods produced and services provided in a country in 1 year

GLOW

Global Longitudinal Study of Osteoporosis in Women

ICD

International classification of diseases

IMS

Intercontinental Marketing Services

Incidence

The frequency of an event, usually expressed as a rate e.g. 10 per 1000 of the population/year.

IOF

International Osteoporosis Foundation

Milligram

MPR

Medication possession ratio

NHANES

National Health and Nutrition Examination Survey

NICE

National Institute of Health and Clinical Excellence

NOGG

National Osteoporosis Guideline Group

Prevalence

The number of cases of disease (e.g. osteoporosis) for a given area or at a given time

Probability

The likelihood of an event, e.g. fracture. Fracture probability depends on two hazards—the incidence of fracture and the incidence of death

QALY

The QALY is a multi-dimensional outcome measure that incorporates both the quality (health related) and quantity (length) of life. The value of a QALY was set at value of 2× GDP per capita

QCT

Quantitative computed tomography

QoL

Quality of life

QUS

Quantitative ultrasound

SCOPE

Scorecard for osteoporosis in Europe

Standard deviation

T score

Describes the number of standard deviations (SD) by which the BMD in an individual differs from the mean value expected in young healthy women. The operational definition of osteoporosis is defined as a value for BMD 2.5 SD or more below the young female adult mean (T score less than or equal to −2.5 SD).

WHO

World Health Organization

WTP

Willingness to pay, used in Health Technology assessment to describe the value that society or a health care payer is prepared to pay to gain a QALY. The value of a QALY was set at value of 2× GDP per capita.

AGREE criteria

Systematic search. How thorough was the evidence base? Were the guidelines based on a systematic literature review conducted at the time of the guideline development (or on a previously conducted review that was updated).

Recommendations: Were recommendations graded (e.g. A, B, C) according to the levels of evidence provided by the systematic review?

Stakeholder involvement: Was there involvement from patient organisations, primary care physicians, national/EU societies in the consultation process for the guidelines?

External review: Were the guidelines reviewed by independent experts? i.e. have they undergone a rigorous external review in addition to consultation.

Procedure for update: Were the guidelines updated as and when necessary or was there explicit mention of a provision to update the guidelines in the future?

Economic analysis: Were the recommendations underpinned by an economic analysis?

Editorial independence: Did the guidelines explicitly state that there was editorial independence of the writing group from any funding body?

Title: SCOPE: a scorecard for osteoporosis in Europe
Authors: J. A. Kanis
F. Borgström
J. Compston
K. Dreinhöfer
E. Nolte
L. Jonsson
W. F. Lems
E. V. McCloskey
R. Rizzoli
J. Stenmark
Publication date: 01-12-2013
Publisher: Springer London
Published in: Archives of Osteoporosis / Issue 1-2/2013
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-013-0144-1

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SCOPE: a scorecard for osteoporosis in Europe

Abstract

Summary

Introduction

Methods

Results

Conclusions

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Abstract

Summary

Introduction

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Results

Conclusions

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