I am pleased to be confirmed again as Joint-Chair of the European Parliament Osteoporosis Interest Group. I will continue to work with the International Osteoporosis Foundation to raise awareness of the disease and campaign for funding to improve and extend treatment, as well as for public education about ways in which osteoporosis can be prevented, or at least reduced.
Osteoporosis is a disease in which the density and quality of bone is reduced. As the bones become progressively more porous and fragile, there is an increased risk of fracture, even after a minor bump or fall. Osteoporosis is often called the ‘silent disease’ as there are usually no signs or symptoms until a fracture has occurred. The risk of fractures due to osteoporosis rises progressively with age in men and particularly in women after the age of menopause. In women, the risk is comparable to that of cardiovascular disease and considerably higher than that of breast cancer. Currently, one osteoporotic fracture occurs every 30 seconds in the EU, and the ageing of the population will double the number of osteoporotic fractures over the next 50 years if changes are not made in present practice. Osteoporosis and resulting fractures can often be prevented, they are not “just a part of old age”, as many people wrongly believe.
Osteoporosis has a devastating effect on the individual and society as a whole. Fractures result in pain, disfigurement, and loss of independence. After a hip fracture, approximately 50% of patients can no longer live independently and 20% die within 12 months. If left untreated, the patient who sustains a first fracture has a greater than two-fold increase in the risk of a subsequent fracture. The risk of a third and additional fracture increases exponentially with each new fracture – known as the cascade effect.
Prevention of osteoporotic fractures is key to healthy ageing
Osteoporosis can be diagnosed by measurement of bone mineral density. Effective treatments are widely available in Europe for the management of osteoporosis, but, despite this, the great majority of individuals at high risk (up to 80%) who have already sustained at least one osteoporotic fracture are neither diagnosed nor treated to prevent further fractures. Equity is at stake, as a large gap exists between those who receive treatment and those that would benefit from treatment.
Aside from the personal and social costs, osteoporosis remains a major public health burden with enormous economic impact worldwide. The economic burden of osteoporosis in the EU is estimated at €43 billion annually (for 2010), in direct costs alone and to rise to €58 billion over the next 20 years. The burden on healthcare budgets is currently greater than breast and prostate cancer, myocardial infarction, and diabetes, and very close to stroke.
There have been achievements in the past 10 years: the number of fractures per year is beginning to stabilise, and there are now more evidence-based treatment options available. However, we still have a long way to go:
- 21 out of 27 EU countries do not recognise osteoporosis as a national health priority (this is critical is terms of galvanising public and medical action towards fracture prevention)
- Hip fracture costs have doubled or tripled in some countries
- In many countries, full access to and reimbursement of bone mineral density scans and treatments are not available to high risk individuals (and even to many to have already sustained an osteoporotic fracture)
Building better bone health
The prevention of osteoporosis and fractures should be considered under a lifetime strategy. One of the best preventive measures to avoid fractures in later life is to build a strong bone foundation in youth. Healthy adults generally reach their peak bone mass by the age of 20 years. It is estimated that a 10% increase of peak bone mass would reduce the risk of an osteoporotic fracture during adult life by more than 50%.
The key elements of any chronic disease prevention strategy are diet, exercise, early diagnosis and effective treatment:
- Build strong bones in youth
- Maintain bone strength in the mid-years
- Target high risk individuals over 50 years
- Diagnose and treat ALL individuals who have sustained their first osteoporotic fracture
- Focus on muscle strength and falls prevention in the older years
We need to raise the profile of osteoporosis so that people suffering from the disease are aware of the risk factors and have equitable access to appropriate medical treatment. I have been chair of the Osteoporosis Interest Group in the European Parliament for a number of years and will continue to support initiatives to raise awareness on osteoporosis among politicians and EU institutions.
Are you at risk?
Take the online IOF one-minute risk test and understand better how osteoporosis could be a risk to your quality of life: http://www.iofbonehealth.org/patients-public/risk-test.html
Health care professionals can freely use the fracture risk assessment tool (FRAX® tool, http://www.shef.ac.uk/FRAX) to assess their patients’ risk of fracture at ten years.
For more information, consult the IOF website (www.iofbonehealth.org). The European Parliament Osteoporosis Interest Group supports the IOF EU initiatives for better bone health.