With the number of hip fractures projected to double by 2050, Dr Philippe Halbout, CEO of the International Osteoporosis Foundation, is urging for timely action to address this looming healthcare crisis. Hip fractures, a major consequence of osteoporosis, have devastating consequences in terms of morbidity and mortality. Worldwide, more than 10 million hip fractures occur per year, placing a significant burden on patients, families, and healthcare systems.
The majority of hip fractures are experienced by individuals aged 65 and older, who often have reduced bone density, muscle strength, and balance. As the global population rapidly ages, the number of hip fractures is expected to nearly double by 2050. Males are projected to be particularly affected due to their greater increase in life expectancy.
The current strain on healthcare systems raises concerns about their preparedness to handle this exponential increase in hip fractures related to osteoporosis. Hip fractures require costly surgeries, hospitalization, rehabilitation services, and often burden family caregivers or lead to long-term nursing home care. Furthermore, the mortality rate following a hip fracture is high, with approximately 24% of patients dying within a year. Survivors often experience a profound loss of function and independence, with 60% requiring assistance a year later and up to 33% becoming totally dependent or entering assisted care homes.
One critical issue is the high risk of sustaining another serious and life-threatening fracture in the future for patients who have already experienced a hip fracture. The risk is especially elevated within the next one to two years. Around one in four patients who have previously experienced any osteoporotic fracture will suffer a second hip fracture, while one in three patients with a history of hip fracture will experience another fracture within one and a half years.
Despite the evident need for prompt anti-osteoporosis treatment to prevent secondary fractures, there is a tragic treatment gap among those who have already suffered a fracture. The vast majority of individuals in this group do not receive anti-osteoporosis medication to protect against future fractures. This treatment gap reflects the insufficient prioritization of bone health within healthcare systems worldwide, as well as by patients and physicians. For instance, in the US, only 23% of elderly hip fracture patients receive osteoporosis medication, compared to 96% of heart attack patients who receive beta blockers for future prevention.
To address this issue and alleviate the growing burden of hip fractures among older populations, a change in mindset is necessary. The societal and human costs of fragility fractures must no longer be underestimated by policymakers, healthcare professionals, and patients alike. It is essential to debunk the myth that osteoporosis is an inevitable consequence of aging when it is, in fact, a preventable and treatable disorder.
The International Osteoporosis Foundation (IOF) is actively working to promote a two-pronged approach to prevent fragility fractures. Firstly, there is a need to raise awareness among the younger population about maintaining bone-healthy lifestyles to reduce the risk of osteoporosis in later life. Additionally, primary care physicians must be educated about the importance of early identification and treatment of at-risk patients to prevent their first fracture.
The second component of the strategy involves focusing on secondary fracture prevention. The IOF, alongside national experts worldwide, has prioritized investment in secondary fracture prevention as an efficient way to combat the rising number of hip fractures. This preventive approach targets those who are at the highest risk and have already experienced a fracture.
The IOF has successfully launched a global program called Capture the Fracture®, which aims to enhance the implementation and effectiveness of coordinated post-fracture care services, such as Fracture Liaison Services (FLS), in hospitals worldwide. FLS involves a multidisciplinary team with a dedicated coordinator who acts as the link between the patient, orthopedic team, other specialists, falls prevention services, and primary care physicians. The goal is to ensure that fragility fracture patients receive comprehensive evaluation and treatment.
For instance, hip fracture patients would receive appropriate care, including rehabilitation, falls prevention assessment, anti-osteoporosis treatment, and monitoring to improve outcomes and reduce the risk of future hip and other osteoporotic fractures. The widespread implementation of Fracture Liaison Services would likely result in significant reductions in recurring fractures.
Addressing the issue of osteoporosis and fragility fractures requires action across various sectors, from the public and research spheres to medical and policy domains. The recommended solutions are clearly outlined in IOF policy publications, such as the IOF Compendium of Osteoporosis and the recent Capture the Fracture® Guidance for Policy Shaping.
Ultimately, real change requires health authorities to allocate resources for the prevention of osteoporosis and fragility fractures. This investment is crucial to safeguard millions of older adults from the suffering, disability, and loss of independence associated with hip fractures. By prioritizing prevention and implementing comprehensive post-fracture care, healthcare systems can better address the impending healthcare crisis posed by the increasing number of hip fractures.
