Summary This report describes the epidemiology, burden, and treatment of osteoporosis in the 27 countries of the European Union (EU27). Introduction Osteoporosis is characterized by reduced bone mass and disruption of bone architecture, resulting in increased risk of fragility fractures which represent the main clinical consequence of the disease. Fragility fractures are associated with substantial pain and suffering, disability and even death for affected patients and substantial costs to society. The aim of this report was to characterize the burden of osteoporosis in the EU27 in 2010 and beyond. Methods The literature on fracture incidence and costs of fractures in the EU27 was reviewed and incorporated into a model estimating the clinical and economic burden of osteoporotic fractures in 2010.Results Twenty-two million women and 5.5 million men were estimated to have osteoporosis; and 3.5 million new fragility fractures were sustained, comprising 610,000 hip fractures, 520,000 vertebral fractures, 560,000 forearm fractures and 1,800,000 other fractures (i.e. fractures of the pelvis, rib, humerus, tibia, fibula, clavicle, scapula, sternum and other femoral fractures). The economic burden of incident and prior fragility fractures was estimated at € 37 billion. Incident fractures represented 66 % of this cost, long-term fracture care 29 % and pharmacological prevention 5 %. Previous and incident fractures also accounted for 1,180,000 quality-adjusted life years lost during 2010. The costs are expected to increase by 25 % in 2025. The majority of individuals who have sustained an osteoporosis-related fracture or who are at high risk of fracture are untreated and the number of patients on treatment is declining.

Summary This report describes epidemiology, burden, and treatment of osteoporosis in each of the 27 countries of the European Union (EU27). Introduction In 2010, 22 million women and 5.5 million men were estimated to have osteoporosis in the EU; and 3.5 million new fragility fractures were sustained, comprising 620,000 hip fractures, 520,000 vertebral fractures, 560,000 forearm fractures and 1,800,000 other fractures. The economic burden of incident and prior fragility fractures was estimated at € 37 billion. Previous and incident fractures also accounted for 1,180,000 quality-adjusted life years lost during 2010. The costs are expected to increase by 25 % in 2025. The majority of individuals who have sustained an osteoporosis-related fracture or who are at high risk of fracture are untreated and the number of patients on treatment is declining. The aim of this report was to characterize the burden of osteoporosis in each of the EU27 countries in 2010 and beyond. Methods The data on fracture incidence and costs of fractures in the EU27 were taken from a concurrent publication in this journal (Osteoporosis in the European Union: (2013( ) 8:137 DOI 10.1007 Medical Management, Epidemiology and Economic Burden) and country specific information extracted. Results The clinical and economic burden of osteoporotic fractures in 2010 is given for each of the 27 countries of the EU. The costs are expected to increase on average by 25 % in 2025. The majority of individuals who have sustained an osteoporosis-related fracture or who are at high risk of fracture are untreated and the number of patients on treatment is declining. Conclusions In spite of the high cost of osteoporosis, a substantial treatment gap and projected increase of the economic burden driven by aging populations, the use of pharmacological prevention of osteoporosis has decreased in recent years, suggesting that a change in healthcare policy concerning the disease is warranted.

The findings in this study indicate that there appear to be important variations in the QoL decrements related to fracture between countries.

In spite of the high cost of osteoporosis, a substantial treatment gap and projected increase of the economic burden driven by an aging population, the use of pharmacological prevention of osteoporosis is significantly less than optimal, suggesting that a change in health care policy concerning the disease is warranted.

The main objective of this study was to describe real-world treatment persistence with subcutaneous tumor necrosis factor-alpha inhibitors (SC-TNFi) in patients with ankylosing spondylitis, psoriatic arthritis, or rheumatoid arthritis [collectively immune-mediated rheumatic disease, (IMRD)] in Sweden. A secondary objective was to describe potential effects on health care resource utilization (HCRU) cost from non-persistence. Patients were identified through filled prescriptions for adalimumab (ADA), etanercept (ETA), certolizumab pegol (CZP), and golimumab (GLM) between 5/6/2010 and 12/31/2012 from the Swedish Prescribed Drug Register. Persistence was estimated using survival analysis. Costs were derived from HCRU and comprised specialized outpatient care, inpatient care and non-disease-modifying antirheumatic drug medications. A total of 4903 patients were identified (ADA: 1823, ETA: 1704, CZP: 622, GLM: 754). Comparisons over 3 years showed that GLM had significantly higher persistence than ADA (p = 0.022) and ETA (p = 0.004). The mean difference in non-biologic HCRU costs between persistent and non-persistent patients was higher after compared to before the start of biologic therapy. SC-TNFi-naïve IMRD patients initiating treatment with GLM had significantly higher persistence rates than patients initiating treatment with ADA or ETA in Sweden. Furthermore, persistence rates observed in the study were lower than those observed in clinical trials, highlighting the need for an all-party (provider-patient-payer-drug manufacturer) engagement and development of programs to increase persistence rates in clinical practice, thus leading to improved clinical outcomes. In addition, the results of this study indicate that persistence to treatment with SC-TNFi may be associated with cost offsets in terms of non-biologic costs.

