Fragility fractures in Europe: burden, management and opportunities

Abstract

This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five countries of the European Union plus Sweden (EU6). In 2017, new fragility fractures in the EU6 are estimated at 2.7 million with an associated annual cost of €37.5 billion and a loss of 1.0 million quality-adjusted life years.

Introduction: Osteoporosis is characterized by reduced bone mass and strength, which increases the risk of fragility fractures, which in turn, represent the main consequence of the disease. This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five EU countries and Sweden (designated the EU6).

Methods: A series of metrics describing the burden and management of fragility fractures were defined by a scientific steering committee. A working group performed the data collection and analysis. Data were collected from current literature, available retrospective data and public sources. Different methods were applied (e.g. standard statistics and health economic modelling), where appropriate, to perform the analysis for each metric.

Results: Total fragility fractures in the EU6 are estimated to increase from 2.7 million in 2017 to 3.3 million in 2030; a 23% increase. The resulting annual fracture-related costs (€37.5 billion in 2017) are expected to increase by 27%. An estimated 1.0 million quality-adjusted life years (QALYs) were lost in 2017 due to fragility fractures. The current disability-adjusted life years (DALYs) per 1000 individuals age 50 years or more were estimated at 21 years, which is higher than the estimates for stroke or chronic obstructive pulmonary disease. The treatment gap (percentage of eligible individuals not receiving treatment with osteoporosis drugs) in the EU6 is estimated to be 73% for women and 63% for men; an increase of 17% since 2010. If all patients who fracture in the EU6 were enrolled into fracture liaison services, at least 19,000 fractures every year might be avoided.

Conclusions: Fracture-related burden is expected to increase over the coming decades. Given the substantial treatment gap and proven cost-effectiveness of fracture prevention schemes such as fracture liaison services, urgent action is needed to ensure that all individuals at high risk of fragility fracture are appropriately assessed and treated.

Keywords: Disability-adjusted life years; Fracture costs; Fragility fracture; Quality-adjusted life years; Treatment gap.

Fig. 1

Prevalence of osteoporosis in the EU6 by age and sex

Fig. 2

Number (thousands) of new fragility fractures by country in 2017

Fig. 3

Lifetime risk of hip fracture from the age of 50 years, by country and sex, and the equivalent risk for stroke

Fig. 4

Lifetime risk of fragility fracture from the age of 50 years, by country and sex, and the equivalent risk for cardiovascular disease (CVD). Source: National fracture incidences and own calculations

Fig. 5

Estimated number of fragility fractures by fracture category in 2017 and 2030. Numbers denote the percentage change for all fragility fractures, major osteoporotic fractures (MOF), hip and clinical spine fractures

Fig. 6

Number of fragility fractures by country in the EU6 and the projected numbers in 2030

Fig. 7

Risk per 100,000 (95%CI) of a second MOF after a first MOF for a woman at the age of 75 years at her first fracture [23]. The dashed line represents the risk of first MOF in the age- and sex-matched population

Fig. 8

Number and cost of fragility fractures in the EU6 expressed as a percentage of the totals. Note: The estimates conservatively assume no long-term costs for ‘other fractures’

Fig. 9

Annual cost of fractures by site in the EU6 for 2017 and projected increase by 2030

Fig. 10

Cost of fragility fractures in 2017 and that expected in 2030 by country and fracture site

Fig. 11

Quality of life years (QALYs) lost in 2017 due to fragility fractures per 1000 of the population age 50 years or more in countries of the EU6

Fig. 12

Quality of life years (QALYs) lost due to fragility fractures in countries of the EU6 in 2017 and 2030

Fig. 13

Total DALY distribution by fracture site

Fig. 14

Total DALYs by age for hip fractures in women

Fig. 15

Total DALYs by age for non-hip, non-vertebral (NHNV) fractures in women

Fig. 16

Total DALYs by country (left panel) and DALYs per 1000 individuals by country (right panel)

Fig. 17

DALYs by disease in EU6 in 17 selected non-communicable diseases

Fig. 18

Average sick days taken after fragility fracture per 1000 individuals’ age 50–65 years, by country

Fig. 19

Average annual hours of care by relatives after hip fracture by country

Fig. 20

Percentage of patients admitted to long-term care (LTC) within 12 months after a fracture by fracture site (ICUROS Europe). Other refers to other fragility fractures

Fig. 21

Percentage in long-term care (LTC) at one year after hip fracture, by age group

Fig. 22

Treatment gap in men and women by country in 2017

Fig. 23

The treatment gap (percent eligible patients not treated) in men from the EU6 in 2010 and 2017

Fig. 24

The treatment gap (percent eligible patients not treated) in women from the EU6 in 2010 and 2017

Fig. 25

Percentage (%) of women (50 years and above) not treated within a year of an osteoporotic fracture or a hip fracture

Fig. 26

Percentage of women untreated within one year of fracture by site of fracture and prior exposure to osteoporosis treatment in Sweden. N, treatment-naïve; E, prior exposure

Fig. 27

Percentage of men untreated within one year of fracture by site of fracture and prior exposure to osteoporosis treatment in Sweden. N, treatment-naïve; E, prior exposure

Fig. 28

FRAX calculations by URL source per million in the general population November 2010– October 2011 and April 2017– March 2018