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Europe

Aside from its personal and human cost, osteoporosis is a major public health problem, with enormous social and economic impact.  Worldwide it is estimated that 1 in 3 women and 1 in 5 men over the age of 50 years will sustain an osteoporotic fracture.  In the European Union, someone has a fracture as a result of osteoporosis every 30 seconds, and with an ageing population, the yearly incidence of hip fracture alone in the EU is expected to more than double from approximately 500,000 to 1,000,000 over the next 50 years (1).  Of the estimated 9 million osteoporotic fractures that occurred worldwide in the year 2000, 1.6 million were hip fractures, 1.7 million were forearm fractures, and 1.4 million were clinical vertebral fractures; the greatest number of osteoporotic fractures occurred in Europe (34.8% of the total) (2).

Although osteoporosis can be easily diagnosed and treated, studies have shown that it remains seriously under-diagnosed and under-treated.  It is estimated that only one out of three vertebral fractures comes to clinical attention (3).  Despite this, it is known that having one spine fracture increases the risk for sustaining additional spine fractures five-fold within the next year (4), a phenomenon commonly known as the 'fracture cascade'.  In Europe, osteoporotic fractures are responsible for a higher disease 'burden', in terms of disability and excess mortality, than common cancers with the exception of lung cancer (2).  Furthermore, in women over 45 years of age, osteoporosis accounts for more days spent in hospital than many other diseases, including diabetes, myocardial infarction and breast cancer (5).  Despite these statistics, many countries continue to place osteoporosis low on the list of priorities in their health care agendas.

As a key component of its European policy programme, the IOF lobbies to convince policy makers and health authorities to increase accessibility to diagnosis and treatment prior to the first fracture, and thereby reduce the costs and suffering associated with osteoporosis. 
Unless osteoporosis prevention and treatment become a priority for governments and healthcare providers, this growing number of osteoporotic fractures will have serious impact on society, not just in terms of people's quality of life, but also in regard to increased expenditure for healthcare, rehabilitation and nursing care.

The most important objective of IOF's policy work in Europe has been to further implement the Eight Recommendations published by the European Commission in 1998, to make the prevention of osteoporosis and related fractures a governmental health care priority in all European Union Member States.  Among other actions since 1998, IOF has assisted in the development and launch of the  European Union Osteoporosis Consultation Panel (now with representation from all 27 Member States) and the European Parliament Osteoporosis Interest Group, supports their annual meetings, and has published multiple publications on their behalf which are a pivotal component of the "Call to Action" which aims to galvanise government action against osteoporosis.

Supported by IOF, the EU Osteoporosis Consultation Panel is planning a major new EU-wide audit on the prevalence of osteoporosis and status of its management in Europe for 2008, to assess progress and challenges a decade on since publication of the Eight Recommendations, and to provide an authoritative report that is intended to be a catalyst for action by health ministries across the Union.  It will also be an opportunity to audit those countries which have in the last few years joined the EU and were not included in the original audit.

References

  1. Blanchard F, President, Report Working Group.  Report on Osteoporosis in the European Community: Building Strong Bones and Preventing Fractures - Action for Prevention.  European Communities.  Brussels, 1998. EC Report CE-09-97-915-EN-C.
  2. Johnell O and Kanis J. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 2006; in press (published online, September 2006).
  3. Cooper C, Atkinson EJ, O'Fallon WM, et al. Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985-1989. J Bone Miner Res 1992;7:221-27.
  4. Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA 2001;285:320-23
  5. Kanis JA, Delmas P, Burckhardt P, et al. Guidelines for diagnosis and management of osteoporosis. The European Foundation for Osteoporosis and Bone Disease. Osteoporos Int 1997;7:309-406.

 
Read articles on European policy events and issues that have appeared in the IOF policy-related newsletter Osteoporosis Action.
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