Many guidelines for the assessment and treatment of osteoporosis recommend that intervention be considered in men and women who have sustained a fragility fracture.(1) Guidelines in North America (2,3) specifically refer to a prior hip fracture (and spine fracture) as a condicio sine qua non for treatment because of the marked effect of fractures at these sites on both morbidity and mortality. In addition, hip fractures have large economic consequences. For example, hip fractures account for 17% of all osteoporotic fractures in Europe but comprise 54% of the direct cost of fractures.(1) The need for treatment arises because of the increased risk of a second fracture, (4) which is particularly acute in the immediate postfracture period when fracture rates are substantially increased. Despite a number of advances, particularly in the diagnosis of osteoporosis, the assessment of fracture risk, the development of interventions that reduce the risk of fractures, and the production of practice guidelines, many surveys indicate that a minority of men and women at high fracture risk actually receive treatment. (8)(9)(10)(11)(12)(13)(14) In patients who sustain a fragility fracture, fewer than 20% of individuals receive therapies to reduce the risk of future fracture within the year following the fracture. (11,12,(15)(16)(17)(18) Paradoxically, the therapeutic care gap may be particularly wide in the elderly in whom the importance and impact of treatment is high; studies have shown that as few as 10% of older women with fragility fractures receive any osteoporosis therapy (estrogens not considered). (11,19,20) Furthermore, treatment rates following a fracture are lower for those individuals who reside in long-term care.(12) This contrasts with the situation following myocardial infarction, for which condition a significant care gap has been overcome in the past 15 years: 75% of such individuals now receive beta blockers to help prevent recurrent myocardial infarction. (21) In this issue of the Journal of Bone and Mineral Research, Solomon and colleagues (22) report on the uptake of osteoporosis medications in the year following hip fracture in a large retrospective analysis of nearly 100,000 men and women aged 50 years or more who were hospitalized for hip fracture over a period of 1 year. The study, based on U.S. administrative insurance claims data, followed the uptake of osteoporosis medication within 12 months after discharge from hospital. The estimated probability of receiving osteoporosis medication within 12 months after discharge from hospital was 28.5% over this time period, but varied by year. Indeed, the rates declined significantly over a 10-year interval, from 40.2% in 2002, to 20.5% in 2011.European studies have compared the treatment gap across countries, albeit indirectly. The number of patients treated in each country was computed from IMS Health (Danbury, CT, USA) sales data for 2010, adjusted for suboptimal adherence, and expressed as treatment years.(1) The use of hormone replacement therapy was excl...

The present study indicates that since 2006, age-standardized incidence of hip fractures has been declining in the Austrian population aged 50 years and above. This reversal in the secular trend has primarily been driven by a decrease in hip fracture incidence in women.

Several studies have shown excess risk for a number of comorbidities in patients with psoriasis compared with the general population, but data on cause-specific mortality in this patient population are limited. The aim of this study was to estimate the associations of psoriasis and 12 specific causes of death and all-cause mortality in patients with mild and severe psoriasis. The study was based on data from Swedish administrative registers and compared the risk of death in 39,074 patients with psoriasis with 154,775 sex-, age- and residency-matched referents using Cox proportional hazards models. In patients with mild and severe psoriasis, the strongest associations were observed for deaths due to kidney disease (hazard ratio [HR]=2.20, p < 0.01) and liver disease (HR = 4.26, p < 0.001), respectively. Whilst cardiovascular disease was the main driver of excess mortality in absolute terms, the risks for other causes of death were also substantially elevated in patients with psoriasis compared with matched referents.