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Neglecting fragility fractures denies people a chance for active and healthy ageing
20 October 2021
My work on osteoporosis and fragility fractures exposed me to the significant impact both have on economies and health systems across Europe, but earlier this year I learnt first-hand how they can affect a person’s quality of life.
Osteoporosis is a disease characterised by a reduced density of bone tissue and is one of the main risk factors for fragility fractures, which occur when a bone breaks after a person falls from ‘standing height or less’. Fragility fractures are often found in women above the age of 50.
In 2019, there were almost 12,000 fragility fractures every day in Europe – an increase of 22% from 2010–2019. Over the past decade, direct healthcare costs associated with osteoporosis have risen by 64%.
These figures took on greater significance for me after a bike accident earlier this year, when I found myself on a trauma and orthopaedics ward among women in their 50s, 60s and 70s, all of whom were recovering from fragility fractures.
Fragility fractures are life-changing events
Fragility fractures can lead to a rapid decline in functioning and overall health, diminishing independence and reduced quality of life due to the long-term physical impairment and pain they cause. They are responsible for more years of life lost due to disability and early death than stroke in six European countries. After a hip fracture, for example, one in four people will not be able to return to an independent living situation.
Delirium is common, particularly in hip fracture patients. Some of the women I shared a room with were in a delirious state for days; they often didn’t understand what had happened to them.
Delirium is common, particularly in hip fracture patients. It often delays or impedes recovery, increasing medical costs and length of hospital stays. Some of the women I shared a room with were in a delirious state for days; they often didn’t understand what had happened to them. Visiting family members were also highly concerned about their loved one’s level of confusion and difficulty moving. It seemed likely that many of them would either stay in hospital for a long time or not be able to return home.
One evening, a woman on the ward reminisced about her days as a fashion designer and her flamboyant lifestyle – she missed hosting dinner parties for artist friends. As she nervously planned for her discharge, she pondered: who will do the grocery shopping and how she will manage living on her own? For another woman, it wasn’t her first time with a fragility fracture. The pain from her previous fracture persisted, preventing her from sleeping. She also rarely left her house because of the fear of falling again.
We need to ensure people maintain their productivity, mobility and independence as they age
We know how to prevent and mitigate the impact of fragility fractures. But gaps in care persist, leaving many people across Europe to deal with constrained mobility, chronic pain and fear of a subsequent fracture.
Detecting fracture risk early and prescribing osteoporosis medication can effectively prevent fragility fractures. Yet recent data show that 71% of people in Europe who would benefit from preventive osteoporosis medication are not receiving it – a significant increase from 55% in 2010. In addition, dedicated follow-up care post-fracture is key for prevention, but remains insufficient in many countries.
Recent data show that 71% of people in Europe who would benefit from preventive osteoporosis medication are not receiving it – a significant increase from 55% in 2010.
Action on fragility fractures can help us move towards more sustainable health systems
With an ageing population and increasing life expectancy, the number of people with osteoporosis and fragility fractures is expected to rise by almost 25% from 2019 to 2035. This, in conjunction with rising treatment costs, will place significant strain on health system sustainability.
The COVID-19 pandemic has further disrupted care for people with fragility fractures. Data from a UK-based fracture clinic show that the number of people attending follow-up appointments halved during the UK’s first lockdown, from March to May 2020, compared with the same period in previous years. An increased risk of fragility fractures caused by bone and muscle loss can also be attributed to home isolation associated with lockdowns and an extended period of immobilisation for people who have been unwell with COVID-19.
Early detection and implementation of best-practice follow-up care, such as fracture liaison services, could help to tackle the burden of fragility fractures. A recent study found that expanding access to fracture liaison services to everyone above the age of 50 could prevent more than 19,000 fragility fractures per year and save an estimated €285 million in six major European countries. Addressing fragility fractures could contribute significantly to health system sustainability, and ensure that people such as the women I shared a ward with have the opportunity to lead active and healthy lives as they age.