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Fracture risk estimation may facilitate the treatment gap in osteoporosis
  1. Willem F Lems
  1. Correspondence to Professor Willem F Lems, Amsterdam Rheumatology and immunology Centre, VU University Medical Centre, Rheumatology 3A 64, Amsterdam 1007 MB, The Netherlands; wf.lems{at}

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Introduction: the treatment gap

Osteoporosis is a systemic disease, characterised by low bone mass and a deteriorated microarchitecture, leading to an increased susceptibility to fractures.1 SCOPE, a scorecard for osteoporosis in Europe, documents that the number of osteoporotic fractures in the 27 European Union (EU) countries will rise by 35% from 3.49 million in 2010 to 4.48 million in 2025.2 The analysis was performed with the assumption that age-specific and gender-specific incidence rates of fractures will remain constant over the period of 15 years. It is possible that the incidence rate will increase even more, due to an unhealthy lifestyle (immobility) and/or vitamin D deficiency, while the incidence rate may flatten when physicians will be more capable of closing the treatment gap (the proportion of individuals with high risk of fracture with adequate treatment vs the proportion of individuals with high risk of fracture without adequate treatment). At the moment, the treatment gap for osteoporosis is substantial, and varies widely between EU countries, from 25% to 95%2; there is no evidence that the treatment gap is substantially lower in other parts of the world.

Why does the treatment gap persist?

In theory, it is not too difficult to close the gap, since dual-energy X-ray absorptiometry (DXA) machines are widely available for diagnosing osteoporosis, and since effective, relatively safe and inexpensive (generic) drugs are currently available. With DXA, the bone mineral density (BMD) of the spine and hips is measured; a BMD ≥ 2.5 SD below the young female adult mean (T-score ≤−2.5) at the lumbar spine or hip is (arbitrarily) defined as osteoporosis.1 Earlier, it has been documented that the risk of osteoporotic fractures increases continuously as BMD decreases, resulting in a 1.5-fold to 3-fold increase in risk of fracture for each decrease in SD.3 In addition, risk of fracture is elevated in patients with …

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