Barriers and solutions for global access to osteoporosis management: a Position Paper from the International Osteoporosis Foundation
- PMID: 40844608
- PMCID: PMC12460584
- DOI: 10.1007/s00198-025-07628-5
Barriers and solutions for global access to osteoporosis management: a Position Paper from the International Osteoporosis Foundation
Abstract
Our ability to optimally manage bone health across the lifecourse, and so minimise the risk of fractures, has advanced substantially in recent decades. Whilst fractures and osteoporosis in older age were historically viewed simply as inherent in normal ageing, they are now recognised as manifestations of age-related disease. Key to advancing the field was the development of conceptual (relating to impaired bone mass and microarchitecture with increased propensity to fracture), and subsequent World Health Organization densitometric definitions of osteoporosis, cementing the role of dual-energy X-ray absorptiometry in bone health management. However, whilst low bone mineral density is a strong risk factor for fracture, many individuals who do fracture have normal or only modestly reduced bone mineral density. Furthermore, the existence of two definitions constituting a condition called "osteoporosis", one based on a measurement, and the other conceptual, has led to uncertainty in clinical practice. The field is therefore moving towards calculation of an individual's absolute fracture risk, based on clinical risk factors, with the option to incorporate bone mineral density (if available) as a risk factor rather than as an indication for treatment. Uptake of this new direction has been variable internationally, with many parts of the world, particularly low- and middle-income countries, still predicating treatment (where osteoporosis services exist) on bone mineral density, despite poor availability of densitometry in many such settings. In this Position Paper, on behalf of the International Osteoporosis Foundation, we review the current barriers which prevent equitable access to optimal bone health management worldwide and recommend potential solutions which might be implemented to overcome them.
Keywords: Access; Bone health; Epidemiology; Inequity; Management; Osteoporosis.
© 2025. The Author(s).
Conflict of interest statement
Declarations. Ethics approval: This Position Paper article contains no original data and thus issues of ethics, informed consent and patient confidentiality do not apply. Conflicts of interest: NC Harvey reports personal fees, consultancy, lecture fees and/or honoraria from Alliance for Better Bone Health, AMGEN, MSD, Eli Lilly, UCB, Kyowa Kirin, Servier, Shire, Echolight, Consilient Healthcare, Theramex and Internis Pharma outside the submitted work. ML Brandi reports honoraria: Amgen, Ascendis, Bruno Farmaceutici, Calcilytix, Kyowa Kirin; Grants and/or speaker: Alexion, Amgen, Amolyt, Bruno Farmaceutici, CoGeDi, Echolight, Gedeon Richter, Kyowa Kirin, Monte Rosa Therapeutics, UCB; Consultant: Aboca, Alexion, Amolyt, Bruno Farmaceutici, Calcilytix, Echolight, Enterabio, Kyowa Kirin, Personal Genomics, Septerna. C Campusano reports lecture fees and/or honoraria from Faes farma, Novartis, Sandoz, Asofarma. M Chandran reports honoraria and consulting fees from Amgen Asia, Promedius. C Cooper reports personal fees, consultancy, lecture fees and/or honoraria from ABBH, Amgen, Eli Lilly, GSK, Medtronic, Merck, Novartis, Pfizer, Roche, Servier and Takeda. M Lazaretti reports consultancy and lecture fees from Theramex, Sandoz, Astrazeneca, Mantecorp and Myralis. J Kanis is a director of Osteoporosis Research Ltd which maintains FRAX. E McCloskey reports personal fees, consultancy, lecture fees and/or honoraria from Amgen, Fresenius Kabi, Theramex, UCB. Director, Osteoporosis Research Ltd. N Al-Daghri, C Beaudart, N Burlet, E Cavalier, B Dawson-Hughes, P Halbout, T Hough, R Matijevic, A Mithal, N Njeze, R Rizzoli, Y Saleh, K Ward report no disclosures.
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