Swedish osteoporosis care

Abstract

The objective of this study was to review and describe the current state of Swedish osteoporosis care and to highlight ongoing challenges. This report encompasses quantitative health outcomes based on Swedish registry data as well as organizational and management aspects. Swedish osteoporosis care is characterized by a significant burden of disease, difficulties in identifying high-risk patients, and fragmented pathways for patients in need of secondary fracture prevention. This report aimed to describe the current state, gaps, and challenges in Swedish osteoporosis care, using Swedish national databases, questionnaires, and interviews with healthcare representatives. A secondary aim was to develop quality and process measures to compare differences between counties and to use those measures to describe the interaction between quantitative health outcomes and aspects of care organization and management. In conjunction with fractures, a considerably smaller proportion of men are treated than women, and a smaller proportion of older women are treated compared to younger groups. Between 3 and 16 % of patients receive treatment after a fracture, and the treatment rate in this patient group can likely increase. In addition to an unsatisfactory treatment rate, a limited number of those treated continue treatment throughout the recommended treatment durations, leading to increased risk of fracture. With a substantial variation between counties, there is a clear difficulty to identify non-persistent patients and switch to an alternative treatment. Collaboration around the patient across specialties has been lacking, and systems for secondary prevention have been concentrated to a few counties. However, when this study was conducted, there was a general trend towards implementing regional care programs. This report suggests possible strategies for improving quality of care and, hopefully, it can provide a basis for future evaluations and regional improvement of osteoporosis care in Sweden and other countries.

A health economic simulation model for the clinical management of osteoporosis

“…This "treatment gap" has been estimated at 23-80% depending on sex and age group in Sweden [6]. Similar estimates have been found in the UK, Germany, US and Spain [3,7].…”

“…A 10-year maximum treatment length was assumed as this would reflect that a proportion of patients remain on treatment for longer periods in clinical practice. For example, a Swedish register study showed that, using a 1-year permissible gap between prescriptions, the proportion of patients still persistent to treatment at 5 years after treatment start is about 20% and it is not unreasonable that a proportion of patients are treated beyond 5 years [6]. Also, safety and effect are documented in 7-10 years in clinical studies [29].…”

“…In addition to this treatment gap, in those who start treatment, persistence with osteoporosis treatments is poor in clinical practice-approximately 50% of patients discontinue after one year-which is shown to reduce anti-fracture efficacy of treatment [8]. In tandem, few patients switch to another treatment after discontinuation [6]. The future burden of osteoporosis, which is anticipated to grow due to aging populations, could potentially be lowered by reducing this treatment gap.…”

Cost-effectiveness of romosozumab for the treatment of postmenopausal women with severe osteoporosis at high risk of fracture in Sweden

“…This arises because of lower fracture risks in the younger populations, despite having a recent fracture and low BMD T-score. In clinical practice, it is expected that the proportion of the target patient population within the young groups is small since fracture risks increase exponentially with age, and the mean age in patient initiating osteoporosis treatment is around 72 years [ 23 ].…”

“…The proportion persistent to teriparatide, an injectable bone-forming agent administered daily, has been estimated to 70% after 1 year [ 22 ]. Persistence with romosozumab was assumed to be higher than teriparatide since less frequently administered drugs have been shown to be associated with greater persistence [ 23 ]. Persistence for each time point and treatment is shown in Supplementary Table 5 .…”