An estimated four million people in France are living with osteoporosis, the ‘silent’ disease that results in weak and fragile bones. For an individual with osteoporosis, a minor slip on the pavement from standing height can lead to a life-changing fragility fracture, including fractures of the spine or hip which are associated with long-term disability, loss of independence and early mortality. 

In response to the growing burden of osteoporosis-associated fractures, the International Osteoporosis Foundation (IOF)’s Capture the Fracture® policy group has issued the report ‘Solutions for fracture prevention in France’ / 'Solutions de prévention des fractures en France' published in collaboration with leading national experts. The report provides a concise look at the national osteoporosis-related burden and healthcare policy landscape and presents the key policy changes needed to tackle the country’s fragility fracture crisis. 

Undertreatment persists despite the costly burden of fragility fractures

An estimated 500,000 fragility fractures occur annually in France – the equivalent of one fracture per minute. Such fractures pose an immense burden to patients and their family caregivers and result in enormous costs to the healthcare system. In 2019 direct costs and expenditure for long-term disability were estimated at more than €7 billion per year. A recent study that assessed the total cost of individual fractures, including follow-up costs over 18 months, revealed that each hip, vertebral and wrist fracture costs €23,926, €14,561 and €6,905 respectively. 

Co-Author Professor Karine Briot, President of the Groupe de Recherche et d’Information sur les Ostéoporoses (GRIO) and Professor of Rheumatology at Hôpital Cochin in Paris, stated:

“Fragility fractures are among the top five highest chronic disease burdens in France, exceeding even pulmonary heart disease and ischemic stroke. An initial fracture is associated with a 12.5% risk of re-hospitalization within a year and all-cause mortality of up 16.6% following a hip fracture. Given the ageing of the population the enormous fracture burden will escalate - under current conditions, the number of fragility fractures is estimated to increase by 26% between 2019 to 2034. Nevertheless, we estimate that more than two million French women at high risk of fracture remain untreated for osteoporosis, notwithstanding the availability of safe and effective medications to reduce bone loss and the risk of fracture. This situation is highly concerning and unacceptable when one considers the significant human suffering resulting from fragility fractures.” 

Post-fracture care services help protect patients from experiencing a cycle of recurring fractures

Fragility fractures almost double the risk of experiencing a new fracture, especially in the first 24 months. This is why undertreatment of osteoporosis is of particular concern in patients who have experienced an initial broken bone. Currently, more than three-quarters of French women aged 50 years and above who have experienced an initial fracture are not receiving timely treatment to prevent secondary fractures. A key reason is the lack of widespread post-fracture care services known as ‘fracture liaison services’ (FLS). 

Professor Bernard Cortet, co-author and Professor at Roger Salengro Hospital at the University Hospital of Lille, added: “The French population is underserved with fracture liaison services. Currently, fewer than 10% of French hospitals have such a service. This represents a substantial missed opportunity to stop the cycle of recurring fractures that so many patients go on to experience. With a realistic implementation of FLS in France, there would be substantial improvements in patient health and outcomes, with concurrent reductions in hospitalizations and cost savings.”

A solid foundation to build upon important recommendations

In France there is a solid foundation upon which to prioritize fragility fractures within healthcare management. The healthcare system’s ‘Ma Santé 2022’ maps out a robust strategy for osteoporosis policy, and the ‘return home program’ supports rehabilitation after fracture. Furthermore, there is a strong track record of cooperation and commitment among the leading medical organizations in the musculoskeletal field. The roll-out of FLS or other equivalent structured pathways for osteoporotic patient management to increase post-fracture screening, diagnosis and treatment rates would be a tremendous step forward in tackling the fragility fracture crisis.

IOF CEO Dr Philippe Halbout extended his congratulations to the French experts collaborating with the IOF Capture the Fracture® Policy Group on the publication of the report. He emphasized the importance of the report's recommendations, stating:

“IOF urges policymakers in France to implement effective solutions to tackle the fragility fracture crisis. The targeted, collaborative actions proposed in this new report would lead to fewer fractures, improved patient outcomes, reduced healthcare costs, and, most crucially, enhanced mobility for France's elderly population.”