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. 2017 Jul;28(7):2023-2034.
doi: 10.1007/s00198-017-4009-0. Epub 2017 Apr 27.

Identification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting

J A Kanis  1   2 , C Cooper  3   4 , R Rizzoli  5 , B Abrahamsen  6 , N M Al-Daghri  7 , M L Brandi  8 , J Cannata-Andia  9 , B Cortet  10 , H P Dimai  11 , S Ferrari  5 , P Hadji  12 , N C Harvey  3 , M Kraenzlin  13 , A Kurth  14   15 , E McCloskey  16   17 , S Minisola  18 , T Thomas  19 , J-Y Reginster  20 ; European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)
Affiliations

Identification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting

J A Kanis et al. Osteoporos Int. 2017 Jul.

Erratum in

Abstract

Osteoporosis represents a significant and increasing healthcare burden in Europe, but most patients at increased risk of fracture do not receive medication, resulting in a large treatment gap. Identification of patients who are at particularly high risk will help clinicians target appropriate treatment more precisely and cost-effectively, and should be the focus of future research.

Introduction: The purpose of the study was to review data on the identification and treatment of patients with osteoporosis at increased risk of fracture.

Methods: A working group convened by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis met to review current data on the epidemiology and burden of osteoporosis and the patterns of medical management throughout Europe.

Results: In Europe in 2010, the cost of managing osteoporosis was estimated at €37 billion and notably the costs of treatment and long-term care of patients with fractures were considerably higher than the costs for pharmacological prevention. Despite the availability of effective treatments, the uptake of osteoporosis therapy is low and declining, in particular for secondary fracture prevention where the risk of a subsequent fracture following a first fracture is high. Consequently, there is a significant treatment gap between those who would benefit from treatment and those who receive it, which urgently needs to be addressed so that the burden of disease can be reduced.

Conclusions: Implementation of global fracture prevention strategies is a critical need. Future research should focus on identifying specific risk factors for imminent fractures, periods of high fracture risk, patients who are at increased risk of fracture and therapies that are most suited to such high-risk patients and optimal implementation strategies in primary, secondary and tertiary care.

Keywords: Fracture risk; Healthcare burden; Management; Osteoporosis; Secondary prevention; Treatment gap.

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Conflict of interest statement

