Osteoporosis and fragility fractures

Osteoporosis – a chronic disease that weakens bones and leaves people at risk of a fragility fracture – is expected to become more common as populations age across Europe.

Osteoporosis and fragility fractures

Osteoporosis – a chronic disease that weakens bones and leaves people at risk of a fragility fracture – is expected to become more common as populations age across Europe.


Osteoporosis is a disease characterised by a reduction in the density of bone tissues, eventually leading to bone fragility and susceptibility to fractures.

Fragility fractures can be life-changing events, often bringing pain, isolation and dependency. Every day, there are almost 10,000 fragility fractures in the EU – most of which are among women over the age of 50.

While osteoporosis is more prevalent among women than men, the perception that it affects only women is misguided. Globally, 1 in 2 women and 1 in 5 men aged over 50 will experience a fragility fracture in their lifetime. Fragility fractures are a major driver of preventable deaths and disability, representing a significant economic burden on healthcare systems and societies – and this burden will only increase as populations age.

When osteoporosis is identified early and measures such as lifestyle changes and medication are put in place, further loss of bone density can be slowed or reversed, subsequently reducing the risk of a fragility fracture. Yet people with osteoporosis are too often failed by healthcare systems, and too many preventable fractures occur. Across Europe, almost 70% of women over 70 who have osteoporosis have not been diagnosed, and even after a fracture, 60–85% of women do not receive treatment to prevent subsequent fractures from occurring.

Osteoporosis and fragility fractures are a major public health issue. Lifelong prevention, timely intervention and appropriate multidisciplinary management can protect people from developing osteoporosis and minimise their risk of experiencing a fracture – ultimately improving quality of life for millions of people.


Osteoporosis affects 21% of women aged 50–84 in the EU


Osteoporosis affects 6% of men aged 50–84 in the EU


Fracture-related healthcare costs in the EU are expected to increase by 22% between 2010–2025, to €120bn

What we achieved

To support policymakers to implement the highest priority changes for improved care for people with osteoporosis and at risk of fragility fracture, HPP established five key building blocks of an effective policy response. We did this by undertaking desk research and assembling a Working Group and Parliamentary Forum of experts and policymakers from across Europe. Two round-table events were held during 2019, in London and Brussels, at which these stakeholders discussed the research and developed the content for a policy toolkit. This work was supplemented by interviews which HPP conducted with a range of experts including carer representatives, healthcare professionals and healthy ageing advocates.

The project’s main output is Osteoporosis and fragility fractures: a policy toolkit, which brings together the recommendations for a policy response in a call to action for policymakers working at the European, national and regional levels. This is supplemented by case studies of best practice, supporting resources for policymakers and individual country profiles for 10 countries: Belgium, Finland, France, Germany, Ireland, Italy, the Netherlands, Romania, Spain and the UK. A video was also produced to support the launch of the policy toolkit, featuring experts from the project’s Working Group and Parliamentary Forum.

Additional outputs include individual national-level infographics for each of the featured countries, produced in the local language. Key stakeholders in these countries were provided with bespoke in-language social media content to promote the work.

HPP’s work in this area continues, with plans to publish focus briefs on key topics in the coming months.

Key partners and stakeholders

Working group and Parliamentary Forum:

  • John Bowis, Honorary Patron, Health First Europe; Former Health Minister, UK; Member of the European Parliament for the UK
  • Cyrus Cooper, President, International Osteoporosis Foundation; Professor of Rheumatology and Director, MRC Lifecourse Epidemiology Unit; Vice-Dean of Medicine, University of Southampton; Professor of Epidemiology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
  • Penilla Gunther, Project Manager, FOKUS Patient; Former Member of Parliament, Sweden
  • Marian Harkin, Former Member of the European Parliament for Ireland
  • Paul Mitchell, Communications Director, Fragility Fracture Network; Honorary Departmental Senior Research Fellow, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
  • Adrian Sanders, Secretary General Parliamentarians for Diabetes Global Network; Former Member of Parliament, UK

Experts who provided interviews, document review, feedback and/or comments on drafts:

  • Clive Bowman, Visiting Professor of Gerontology, School of Health Sciences, City, University of London, UK
  • Karsten Dreinhöfer, Chair, Global Alliance for Musculoskeletal Health of the Bone and Joint Decade (G-Musc); Professor, Department of Orthopedics and Traumatology Medical Park Berlin Humboldtmühle and Charité Universitätsmedizin Berlin, Germany
  • Mickaël Hiligsmann, Associate Professor of Health Economics and Health Technology Assessment, Maastricht University, the Netherlands
  • Timo Jämsä, President, European Alliance for Medical and Biological Engineering & Science; Professor, Medical Technology, University of Oulu, Finland
  • Nadia Kamel, Project Officer, Eurocarers
  • Andréa Marques, Professor, Nursing School of Coimbra; Registered Nurse of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Portugal
  • Maria Teresa Parisotto, Chief Nurse Advisor, Fresenius Medical Care; upcoming Executive Director, European Specialist Nurses Organisation
  • Didier Poivret, Rheumatologist, Regional Hospital Metz-Thionville, France
  • Wolfhart Puhl, Professor Emeritus, University Ulm, Germany; Past President, European Federation of National Associations of Orthopaedics and Traumatology
  • Marcel Smeets, Senior Consultant, European Ageing Network
  • Stecy Yghemonos, Director, Eurocarers

Experts interviewed for country profiles:

  • Casandra Cristea, Project Manager, C’entro associazione, Italy
  • Ansa Holm, Executive Director, Finnish Osteoporosis Association, Finland
  • Conor Hurson, Clinical Orthopaedic Lead, Irish Hip Fracture Database, Ireland
  • M Kassim Javaid, Associate Professor in Metabolic Bone Disease, University of Oxford, UK
  • Andreas Kurth, Professor, Campus Kemperhof, Community Clinics Middle Rhine; Chairman, Dachverband Osteologie, Germany
  • Michaël Laurent, Board Member, Belgian Bone Club; Consultant, Centre for Metabolic Bone Diseases, University Hospitals Leuven; Attending Geriatrician, Department of Geriatrics, Imelda Hospital Bondheiden, Belgium
  • Jan van Megen, Senior Director Marketing & Academy Europe, Arjo, Netherlands
  • Moira O’Brien, Emeritus Professor of Anatomy, Trinity College Dublin; President, Irish Osteoporosis Society, Ireland
  • Diana Păun, Associate Professor of Endocrinology, CI Parhon National Institute of Endocrinology, Carol Davila University of Medicine and Pharmacy, Romania
  • Olli Simonen, Chairman, Finnish Osteoporosis Society, Finland
  • Pauliina Tamminen, Self-management Coordinator, Finnish Osteoporosis Association, Finland
  • Sari Tervonen, Executive Director, Carers Finland, Finland
  • Thierry Thomas, Professor of Medicine and Head of Rheumatology, University Hospital St Etienne, France
  • Anne Thurston, Head of Quality Improvement, Royal Osteoporosis Society, UK
This project was initiated and funded by Amgen (Europe) GmbH.