More than 831,000 fragility fractures occur annually in Germany, the equivalent of 95 broken bones per hour. The cause is osteoporosis, a disease in which the skeleton becomes weak and fragile, increasing the risk of fragility fractures that result in disability, loss of independence, and premature death for some sufferers. Across the country, osteoporosis affects nearly 5.6 million people, of which 4.5 million are women. Despite the availability of effective and safe medications to reduce the risk of fragility fractures, an enormous treatment gap persists: it is estimated that 2.5 million women aged 50 years or over, or approximately 76% of all women who are at high risk of fracture, remain untreated for osteoporosis.

The International Osteoporosis Foundation (IOF) Capture the Fracture® program, in partnership with leading German experts, has released a new report entitled 'Solutions for Fracture Prevention in Germany' (English / German ). The report outlines the osteoporosis burden and healthcare policy landscape in Germany and proposes key strategies aimed at curbing the escalating incidence of costly fragility fractures. 

The aging of the population is driving a rapid rise in osteoporosis-related fractures and associated healthcare costs

A co-author of the report, Dr Uwe Maus, Head of Endoprosthetics and Osteology at the University Hospital Düsseldorf and Vice-President of the German Osteology Society (DVO), stated:

“Fragility fractures already pose a major health burden in the senior population, and they are associated with escalating financial costs which amounted to an estimated €13.8 billion in 2019. By 2050, 30% of the German population will be aged over 65 years, compared to 19% in 2006. This shift in demographics will markedly increase the incidence and societal burden of fragility fractures, threatening to strain the capacity of our healthcare system, including the provision of long-term care. It’s evident that this impending crisis needs to be addressed urgently, starting with the implementation of strategies to improve treatment initiation and adherence, and a focus on the prevention of recurring fractures.” 

Addressing the urgent need to prevent recurring fractures

It is critically important that any patient who has fractured is identified and treated to reduce the risk of future fractures.  A German study that included about 18,000 fracture patients demonstrated that subsequent fractures occurred in 16% of patients during a 1-year follow-up period. Another study found that in patients aged 70 years and above, 30% had at least one subsequent fracture during a median follow-up of 3.2 years. Hip fractures are of particular concern given that they are life-threatening and costly, generating a legacy of financial burden. In Germany, 12% of hip fracture patients are institutionalized within 6 months of discharge from the hospital, with the risk of institutionalization rising exponentially with age. Approximately 21% of hip fracture patients die within 6 months and 28% within 12 months of the fracture. 

Nevertheless, only 20% to 40% of German women receive anti-osteoporosis treatment within the first year of an osteoporotic fracture, and persistence to the medications is low, estimated to lie between only 17% and 40%. 

A multidisciplinary, coordinator-based post-fracture care service, most commonly known as a Fracture Liaison Service (FLS), is a proven way to ensure that these high-risk patients are identified and offered the post-fracture care they need to regain healthy mobility and prevent future fractures. Germany currently lags in the implementation of FLSs, which are available in only 1-10% of hospitals that treat fracture patients.

Positive conditions for effective management are outweighed by gaps and missed opportunities

Germany has several positive pre-conditions for effective osteoporosis management in place, including universally adopted management guidelines, robust collection of data through a national hip fracture registry, and full reimbursement of osteoporosis medications. Furthermore, the approval of the Disease Management Program for Osteoporosis (DMP) by the responsible government agency has elevated osteoporosis to its justified status as one of the most important chronic and progressive conditions. This means that, roughly since 2023, patients diagnosed with osteoporosis and requiring anti-osteoporosis medication are theoretically able to receive care within the structured treatment program. 

Dr Peyman Hadji, Professor of Obstetrics, Gynaecology and Endocrinology at Philipps University, Marburg, Germany, and member of the IOF Committee of Scientific Advisors, stated: 

“The approval of the DMP was an important step forward, and it’s a pity that organizational and funding issues have stifled its progress and uptake. However, this is just one among several challenges we face. There is currently no consistent implementation of a robust treatment pathway to ensure adequate post-discharge care, reinforced by a split between hospital and primary care settings regarding the diagnosis and treatment of osteoporosis. This is further hindered by the lack of an electronic sharing system, which means that critical information such as a patient’s imaging results, previous fractures, and prescribed treatments, is not shared between hospitals and private practices.”

The new report makes four key recommendations that would address these key obstacles. They include the need for greater financial incentives for osteoporosis care and FLS development; optimization of the patient and treatment pathway; facilitating greater FLS uptake to increase post-fracture screening, diagnosis, and treatment rates; and improving public awareness of osteoporosis.

Dr Philippe Halbout, CEO of the International Osteoporosis Foundation, thanked the many national experts who worked with the IOF Capture the Fracture® Policy Group to publish the recommendations, adding: 

“This valuable resource serves as a guide to effective solutions that, when implemented together, would result in fewer fractures, lower healthcare costs, improved patient outcomes, and, crucially, enhanced health, mobility, and quality of life for the elderly population in Germany.”