JAK reports grants from Amgen, Eli Lilly and Radius Health; non-financial support from Medimaps, and Asahi; and other support from AgNovos outside the submitted work. JAK is the architect of FRAX but has no financial interest. CC has received consultancy, lecture fees and honoraria from Amgen, GlaxoSmithKline, Alliance for Better Bone Health, Merck Sharp & Dohme, Eli Lilly, Pfizer, Novartis, Servier, Medtronic and Roche. RR has received consulting fees or advisory board fees from Radius Health, Labatec, Danone and Nestlé. BA has institutional research contracts with Novartis and UCB outside of the submitted work. NMA-D has received support from the Prince Mutaib Chair for Biomarkers of Osteoporosis, Deanship of Scientific Research Chairs, King Saud University. MLB has received consultancy fees and grants from Alexion, Abiogen, Amgen, Eli Lilly and Shire. JC-A has received grants and/or advisory board fees from Amgen, Servier, Fresenius-VIFOR and Shire. BC has received consultancy fees, lecture fees and honorarium from Amgen, Eli Lilly, Expanscience, Ferring, Medtronic, Novartis, Roche Diagnostics and Servier. HPD has received lecture fees, consulting fees and/or advisory board fees from Amgen, Daiichi-Sankyo, Eli Lilly, Genericon, Kyphon, Merck Sharp & Dohme, Novartis, Nycomed, Servier and Sinapharm. SF has received grants or research support from Amgen and Merck Sharp & Dohme and consultancy fees from Amgen, Merck Sharp & Dohme, GlaxoSmithKline, Eli Lilly and UCB. PH has received grants, advisory board or speaker fees from Amgen, AstraZeneca, Eli Lilly, Exeltis, Daichii-Sankyo, Gedeon Richter, Meda, Merck Sharp & Dohme, Mylan, Novartis, Pfizer, Roche and UCB. NCH has received consultancy, lecture fees and honoraria from Alliance for Better Bone Health, Amgen, Merck Sharp & Dohme, Eli Lilly, Servier, Shire, UCB, Consilient Healthcare and Internis Pharma. MK has no conflicts of interest to declare. AK has received consulting and speaker fees from Agnovos, Amgen, Eli Lilly, Novartis, Novo Nordisk, Roche, Servier, Biomet and Dfine, Inc. EM is or has acted as a consultant, advisor, speaker and/or received research support from ActiveSignal, Amgen, Arthritis Research UK, AstraZeneca, Consilient Healthcare, EPSRC, GlaxoSmithKline, Hologic, I3 Innovus, Internis, the International Osteoporosis Foundation, Eli Lilly, the Medical Research Council, Medtronic, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis, Servier, Synexus, Tethys, UCB, Unilever and Warner Chilcott. SM has served as a speaker for Abiogen, Amgen, Diasorin, Eli Lilly, Italfarmaco, Fujii, Merck Sharp & Dohme and Takeda and on advisory boards for Amgen and Eli Lilly. TT has received advisory board or speaker fees from Amgen, Chugai/Roche, Expanscience, Genévrier, GlaxoSmithKline, HAC-Pharma, Eli Lilly, Medac, Merck Sharp & Dohme, Novartis, Teva and UCB and research grants or investigator fees from Amgen, Bone Therapeutics, Chugai/Roche, LCA, Merck Sharp & Dohme, Novartis, Pfizer and UCB. J-YR has received advisory board or speaker fees from Asahi-Kasei, Eli Lilly, IBSA-Genévrier, Nycomed-Takeda, PharmEvo, Radius Health, Roche, Servier, UCB, Will Pharma and Zodiac.

Figures

Fig. 1
Fig. 1
Estimated number of incident fractures by type and country in the European Union in 2010 [1]
Fig. 2
Fig. 2
Estimated cost of osteoporosis (excluding values of quality-adjusted life-years lost) per capita (€, 2010) in Europe [1, 12]. EU27 27 member states of the European Union, OP osteoporosis
Fig. 3
Fig. 3
Estimated sales (defined daily doses [DDDs]/100 population aged 50+ years) from 2001 to 2011 [1]. Alendronate, etidronate, risedronate and raloxifene were available before 2001. PTH parathyroid hormone. Reprinted with kind permission from Springer Science and Business Media
Fig. 4
Fig. 4
Osteoporosis treatment gap in women across Europe in 2010 [1, 12]. EU27 27 member states of the European Union. Reprinted with kind permission from Springer Science and Business Media
Fig. 5
Fig. 5
Risk per 100,000 (95% confidence interval) of a second major osteoporotic fracture (MOF) after a first MOF for a woman aged 75 years at her first fracture. Knots for the spline function are set at 0.5, 2.5 and 15 years of follow-up after the first fracture. The dashed line is the risk of first MOF in the whole population (n = 18,872) for a woman aged 75 years at baseline [14]. Reprinted with kind permission from Springer Science and Business Media
Fig. 6
Fig. 6
a Number of fractures at the sites shown in patients given placebo (n = 825), teriparatide (n = 818) or abaloparatide (n = 824) after 18 months of treatment [39] (abaloparatide significantly different from placebo; romosozumab significantly different from placebo; risk ratio 0.27; P < 0.001.). b Incidence of new vertebral fracture following treatment with romosozumab [63] (abaloparatide significantly different from teriparatide; romosozumab significantly different from teriparatide; risk ratio 0.25; P < 0.001). The risk ratio was assessed among patients in the romosozumab group compared with those in the placebo group at 12 months (end of the double-blind period) and at 24 months (by which time patients in both groups had received open-label denosumab for 12 months)
See this image and copyright information in PMC

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