In France, seven key proposals for national action against osteoporosis

Let the first fracture be the last! Following a first national enquiry, AFLAR, with the National Alliance Against Osteoporosis, issues a White Paper on osteoporosis – including a manifesto calling for seven key actions to prevent osteoporosis and to change the care protocol for fracture patients.

The Association Française de Lutte Antirhumatismale (AFLAR) together with the National Alliance Against Osteoporosis have documented the burden of osteoporosis and published an important manifesto calling for urgent action on the part of health authorities. The White Paper was presented to the Senate on October 17, in conjunction with World Osteoporosis Day 2017.

In France, as elsewhere, osteoporosis is a disease which is vastly under-diagnosed and under treated. Patients often see osteoporosis as a natural consequence of ageing and its treatment by doctors has decreased steadily over the last 10 years. If this decrease goes on, France, with an ageing population, will see a ‘tsunami’ of fractures in the coming years, particularly of the spine and hip. This is all the more disquieting in that patients are not treated even after they have suffered a first fracture – 51 % patients will not see a doctor in the month following their hospitalisation, and only 15 % of patients are treated for osteoporosis. Consequently, 29 % are admitted again after sustaining a new fracture. Such fractures are the cause of immense disability and early death - hip fractures in particular are associated with a mortality rate of approximately 20 %.

In order to address this denial of the reality of the disease, AFLAR and the National Alliance against Osteoporosis organised general conferences on osteoporosis throughout the country. The findings were compiled into a White Paper ‘Livre Blanc - États Généraux De L’ostéoporose - Pour un plan de santé publique contre les fractures liées à l’ostéoporose’ which calls for a strong response from health authorities. 

Results of the first national enquiry on osteoporosis

In a first phase, the general conference identified the needs and expectations of patients and general physicians on the treatment of osteoporosis following a survey of patients and physicians. The key findings were:

1. Poorly informed and non-recognition of risks
The enquiry shows that there are a great number of inaccurate or false ideas or beliefs expressed by people directly concerned by osteoporosis. According to AFLAR 

Misunderstanding is extensive from the start:  56 % replied that they only associate osteoporosis as a serious disease, 50 % said they were concerned by a decrease in height up to 3 cm.  The disease is considered as trivial. It’s implications, 3 cm lost in height, is anything but trivial!"

2. Better information needed for health professionals
General physicians, conscious of their important role in the treatment of osteoporosis, admit that their understanding of the disease is superficial. Far from accepting it, they are willing to improve their knowledge. 66 % estimated they need better information about osteoporosis, and 84% stated that they need to know more about the various treatments.

3. A false perception of the ‘benefit/risk’ ratio in regard to treatments
When asked whether the treatments for osteoporosis are hard to bear, 35 % female patients said yes without detailing the reasons. For Françoise Alliot-Launois, Vice President of AFLAR, these figures have to be compared to others:

Only 50 % of female patients take treatment for osteoporosis, whereas it should be a majority. Whatever their reasons, it means that one female patient out of two prefers not to take a treatment. This rejection of medical treatment reflects a lack of information on the usefulness of treatment: 30 % female patients think it is impossible to cure osteoporosis."

Osteoporosis: enormous socio-economic costs 

In 2010 in France, the economic impact of fractures due to fragility fractures (prevalent and previous) has been estimated at 4,8 billion euros (2,5 for hip fractures only); 66 % of the costs concerned medical care provided in the first year following the fracture, 27 % for long term care (disability) and 7 % for medical management.

In 2025, one person out of three will be aged 60 or more (20 million people) and the number of fractures will go from 376 000 (in 2010) to 491 000 (2025), leading to an increase of costs of 26 %. Prof. Robert Launois, a health specialist, reveals that

Osteoporosis is a costly disease for the community - we must reflect on public health measures for prevention.”

General conferences: a year devoted to osteoporosis in 10 French cities

General conferences were held across France from November 2016 to June 2017. They revealed that the treatment of osteoporosis in France is at a low point. As Dr Laurent Grange, President of AFLAR, says:

Between 2010 and 2014, the number of patients treated decreased from 1,100,000 to 800,000 in four years, a decrease of 380,000 patients. This decrease of treated patients is explained by a lack of interest among patients resulting from a denial of the reality of this disease, and is also linked to false information about the dangerous side effects of treatments.”

The White Paper evaluates the state of osteoporosis management in France and acknowledges which actions for improvement are needed. It will help authorities and decision-makers to understand the major public health issues regarding osteoporosis in France. Seven proposals to improve the treatment of osteoporosis in France are made:

  1. From osteoporosis to fractures: changing the paradigm – Awareness campaigns.
  2. Developing primary strategies to prevent fractures due to bone fragility.
  3. Developing secondary strategies for fractures due to bone fragility: «let the first fracture be the last! ».
  4. Promoting incentives for General physicians in charge of osteoporosis.
  5. Promoting and supporting research -  public and private, medical and economic - regarding the cost of the ‘fracture cascade»  and experimenting with new care pathways among various disciplines.
  6. For people at risk of fractures, promoting falls prevention and helping them remain in their homes.
  7. Creating a national register of fractures due to osteoporosis (starting with pilot experiments in 1 or 2 regions).

> DOWNLOAD Livre Blanc - États Généraux De L’ostéoporose - Pour un plan de santé publique contre les fractures liées à l’ostéoporose  

For further information about IOF's member societies in France who are involved in this important project, visit their respective websites: