Osteoporosis and fractures in women: the burden of disease

Abstract

Osteoporosis is a disease characterized by impaired bone microarchitecture and reduced bone mineral density (BMD) resulting in bone fragility and increased risk of fracture. In western societies, one in three women and one in five men will sustain an osteoporotic fracture in their remaining lifetime from the age of 50 years. Fragility fractures, especially of the spine and hip, commonly give rise to increased morbidity and mortality. In the five largest European countries and Sweden, fragility fractures were the cause of 2.6 million disability-adjusted life years in 2016 and the fracture-related costs increased from €29.6 billion in 2010 to €37.5 billion in 2017. In the European Union and the USA, only a small proportion of women eligible for pharmacological treatment are being prescribed osteoporosis medication. Secondary fracture prevention, using Fracture Liaison Services, can be used to increase the rates of fracture risk assessment, BMD testing and use of osteoporosis medication in order to reduce fracture numbers. Additionally, established primary prevention strategies, based on case-finding methods utilizing fracture prediction tools, such as FRAX, to identify women without fracture but with elevated risk, are recommended in order to further reduce fracture numbers.

女性骨质疏松和骨折：疾病的负担 摘要

骨质疏松的疾病特征是骨微结构受损和骨密度（BMD）减低, 可增加骨脆性与骨折风险。在西方社会, 50岁以后, 三分之一的女性和五分之一的男性可能会发生骨质疏松性骨折。脆性骨折, 尤其是脊柱和髋部骨折的发病率与死亡率会上升。2016年在欧洲五个最大的国家和瑞典, 脆性骨折损失了260万伤残调整生命年, 骨折相关成本从2010年的296亿欧元增加到了2017年的375亿欧元。在欧盟和美国, 仅小部分女性有资格获得抗骨质疏松药物治疗。骨折联络服务可用于骨折的二级预防, 增加骨折风险评估、骨密度检测及使用抗骨质疏松药物的机率, 可减少骨折的发生。此外, 还应建立骨折的一级预防策略, 利用以发现疾病为目标的骨折预测工具, 如FRAX, 识别没有骨折但存在较高风险的女性, 以减少骨折的发生。

Keywords:

• Osteoporosis
• fracture
• postmenopausal
• epidemiology

Potential conflict of interest

M. Lorentzon has received lecture fees from Amgen, Astellas, Lilly, Meda, Renapharma and UCB Pharma, and consulting fees from Amgen, Radius Health, UCB Pharma, Renapharma and Consilient Health. N. C. Harvey has received consultancy, lecture fees and honoraria from Alliance for Better Bone Health, AMGEN, MSD, Eli Lilly, Servier, Shire, UCB, Kyowa Kirin, Consilient Healthcare, Radius Health and Internis Pharma outside the scope of the submitted work. E. McCloskey has received consultancy, research funding, lecture fees and/or honoraria from AgNovos, AgNovos, AstraZeneca, Consilient Healthcare, Fresenius Kabi, GSK, Hologic, Internis, Lilly, ObsEva, Synexus and UCB outside the scope of this work. All other authors have no conflicts of interest.

Source of funding

Nil.