New report offers solutions to tackle the fragility fracture crisis in Italy
“Broken bones due to osteoporosis, known as fragility fractures, are a major concern for public health in Italy. Unless solutions are found, the current crisis will only escalate as our population continues to age,” warns Professor Maria Luisa Brandi, bone health expert at the San Raffaele Hospital of Milan and and President of the Fragility Fracture Observatory (Osservatorio Fratture da Fragilità [O.F.F.]).
“Although osteoporosis has an immense and increasing cost to society, it remains largely underdiagnosed and undertreated, with more than 2 million Italian women at high risk of fracture remaining untreated for the disease despite the existence of safe and effective medications. Should there be no change in policy, the number of fragility fractures is expected to increase by 25% over the next 15 years.”
To stimulate health policy change that could address the country’s osteoporosis treatment gap, the International Osteoporosis Foundation (IOF) Capture the Fracture® programme, in collaboration with leading Italian experts, has published a new policy report ‘Solutions for fracture prevention in Italy’. The report, available in English and Italian and developed with support from the Capture the Fracture® Partnership, highlights the osteoporosis burden and current policy landscape in Italy, and most importantly, outlines the policy recommendations that would effectively help to reduce fragility fractures in the population.
Professor Paolo Tranquilli Leali, past-President of the Società Italiana di Ortopedia e Traumatologia (SIOT) and President of the Foundation SIOT-DELITALA, stated: “Osteoporosis mostly affects older adults and this is a major cause for concern in Italy where 23.1%, of the Italian population is aged 65 years or older, projected to increase to a staggering 35% by 2050. Already, fragility fractures are among the top five causes of hospitalisation, posing a substantial societal and financial burden to the healthcare system. About 570,000 fragility fractures occurred in the year 2019 and the osteoporosis-related costs were estimated at €9.5 billion in the same year. The burden on family caregivers is the highest within the EU, with over 882 hours per 1,000 people, each year.”
The report’s key recommendations include the need for health authorities and healthcare providers to develop a common voice and strategy to integrate bone fragility prevention in national policies; to continue to identify and share best practices at a local level leading to the publication of an optimal patient pathway; and to increase post-fracture screening, diagnosis and treatment rates by facilitating the effective implementation of coordinated, multidisciplinary post-fracture care services, such as Fracture Liaison Services (FLS), in hospitals across the country.
An FLS serves to identify, treat and monitor patients who have sustained a first fracture and who are at highest risk of sustaining further fractures, especially within the first two years. Currently, it is estimated that only 3% of Italian hospitals and a maximum of 10% of general practitioners have an established referral system for fracture patients. This is significantly less than seen in the UK, where an estimated 55% of the population can be referred to an FLS.
Professor Brandi stated: “We’re clearly missing out on the opportunity to prevent recurring fractures, which are very costly to society and to the healthcare system. Today, approximately three-quarters of Italian women aged 50 years who have sustained a first fracture, don’t receive effective management to prevent recurring fractures. This is a dangerous disregard for those who are at highest risk of sustaining injuries such as hip fractures, which are life-threatening and, in survivors aged 90 years or more, result in some 35% being admitted to long-term care.”
“With collaboration and the will to succeed, we can build on a strong foundation to make change happen for the benefit of people with osteoporosis in Italy,” added Professor Tranquilli Leali. We have excellent clinical guidelines, there is a strong track record of cooperation among medical professionals and societies, and we have an adequate number of DXA scanners and access to medical interventions – in fact, more so than in other countries in the EU. Now it’s time to turn these successes into concerted action.”
Dr Philippe Halbout, CEO of the International Osteoporosis Foundation concluded: “We would like to extend our thanks to the dedicated Italian experts who have worked with the IOF Capture the Fracture® Policy Group to publish this important report. It provides a ‘roadmap’ of effective solutions that in synergy, would work to address the fragility fracture crisis in Italy. Through targeted, collaborative action, Italy could see fewer fractures, better patient outcomes, reduced healthcare costs, and most importantly, healthy mobility for its older population.”
About the Report
Solutions for Fracture Prevention in Italy is available in English and Italian on the Capture the Fracture® website. It is authored by the following Italian experts: Prof. Maria Luisa Brandi (Observatory on Fragility Fractures), Prof. Stefano Gonnelli (Universitá degli Studi di Siena), Prof. Andrea Giustina (University Vita-Salute San Raffaele), Prof. Paolo Tranquilli Leali (Società Italiana Ortopedia e Traumatologia), Prof. Giovanni Iolascon (Università degli Studi della Campania), and Prof. Umberto Tarantino (Tor Vergata University) in collaboration with the IOF-Capture the Fracture® Policy Group: Dr N. Fuggle, Prof. C. Cooper (University of Southampton); Ass. Prof. K. Javaid, Ass. Prof. R. Pinedo-Villanueva (University of Oxford), Ass. Prof. M. Hiligsmann (Maastricht University); and A. Soulié-Mlotek, Dr P. Halbout (International Osteoporosis Foundation).
About Capture the Fracture®
Capture the Fracture® (CTF) is a multi-stakeholder initiative, led by the International Osteoporosis Foundation (IOF), to facilitate the implementation of Post-Fracture Care (PFC) Coordination Programs, such as Fracture Liaison Services (FLS), for secondary fracture prevention. The CTF initiative, now celebrating its 10th year of service, aims to drive changes at local and regional levels to prioritize secondary fracture prevention. It sets global best practice standards and offers recognition for Fracture Liaison Services (FLS) through its Best Practice Framework. CTF also provides essential resources and documentation to build the case for prioritization of secondary fracture prevention and to help drive the implementation and quality improvement of FLS. Mentorship programs that support the development of FLS at the local level are also offered.
The Capture the Fracture® Partnership, a global initiative launched in 2020, is a collaboration between the International Osteoporosis Foundation (IOF), the University of Oxford, Amgen and UCB, amplifying the Capture the Fracture® programme launched in 2012. It seeks to address the global health burden of osteoporosis through five interconnected pillars, following a comprehensive, top-down and bottom-up approach, and aligning stakeholders at the international, national and local level in prioritized countries across the Asia Pacific, Europe, Latin America and the Middle East. The aim is to prioritize PFC and drive more rapid uptake of PFC coordination programs around the world.
Currently, the CTF network includes 810 FLS in 53 countries worldwide. FLS are invited to apply for free assessment and recognition via the CTF website’s online Best Practice Framework application platform.
The International Osteoporosis Foundation (IOF) is the world's largest nongovernmental organization dedicated to the prevention, diagnosis, and treatment of osteoporosis and related musculoskeletal diseases. IOF members, including committees of scientific researchers as well as more than 300 patient, medical and research organizations, work together to make fracture prevention and healthy mobility a worldwide heath care priority. https://www.osteoporosis.foundation @iofbonehealth