Bone health neglected during medical check-ups, IOF survey reveals

Reviewed by Lily Ramsey, LLMOct 20 2023

An International Osteoporosis Foundation (IOF) survey completed by more than 7000 women aged 60 and over from five countries has revealed that broken bones affect almost one in two women in this age group, and that, paradoxically, bone health is neglected during medical check-ups.

The survey, carried out via Facebook in the lead-up to World Osteoporosis Day, was targeted at women aged over 60 in Brazil, Japan, South Korea, Spain, and the UK.

The survey invitation reached more than 2.5 million women, and a total of 7139 surveys were fully completed.

Key findings of the survey

• On average, almost half (43%) of the women surveyed stated that they had broken a bone following a minor fall or bump after the age of fifty. The percentage was highest in Japan (73.3%) and the UK (60.9%), and lowest in Brazil (21.6%).
• Evaluation and treatment were clearly inadequate as an average of 32.7% did not have a diagnostic scan and 45% did not receive any kind of treatment for osteoporosis following their fracture. The treatment gap was highest in Spain where 58.4% stated that they had not received treatment, followed by Brazil (52.4%).
• Of the 57.16% of respondents who indicated they had not broken a bone, an average of 31.3% stated that they had never discussed bone health or osteoporosis with their doctors. This was highest in the UK (51.1%) followed by Japan and Spain (each 31.3%). Of those who had discussed bone health with their doctors, an average of 63% indicated that they had a diagnostic scan (ranging from 43.7 % in the UK to 72% in Brazil and South Korea) and an average of only 13% stated that they had discussed risk factors.
• In all countries surveyed, wrist fractures were the most common type of fracture (average 33.1%) followed by spine fractures (average 20.1%).
• Spinal fractures due to osteoporosis often remain undiagnosed and unrecognized. A high percentage of the women who said they had not broken a bone indicated that they were experiencing either back pain (average 49.4%) or height loss of more than 4 cm / 1 ½ inches (average 18.2%), with the latter ranging from 6.7% in Japan to 25.7% in Spain.

Osteoporosis and the need for post-fracture care

Osteoporosis is a progressive disease that results in weak and fragile bones which can break easily, even after a minor slip from standing height, a sneeze, or simply from bending to pick up a grocery bag. Although osteoporosis affects both women and men, it is most common in older women as the protective effect of oestrogen declines with menopause. Fractures resulting from osteoporosis can be life-changing, leading to pain, immobility, extended hospital stays and, often, to significant loss of quality of life and independence.

A prior osteoporotic fracture is a predictor of more, and often more serious, secondary fractures. Without appropriate post-fracture care women who have fractured are at double the risk of more fractures, and the risk is highest in the following two years. With post-fracture care, including appropriate evaluation, treatment and follow-up, the risk of subsequent fractures can be greatly reduced.

This international survey confirms that osteoporosis-related fractures represent a major health issue, with almost one in two of the women surveyed having sustained an osteoporosis-related fracture. Furthermore, although we know that one fragility fracture doubles the risk of more fractures, the survey found that some 45% of the women who had broken a bone did not go on to receive the anti-osteoporosis treatment needed to prevent more, potentially life-threatening fractures in the future."

It was also distressing to see that so many doctors are not discussing bone health with their patients. Whereas cholesterol levels and blood pressure are routinely controlled and treated for the prevention of cardiovascular events, women are evidently not being routinely evaluated for osteoporosis, the underlying cause of potentially debilitating fragility fractures."

Dr Famida Jiwa, Chair of the IOF Subcommittee of Patient Societies

IOF President Professor Cyrus Cooper called for action:

"On the occasion of World Osteoporosis Day, we urge healthcare professionals to prioritize secondary fracture prevention in their fracture patients, to routinely assess post-menopausal women for osteoporosis risk factors, and to provide diagnostic scanning according to national guidelines."

"A change of mindset is needed to help ensure that women enjoy healthy mobility and independence as they age."