The osteoporosis treatment gap

In recent decades, osteoporosis has evolved from being viewed as an inevitable consequence of ageing to becoming a recognised disease, with a diagnostic definition, validated methods of assessment, and a wide range of highly effective medications. Despite this, osteoporosis care remains notably less than optimal worldwide. Whilst treatment rates with anti osteoporosis medications have increased substantially over the last two decades, in most countries globally it is still the minority of patients at high fracture risk who receive appropriate assessment and treatment for osteoporosis. Even in patients who have sustained a fragility fracture, fewer than 20% actually receive appropriate anti osteoporosis therapy in the year following the fracture. Alarmingly, in many countries there is evidence that treatment rates have actually declined in the last 5-10 years. This chapter documents the current gaps in the assessment and treatment of osteoporosis and explores some of the possible underlying reasons. These include factors such as the lack of prioritisation of osteoporosis therapy in ageing populations with multimorbidity, disproportionate concerns regarding the rare side effects of anti-resorptives and adverse changes to reimbursement. Given that all the elements required to maintain bone health and prevent osteoporotic fractures are now well established, it is absolutely imperative that physicians, policymakers and political leaders make the necessary changes to ensure that every patient at high fracture risk receives appropriate assessment and treatment to prevent a potentially devastating, and life-limiting, osteoporotic fracture.