A new report issued by the International Osteoporosis Foundation (IOF) Capture the Fracture^® programme, in collaboration with leading Spanish experts, aims to stimulate health policy change that will address the enormous osteoporosis treatment gap. Currently, more than 1.1 million Spanish women who are at high risk of fracture remain untreated for osteoporosis, despite the availability of safe and effective medications. Without treatment, osteoporosis leads to broken bones which pose an immense personal and societal burden, resulting in enormous costs to the Spanish healthcare system. Currently, osteoporosis-related healthcare expenditure is at least €4.3 billion annually, of which approximately €2.2 billion is attributed to long-term disability. 

The report ‘Solutions for fracture prevention in Spain’, available in Spanish and English, and developed with support from the Capture the Fracture^® Partnership, outlines the osteoporosis burden and current policy landscape in Spain, and most importantly, provides  policy recommendations that would effectively help to reduce fragility fractures in the population.  

“Given an ageing population and the current treatment gap, the number of fragility fractures in Spain is expected to increase by 30% over the next 15 years,” said Dr Manual Naves, Past President of the Sociedad Española de Investigación Ósea y del Metabolismo Mineral (SEIOMM). He added, “For every 1000 individuals aged over 50 years, an estimated 12 years are lost due to disability, not to mention the high mortality following hip fractures, after which one in three patients die within two years. Aside from the tragic human cost, this increase in older adults needing surgery and long-term care threatens to overwhelm the capacity of our healthcare services. Now is the time to implement proven solutions to tackle this growing fracture crisis.”

The report specifically recommends the implementation of coordinated systems of post-fracture care known as Fracture Liaison Services (FLS). 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, only around 18% of Spanish hospitals have such a service. 

Dr José Ramón Caeiro, Past President and Executive Committee member of the Sociedad Española de Fracturas Osteoporóticas (SEFRAOS), stated: “A hospital without an FLS is missing out on the opportunity to prevent recurring fractures, which are life-threatening and costly to the healthcare system. In fact, a simulation model estimates that increased implementation of FLS nationwide would lead to the prevention of about 3,560 subsequent fragility fractures over the next five years, and would result in substantial improvements in patient outcomes, fewer surgeries and hospitalizations, and greater savings than interventions for other chronic diseases.”

As well as recommending the rollout of more FLS nationwide to increase post-fracture screening, diagnosis and treatment rates, the report also calls for osteoporosis to be recognized as a chronic and progressive condition by health authorities. Currently, despite its immense burden in the older population, osteoporosis is neglected compared to other chronic diseases. Fragility fracture should also be prioritized within healthcare management, including by involving primary care providers in secondary fracture prevention. Furthermore, public awareness of osteoporosis must be heightened, and one way to do so is to empower patient associations to communicate the burden of osteoporosis. Finally, the report recommends the expansion of national fracture registries which would enable health authorities to quantify the burden of fractures, and provide data to measure FLS effectiveness, patient outcomes, and areas where quality improvement is needed.  

As indicated in the new Report, a significant step forward in the mission to prioritize osteoporosis and fracture prevention in Spain was the initiation of the Platform for the Prevention of Osteoporotic Fractures (PFO) in May 2022. The PFO brings together key stakeholders, including influential Spanish patient and scientific organizations in the bone field such as AECOSAR, SEIOMM, FHOEMO, SEFRAOS, among other health-related organizations. Thanks to the efforts of the PFO Scientific Committee and its Coordinators, Dr Carmen de Aragón (former chair of the Health Commission in the Spanish Senate), and Dr Remedios Martel (former Director General of Public Health in the Andalusian government, former deputy of the Andalusian Parliament and former representative in the Congress of Deputies), the PFO was presented to the Spanish Senate Health Commission, chairs of the Health Commissions from the conservative and socialist parties in the Congress of Deputies as well as the Health Commission of the Madrid, Andalusia & Catalonia Parliaments, thus bringing the fragility fracture crisis to the attention of lawmakers across the political spectrum.

Dr Philippe Halbout, CEO of the International Osteoporosis Foundation concluded: “We thank the leading Spanish experts who have worked with the IOF Capture the Fracture® Policy Group to publish this succinct guidance. The report is a unique resource which provides a ‘roadmap’ of effective solutions that in synergy, would lead to the reduction of osteoporosis-related fractures in Spain.”

“If all stakeholders who have the interest of patients at heart work collaboratively and take action at the national and regional level, the result will be fewer fractures, better patient outcomes, reduced healthcare costs, and most importantly, lives saved.” 

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About the Report 
Solutions for Fracture Prevention in Spain is available in English and Spanish on the Capture the Fracture® website.  It is authored by the following Spanish experts: Dr Manuel Naves Diaz (Hospital Universitario Central de Asturias) , Prof. Santiago Palacios (Instituto Palacios), Dr José Manuel Cancio (Universitat Autónoma de Barcelona), Dr Antonio Naranjo Hernández (University of Las Palmas de Gran Canaria ), Dr Jesus Mora-Fernández (Hospital Clínico San Carlos), and Dr Enric Duaso (Hospital de Igualada), 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 the Platform for the Prevention of Osteoporotic Fractures (PFO)
The PFO’s vision and mission is to advocate for the prioritization of the prevention of osteoporotic fractures on the political agenda so that those responsible for health policies become aware of a serious problem that affects millions of people. The PFO puts forward effective solutions to reduce osteoporotic fractures, including through the implementation of post-fracture care coordination programs such as Fracture Liaison Services, to ultimately improve the quality of life of people who suffer from osteoporosis. Institutional partners of PFO include leading Spanish patient and scientific organizations in the bone field such as AECOSAR, SEIOMM, FHOEMO, SEFRAOS, among other medical and health-related organizations. For further information and to download guidance and resources, visit https://fracturasporosteoporosis.com/  

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 808 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. https://www.capturethefracture.org    #CaptureTheFracture

About IOF
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