BROKEN BONES BROKEN LIVES A roadmap to solve
BROKEN BONES, BROKEN LIVES: A roadmap to solve the fragility fracture crisis in Europe The development of this initiative has been supported by UCB.
DID YOU KNOW THAT. . . Osteoporosis results in weak and fragile bones that break easily Normal bone Osteoporotic bone Broken bone A fragility fracture is a warning sign that has to be taken seriously: a fracture increases the risk of a subsequent fracture 2 Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe Worldwide, 1 in 3 women and 1 in 5 men over the age of 50 will experience a fragility fracture 1 It is not only important to treat the existing fragility fracture, but also to prevent subsequent ones, i. e. secondary fracture prevention 3 2
FRAGILITY FRACTURES ARE A MAJOR OBSTACLE TO HEALTHY AGEING Here is WHY it matters
Fragility fractures are a significant yet ignored public health threat…. … whose burden to patients, healthcare systems and societies is being neglected. As the European population ages, the burden of fragility fractures is set to rise. However this growing crisis can be addressed with appropriate prevention and management measures. NOW is time to BREAK the cycle and act to foster healthy ageing in our societies. Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe 4
20 MILLION WOMEN AND MEN LIVE WITH OSTEOPOROSIS IN THE EU 6* Osteoporosis prevalence in adults over 50 is consistent across Europe: 4 -8 Approximately 16 4 MILLION WOMEN 22. 7% 22. 5% 6. 8% 6. 9% 22. 5% 6. 9% 6. 7% 23. 1% 21. 8% 6. 8% 7. 0% Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe MILLION MEN * Assessed in 2015 1 -5 5
2. 7 MILLION NEW BROKEN BONES EVERY YEAR 9, 10 APPROXIMATELY 3% OF WOMEN OVER 50 Total fragility fracture number and relative distribution across the EU 6 SUFFER A NEW FRAGILITY FRACTURE EVERY YEAR. 9, 10 15% Other Hip Vertebral 20% NORTHERN EUROPEAN COUNTRIES HAVE THE HIGHEST FRACTURE 65% RATES OBSERVED WORLDWIDE Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe 6
MOST OF US UNDERESTIMATE THE RISK OF EXPERIENCING A FRAGILITY FRACTURE The estimated lifetime risk of experiencing a hip fracture for individuals aged 50 or above: Hip fracture: 10% - 23%9 6% - 14%9 Stroke: 20% Stroke: 14% THE LIFETIME RISK OF SUSTAINING A HIP FRACTURE IS SIMILAR TO THE LIFETIME RISK OF A STROKE IN EUROPE. 9 Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe 7
Women who had a fragility fracture are five times more likely to experience a second fracture within the next two years than women who have not had a prior fracture 11… THE GREATEST TREATMENT GAPS ARE FOUND IN: FRANCE (85%)11, 13 AND SWEDEN (84%)12 Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe … yet, 60– 85% of women over 50 years of age with osteoporosis do not receive treatment. 12 8
Fragility fractures are a significant yet ignored public health threat…. … whose burden to patients, healthcare systems and societies is being neglected. As the European population ages, the burden of fragility fractures is set to rise. However this growing crisis can be addressed with appropriate prevention and management measures. NOW is time to BREAK the cycle and act to foster healthy ageing in our societies. Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe 9
FRAGILITY FRACTURES HAVE A MULTIFACETED IMPACT ON THE INDIVIDUAL… “My daily life has changed completely. I now walk with two canes. I can´t bend down and I´m constantly in pain. I cannot carry things, and, therefore, cannot go shopping. I miss my active, very much. ” “Three more vertebral fractures occurred and this second incident was very severe. I couldn’t even get out of a chair. ” - Giovanni, Italy - Inger, Sweden “I can no longer run to catch a bus. I no longer feel young” “I was in constant pain and had major problems in my professional life” - Maryvonne, France - Edmund, Germany “If the fracture I suffered in my spine had been spotted earlier than it was, I would have been spared a great deal of pain and suffering. ” - Christie, UK Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe 10
