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. 2013;8(1):144.
doi: 10.1007/s11657-013-0144-1. Epub 2013 Sep 13.

SCOPE: a scorecard for osteoporosis in Europe

J A Kanis  1 , F Borgström, J Compston, K Dreinhöfer, E Nolte, L Jonsson, W F Lems, E V McCloskey, R Rizzoli, J Stenmark
Affiliations

SCOPE: a scorecard for osteoporosis in Europe

J A Kanis et al. Arch Osteoporos. 2013.

Abstract

Summary: The scorecard summarises key indicators of the burden of osteoporosis and its management in each of the member states of the European Union. The resulting scorecard elements were then assembled on a single sheet to provide a unique overview of osteoporosis in Europe.

Introduction: The scorecard for osteoporosis in Europe (SCOPE) is an independent project that seeks to raise awareness of osteoporosis care in Europe. The aim of this project was to develop a scorecard and background documents to draw attention to gaps and inequalities in the provision of primary and secondary prevention of fractures due to osteoporosis.

Methods: The SCOPE panel reviewed the information available on osteoporosis and the resulting fractures for each of the 27 countries of the European Union (EU27). The information researched covered four domains: background information (e.g. the burden of osteoporosis and fractures), policy framework, service provision and service uptake e.g. the proportion of men and women at high risk that do not receive treatment (the treatment gap).

Results: There was a marked difference in fracture risk among the EU27. Of concern was the marked heterogeneity in the policy framework, service provision and service uptake for osteoporotic fracture that bore little relation to the fracture burden. For example, despite the wide availability of treatments to prevent fractures, in the majority of the EU27, only a minority of patients at high risk receive treatment for osteoporosis even after their first fracture. The elements of each domain in each country were scored and coded using a traffic light system (red, orange, green) and used to synthesise a scorecard. The resulting scorecard elements were then assembled on a single sheet to provide a unique overview of osteoporosis in Europe.

Conclusions: The scorecard will enable healthcare professionals and policy makers to assess their country's general approach to the disease and provide indicators to inform future provision of healthcare.

