General and Specific Considerations as to why Osteoporosis-Related Care Is Often Suboptimal

Abstract

Purpose of review: The assessment of fracture risk and use of antiosteoporosis medications have increased greatly over the last 20-30 years. However, despite this, osteoporosis care remains suboptimal worldwide. Even in patients who have sustained a fragility fracture, fewer than 20% actually receive appropriate antiosteoporosis therapy in the year following the fracture. There is also evidence that treatment rates have declined substantially in the last 5-10 years, in many countries. The goal of this article is to consider the causes for this decline and consider how this situation could be remedied.

Recent findings: A number of possible reasons, including the lack of prioritisation of osteoporosis therapy in ageing populations with multimorbidity, disproportionate concerns regarding the rare side effects of anti-resorptives and adverse changes in reimbursement in the USA, have been identified as contributing factors in poor osteoporosis care. Improved secondary prevention strategies; screening measures (primary prevention) and appropriate, cost-effective guideline and treatment threshold development could support the optimisation of osteoporosis care and prevention of future fractures.

Keywords: Adverse effects; Epidemiology; Fracture; Osteoporosis; Policy; Treatment gap.

Fig. 1

Antiosteoporosis medication prescription incidence from 1990 to 2012 in the UK population aged 50 years or over, reproduced with permission from van der Velde et al. [13]

Fig. 2

Estimated sales of antiosteoporosis drugs (Defined Daily Doses, DDD)/100 population aged 50 + years from 2001 to 2011 in the European Union, reproduced with permission from Hernlund et al. [14]

Fig. 3

Cumulative incidence of hip fracture in the screening versus control arm in the SCOOP Trial. Produced with permission using data from Shepstone et al., 20198 [••]