… AND SOCIETY AT LARGE Relative care hours related to fractures per 1, 000 people, by country, per year 9 Sick days taken in 2017 by working persons due to fragility fractures totaled 7. 615. 720 days. 882 756 Hours of care after hip fracture, per 1, 000 individuals Long-term care 9 35. 3% of patients aged 90+ years move into long-term care following hip fracture. 248 191 138 AS A RESULT OF REDUCED MOBILITY AND ABILITY TO COMPLETE DAILY ACTIVITIES, INDIVIDUALS WHO HAVE SUFFERED A FRAGILITY FRACTURE MAY HAVE TO RELY ON INFORMAL CAREGIVERS. Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe 11
AT A TIME OF GLOBAL ECONOMIC CONSTRAINTS ON HEALTHCARE SPENDING, CAN WE AFFORD TO CONTINUE NEGLECTING FRAGILITY FRACTURES? Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe POST-FRACTURE CARE HAS LONG BEEN NEGLECTED DESPITE THE MASSIVE COSTS ON HEALTHCARE SYSTEMS TOTAL EU 6 - 11. 3 bn € 37. 5 bn 9 9. 4 bn 5. 3 bn 4. 2 bn (all costs in €) FRACTURE-RELATED COSTS: 14, 15 Mostly occur in the first year following a fracture Differ between fracture sites and, to some extent, reflect severity of fracture Tend to be highest with hip fractures, as this is the most severe fracture site 12
THE FRAGILITY FRACTURE BURDEN IN THE EU 6 IS GREATER THAN THAT OF MANY OTHER CHRONIC DISEASES FRAGILITY FRACTURES ARE THE FOURTH LEADING CAUSE OF CHRONIC DISEASE MORBIDITY Country contribution to total disability-adjusted life years (DALYs) by disease in EU 6 in 17 selected diseases 9 Ischemic heart disease Dementia Lung cancer Fragility fractures COPD Ischemic stroke Cirrhosis of the liver Migraine Osteoarthritis Hypertensive heart disease Asthma Parkinson’s disease Rheumatoid arthritis Melanoma and other skin cancers Peptic ulcer disease France Germany Italy Spain Sweden UK Multiple sclerosis Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe 0 2, 000 4, 000 6, 000 13
Fragility fractures are a significant yet ignored public health threat…. … whose burden to patients, healthcare systems and societies is being neglected. As the European population ages, the burden of fragility fractures is set to rise. However this growing crisis can be addressed with appropriate prevention and management measures. NOW is time to BREAK the cycle and act to foster healthy ageing in our societies. Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe 14
WITH THE AGEING OF THE POPULATION, THE BURDEN OF FRAGILITY FRACTURES WILL INCREASE Incidence of fragility fractures 9 Fracture-related costs 9 3. 3 € 47. 4 2030 million +23% billion +27% 2. 7 € 37. 5 2017 million The greatest increases in costs are expected to be seen in: 9 Spain (30. 6%) The UK (30. 2%) billion Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe 15
Fragility fractures are a significant yet ignored public health threat…. … whose burden to patients, healthcare systems and societies is being neglected. As the European population ages, the burden of fragility fractures is set to rise. However this growing crisis can be addressed with appropriate prevention and management measures. NOW is time to BREAK the cycle and act to foster healthy ageing in our societies. Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe 16
COORDINATED CARE MODELS IMPROVE HEALTH OUTCOMES AND MUST BE IMPLEMENTED WIDELY IN THE UK, THE NATIONAL OSTEOPOROSIS SOCIETY ESTIMATED THAT 55% OF THE UK POPULATION HAS ACCESS TO AN FLS. Coordinated care models, such as Fracture Liaison Services (FLS), are multidisciplinary healthcare delivery models which aim to identify, diagnose, and treat patients who have suffered a fragility fracture Effects of FLS 14 (absolute change) BDM testing +24% Treatment adherence +22% Treatment initiation +20% -5% Re-fracture rate Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe -3% Mortality 17
THE MORE COMPREHENSIVE THE COORDINATED CARE MODEL, THE BETTER THE HEALTH OUTCOMES Amongst the different models of care, a meta analysis by Ganda et al. 18 demonstrated that adoption of the 3 “I” model, with core priorities of Identify, Investigate and Intervene, offered greater effectiveness in patient assessment and treatment than other models. 3 “I” model Identify Investigate Intervene 2 “I” model Identify Investigate 1 “I” model Identify 0 “I” model 79% 60% 43% N/A 48% 41% 23% 8% receive BMD testing receive osteoporosis treatment Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe no studies on BMD testing receive osteoporosis treatment 18
