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Archives of Osteoporosis
Published in: Archives of Osteoporosis 1/2020

Open Access 01-12-2020 | Osteoporosis | Original Article

Fragility fractures in Europe: burden, management and opportunities

Authors: Fredrik Borgström, Linda Karlsson, Gustav Ortsäter, Nicolas Norton, Philippe Halbout, Cyrus Cooper, Mattias Lorentzon, Eugene V. McCloskey, Nicholas C. Harvey, Muhamamd K. Javaid, John A. Kanis, for the International Osteoporosis Foundation

Published in: Archives of Osteoporosis | Issue 1/2020

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Abstract

Summary

This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five countries of the European Union plus Sweden (EU6). In 2017, new fragility fractures in the EU6 are estimated at 2.7 million with an associated annual cost of €37.5 billion and a loss of 1.0 million quality-adjusted life years.

Introduction

Osteoporosis is characterized by reduced bone mass and strength, which increases the risk of fragility fractures, which in turn, represent the main consequence of the disease. This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five EU countries and Sweden (designated the EU6).

Methods

A series of metrics describing the burden and management of fragility fractures were defined by a scientific steering committee. A working group performed the data collection and analysis. Data were collected from current literature, available retrospective data and public sources. Different methods were applied (e.g. standard statistics and health economic modelling), where appropriate, to perform the analysis for each metric.

Results

Total fragility fractures in the EU6 are estimated to increase from 2.7 million in 2017 to 3.3 million in 2030; a 23% increase. The resulting annual fracture-related costs (€37.5 billion in 2017) are expected to increase by 27%. An estimated 1.0 million quality-adjusted life years (QALYs) were lost in 2017 due to fragility fractures. The current disability-adjusted life years (DALYs) per 1000 individuals age 50 years or more were estimated at 21 years, which is higher than the estimates for stroke or chronic obstructive pulmonary disease. The treatment gap (percentage of eligible individuals not receiving treatment with osteoporosis drugs) in the EU6 is estimated to be 73% for women and 63% for men; an increase of 17% since 2010. If all patients who fracture in the EU6 were enrolled into fracture liaison services, at least 19,000 fractures every year might be avoided.

Conclusions

Fracture-related burden is expected to increase over the coming decades. Given the substantial treatment gap and proven cost-effectiveness of fracture prevention schemes such as fracture liaison services, urgent action is needed to ensure that all individuals at high risk of fragility fracture are appropriately assessed and treated.
Appendix
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Glossary
France
Bernard Cortet
University Hospital Lille, France
Thierry Thomas
Rheumatology Department, University Hospital St. Etienne, France
Laurent Grange
Department of Rheumatology, University Hospital Grenoble, France
Germany
Claus Glüer
Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel University, Germany
Andreas Kurth
Department of Traumatology, Orthopedics and Hand Surgery, Community Hospital Mittelrhein gGmbH, Germany
Peyman Hadji
Department of Bone Oncology, Endocrinology and Reproductive Medicine, Krankenhaus Nordwest, Germany
Thorsten Freikamp
Federal Self-help Association for Osteoporosis (BfO), Germany
Italy
Maria Luisa Brandi
Department of Endocrinology and Metabolic Diseases and Director of the Operative Unit of Diseases of Mineral and Bone Metabolism, Medical School, University of Florence, Italy
Stefano Gonnelli
Department of Internal Medicine and Director of the School of Specialization in Emergency Medicine and Urgency, University of Siena, Italy
Giuseppe Sessa
Department of Orthopedics and Traumatology and Orthopedic Clinic of the Vittorio Emanuele Polyclinic, University of Catania, Italy
Spain
Josep Blanch Rubio
Department of the Institut Blanch de Reumatologia, Spain
Adolfo Diez-Perez
Department of Internal Medicine at the Hospital del Mar, Autonomous University of Barcelona, Spain
Maria A Robles Palacios
Asociación Española con la Osteoporosis y la Artrosis, Spain
Santiago Palacios
Instituto Palacios, Salud y Medicina de la Mujer, Spain
Sweden
Mattias Lorentzon
Department of Geriatric Medicine, Institute of Medicine, University of Gothenburg, and Osteoporosis Clinic at the Sahlgrenska University Hospital, Sweden
Lisa Keisu Lennerlöf
Osteoporosforbundet, Swedish Osteoporosis Association, Sweden
UK
Cyrus Cooper
MRC Lifecourse Epidemiology Unit, University of Southampton, UK and Professor of Musculoskeletal Science at the NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, UK.
Fizz Thompson
National Osteoporosis Society, UK
Celia L Gregson
Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, UK
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Metadata
Title
Fragility fractures in Europe: burden, management and opportunities
Authors
Fredrik Borgström
Linda Karlsson
Gustav Ortsäter
Nicolas Norton
Philippe Halbout
Cyrus Cooper
Mattias Lorentzon
Eugene V. McCloskey
Nicholas C. Harvey
Muhamamd K. Javaid
John A. Kanis
for the International Osteoporosis Foundation
Publication date
01-12-2020
Publisher
Springer London
Published in
Archives of Osteoporosis / Issue 1/2020
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-020-0706-y

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