Fractures, the clinical manifestations of osteoporosis, are associated with pain, poor functional outcomes and increased mortality. Despite the increasing awareness of its consequences, osteoporosis has recently been recognized as a major public health burden around the world. In many industrialized countries the increased longevity of the population causes, at least in part, the rising frequency of fragility fractures, most notably those of the hip, vertebrae and distal forearm. In order to address secular trends in the incidence of hip and other fractures, review of studies in western populations (1), such as North America, Europe or Oceania, have generally reported increases in hip fracture incidence through the second half of the last century, but those continuing to follow trends over the last two decades have found that rates stabilise, with age-adjusted decreases being observed in certain centres. In contrast, some studies suggest that the rate is rising in Asia. Using FRAX™ algorithm Kanis et al. (2) found a remarkable variation in the 10 year risk of hip fracture worldwide (62 countries): age-standardised rates varied approximately 10-fold in both men and women and the difference in incidence between countries was much greater than the differences in incidence between sexes within a country. In Europe country-specific incidence data for forearm, clinical vertebral, and other osteoporotic fractures are scarce, with the exception of Sweden. For hip fracture, the most serious osteoporotic fracture associated with increased morbidity and mortality, a recent report (3) from the International Osteoporosis Foundation (IOF) show that the annual incidence documented in EU5+ range from 0.01% and 0.04% for women aged 50–54 in Spain and Italy respectively to 3% and 4.77% for women aged 95 or older in Italy and in the UK respectively. The corresponding estimates for men aged 95 or older are 2.0% and 2.13% in the UK and Italy respectively.
In the acute phase the consequences of a fracture such as lost of qualityof life, costs, and mortality are considerable while in the long-term phase the fracture effect on morbidity and costs persists, but is less pronounced.
The total cost burden of osteoporosis in EU5+, including pharmacological prevention, was estimated as high as at € 30.7 billion, and 70% of the total costs involved individuals older than 74 years with hip fractures accounting for 54% of these costs (3). Osteoporosis-related hip fractures do not only lead to high medical care costs but also to high rehabilitation costs, which represent more than 50% of total costs. A majority of the total costs burden may be attributed to incident fractures while pharmacological prevention and treatment management only represented 4.7% of total costs (1.9% in Sweden; 14.7% in Spain; 6.9% in France; 2.2% in UK; 5.0% in Italy; 2.6% in Germany).
With respect to Italian country, it has been estimated that the total monetary burden in Italy sustained by the national healthcare will increase from € 7 billion in 2010 to €8.6 billion in 2025 since the number of hip fractured patients is annually growing up. All industrialized countries where the number of elderly people is still increasing should adopt adequate preventive strategies aimed to reduce the risk of incident fractures (in particular hip fracture) especially in the oldest age groups. Finally there is a need for implementing strategies in order to reduce also re-fractures by increasing the number of patients on treatment and incrementing adherence to treatment.
EU5+: Germany, UK, Spain, France, Italy Sweden
Cooper C et al. Secular trends in the incidence of hip and other osteoporotic fracture. Osteoporos Int 22:1277–1288, 2011
Kanis JA et al. Systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int, Published online 15 march 2012
Strom O et al. Osteoporosis: burden, health care provision and opportunities in the EU. Arch Osteoporos Published online 17 june 2011
Disclosure of Interest None Declared