Reducing the treatment gap in osteoporosis

Despite their high incidence and the substantial associated morbidity, mortality, and cost to health care and social services, osteoporotic fractures remain under-recognised and under-treated. This neglect has persisted despite advances that have enabled accurate fracture risk prediction and the availability of a range of cost-effective therapeutic interventions to reduce fractures. 1 Compston JE McClung MR Leslie WD Osteoporosis. Lancet. 2019; 393: 364-376 Summary Full Text Full Text PDF PubMed Scopus (781) Google Scholar A new report, 2 National Osteoporosis Foundation National Bone Health PolicyNew report on burden of osteoporosis highlights huge and growing economic and human toll of the disease. National Osteoporosis Foundation, 2019https://www.nof.org/news/new-report-on-burden-of-osteoporosis-highlights-huge-and-growing-economic-and-human-toll-of-the-disease/Date accessed: November 12, 2019 Google Scholar issued by the US National Osteoporosis Foundation, provides a stark reminder of the burden of these fractures and emphasises the potential of strategies for the secondary prevention of fractures to reduce suffering and economic costs. The report, which focuses on the US Medicare population, found that about 2 million Americans had 2·3 million osteoporotic fractures in 2015 and that hospitalisation due to these fractures exceeded that due to breast cancer, heart disease, and stroke combined. Only 9% of those with a fracture underwent bone mineral density testing within 6 months of the fracture, and in the first 2–3 years following fracture, 307 000 individuals had a second fracture, incurring additional costs of more than US$6·3 billion. On the basis of the conservative assumption that pharmacological intervention would reduce 20% of these secondary fractures, potential savings of more than $1 billion could be realised if preventive measures were fully implemented.