Osteoporosis : Treatment gaps and health economics

Amongst patients who sustain a fragility fracture, fewer than 20% of individuals receive therapies to reduce the risk of future fracture within the year following the fracture. Paradoxically, the therapeutic care gap may be particularly wide in the elderly in whom the importance and impact of treatment is high; studies have shown that as few as 10% of older women with fragility fractures receive any osteoporosis therapy (with oestrogens not considered). Furthermore, treatment rates following a fracture are lower for those individuals who reside in long term care. This contrasts with the situation following myocardial infarction, for which condition a significant care gap has been overcome in the past 15 years: 75% of such individuals now receive beta blockers to help prevent recurrent myocardial infarction. Many studies demonstrate the cost-effectiveness of therapeutic approaches to fracture prevention, but despite clinical effectiveness, evidence suggests declining rates of treatments internationally. The reasons for these trends appear multifactorial, but of clear importance are approaches to communication around rare side effects of long-term antiresorptive therapies. These suggest important lessons for the field in terms of our interactions with patients, funders and policymakers to ensure that all individuals at high risk of fracture are assessed and treated appropriately.

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We would like to thank the Medical Research Council (UK), National Institute for Health Research, Wellcome Trust, Arthritis Research UK, National Osteoporosis Society (UK), and International Osteoporosis Foundation for supporting this work.