POST-FRACTURE CARE MODELS ARE COST-EFFECTIVE INTERVENTIONS An FLS is markedly more effective than the more commonly utilized post-stroke care model Post-fracture care models: ICER value of € 3, 108 per QALY saved 19 QALYS are a measure of the state of health of a person or group which looks at both quality and quality of life lived. One QALY is equal to 1 year of life in perfect health. 21 Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe The incremental cost-effectiveness ratio (ICER) is a statistic used to summarize the cost-effectiveness of a healthcare intervention Stroke care and prevention models: ICER value of € 11, 685 per QALY gained 20 19
WHILE THERE ARE ISOLATED EXAMPLES OF POSITIVE INITIATIVES BY PATIENT GROUPS, HEALTHCARE INSTITUTIONS, AND PROFESSIONALS, ALL STAKEHOLDERS NEED TO UPSCALE THEIR RESPONSE TO THE SILENT THREAT OF FRAGILITY FRACTURES. Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe “There is indeed one thing I have learned: that an accurate diagnosis, which is relatively simple, can save women from a lot of suffering, fractures, and emotional damage. ” - Carmen, Spain FLS assessed by IOF Capture The Fracture® Program 20
Fragility fractures are a significant yet ignored public health threat…. … whose burden to patients, healthcare systems and societies is being neglected. As the European population ages, the burden of fragility fractures is set to rise. However this growing crisis can be addressed with appropriate prevention and management measures. NOW is time to BREAK the cycle and act to foster healthy ageing in our societies! Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe 21
FRAGILITY FRACTURES ARE A MAJOR OBSTACLE TO HEALTHY AGEING What will YOU do?
WHAT CAN YOU DO FOR PATIENTS WITH FRAGILITY FRACTURES? Policy recommendations across the EU 6 countries France Germany Italy § Implement the best secondary prevention strategies so that the first fracture is the last § § § Put in place incentives supporting the involvement of GPs in osteoporosis management Ensure consistent implementation of the DVO Medical Guidelines by all physicians treating patients with fragility fractures Put in place integrated care pathways specifically designed for patients who have experienced a fragility fracture § Overcome the existing sectoral split between hospital and outpatient care § Reduce costs associated with hospitalization through quality metrics § Foster interdisciplinary collaboration § Motivate individuals to play an active role in post-fracture care management § Create a fragility fracture registry Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe 23
WHAT CAN YOU DO FOR PATIENTS WITH FRAGILITY FRACTURES? Policy recommendations across the EU 6 countries Spain Sweden § Create national consensus care protocols § § Strengthen registries tracking fragility fractures and FLS’ impact Reach the 30% treatment target set by the National Board of Health and Welfare § Foster the development of fracture chains in all counties § Foster general practitioners’ involvement in secondary fracture prevention § Improve and harmonize post-fracture care through quality standards Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe UK § Improve the effectiveness, efficiency and patient experience of services against national guidance/standards § Direct future policies towards prioritising the effective reduction of the burden from fragility fractures § Motivate patients to change their behavior 24
THIS PROJECT WAS SUPPORTED BY A COALITION OF 12 ORGANISATIONS The data analysis presented in this report was conducted by Quantify, a health economics analysis and consulting firm based in Stockholm. Broken bones, broken lives: A roadmap to solve the fragility fracture crisis in Europe 25
FOR MORE INFORMATION www. iofbonehealth. org/broken-bones-broken-lives
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