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Figures

Fig. 1
Fig. 1
Proportion (%) of the total direct healthcare spend in the EU27 countries allocated to osteoporotic fractures [3]
Fig. 2
Fig. 2
Components (%) of the cost of osteoporosis and fractures [1]
Fig. 3
Fig. 3
Components (%) of the cost of osteoporosis and fractures [1]
Fig. 4
Fig. 4
Annual incidence of hip fracture in women from countries of the EU age-standardised to the world population for 2010 [1]
Fig. 5
Fig. 5
The number of deaths associated with fracture events expressed per 100,000 of the population added 50 years or more in the EU27 [2]
Fig. 6
Fig. 6
The annual number of fragility fractures in men and women combined expressed/1,000 of the population aged 50 years or more
Fig. 7
Fig. 7
Remaining lifetime probability of hip fracture (%) in men and women from 21 countries in the EU from the age of 50 years [1]
Fig. 8
Fig. 8
Remaining lifetime probability of hip fracture (%) in women in the EU from the age of 50 years [1]
Fig. 9
Fig. 9
Proportion of men and women (%) aged 50–89 years with a 10-year probability of a major fracture that is 10 % or more and 20 % or more by member state
Fig. 10
Fig. 10
The proportion of the population (%) aged 50–89 years with a 10-year probability of a major fracture that is 10 % or more by member state
Fig. 11
Fig. 11
Projected increase by country in the female population aged 75 years or more (%) between 2010 and 2025 [1]
Fig. 12
Fig. 12
The relation between the percentage increase in the male and female population aged 75 years or more in EU member states. The diagonal shows the line of identity
Fig. 13
Fig. 13
The percentage increase in the number of fragility fractures between 2010 and 2025 in the EU and its member states [2]
Fig. 14
Fig. 14
Quality of information available on the epidemiology of hip fractures in the EU [IOF audit]
Fig. 15
Fig. 15
Categorisation of EU countries according to the existence of government-backed NHP for osteoporosis or musculoskeletal diseases [IOF audit]
Fig. 16
Fig. 16
Patterns of principal care of patients with osteoporosis [IOF audit]. *See comment below
Fig. 17
Fig. 17
The specialty representation in the EU countries. Note that more than one specialty per country can be represented (see Table 22) [IOF audit]
Fig. 18
Fig. 18
The score allocation and grade for specialist training in each country [IOF]
Fig. 19
Fig. 19
Society support to osteoporosis by score [IOF audit]
Fig. 20
Fig. 20
Ranking and score for access to medical intervention [IOF audit]. *See comment below [IOF audit]
Fig. 21
Fig. 21
DXA units/million of the general population in 2010 based on sales of DXA in the EU supplied by manufacturers [1]. The horizontal line denotes a minimum service requirement [2]
Fig. 22
Fig. 22
Reported average waiting time for a DXA assessment by EU country [IOF audit]
Fig. 23
Fig. 23
Categorisation of access to DXA by score in the EU27 [IOF audit]
Fig. 24
Fig. 24
The score assigned to each country on the basis of its provision of fracture risk assessment algorithms. The star denotes that guidance given by the National Osteoporosis Guideline Group scores 3 but the score based on NICE is less
Fig. 25
Fig. 25
Score allocation based on the scope and quality of guidelines available for the assessment and treatment of osteoporosis. For the UK (star), the score for guidance provided by NICE is 8 and hat provided by the National Osteoporosis Guidelines Group has a score of 10 [IOF audit]
Fig. 26
Fig. 26
The distribution of the use of risk assessment models in assessment guidelines of the EU27 countries [IOF audit]
Fig. 27
Fig. 27
The proportion of hospitals (%) with FLS in the EU countries [IOF audit]
Fig. 28
Fig. 28
Scores allocated by country on the availability of fracture liaison services in hospitals by member state [IOF audit]
Fig. 29
Fig. 29
Score allocation for quality indicators by country [IOF audit]
Fig. 30
Fig. 30
The uptake of BMD testing in men and women by age and sex in Denmark in 2005 [Data kindly provided by Bo Abrahamsen, Gentofte Hospital Copenhagen, Denmark]
Fig. 31
Fig. 31
The uptake of fracture risk assessment tools as judged by the use of FRAX from each EU country by score category. *See comment below with regard to Germany
Fig. 32
Fig. 32
Proportion of women of women at high risk that are untreated (treatment gap) in 2010 ranked by country and score [3]
Fig. 33
Fig. 33
Proportion of women receiving treatment in six EU member states according to category of risk. All women refer to women aged 55 years or more (n = 24,249). Low risk comprises women aged less than 75 years with a T score for BMD in the range of osteopenia, no prior fracture, no maternal hip fracture or osteoporosis (n = 1166). High risk refers to women reported to have a BMD measurement in the range of osteoporosis (n = 5258). Very high risk comprises women with a previous hip or spine fracture (n = 913) [9]
Fig. 34
Fig. 34
The number (rate/thousand) of prescriptions for bone-active medications and the number of patients filling a prescription for bone-active medications in 2010 [National Prescription Databases of Sweden]
Fig. 35
Fig. 35
The proportion (%) of the population aged 50 years or more with a prior hip or vertebral fracture in 2010 [3]
Fig. 36
Fig. 36
The relationship between the prevalence of a prior spine or hip fracture (service need) and the treatment gap (service provision) in the EU27 countries. The horizontal and vertical lines intersect at the EU average (weighted for population size) [3]. Country codes (ISO 3166–1 alpha-2); AT Austria; BE Belgium; BG Bulgaria; CY Cyprus; CZ Czech Republic; DE Germany; DK Denmark; EE Estonia; ES Spain; FI Finland; FR France; GB United Kingdom; GR Greece; HU Hungary; IE Ireland; IT Italy; LT Lithuania; LU Luxembourg; LV Latvia; MT Malta; NL Netherlands; PL Poland; PT Portugal; RO Romania; SE Sweden; SI Slovenia; SK Slovakia
Fig. 37
Fig. 37
Countries categorised by the average waiting time for surgical intervention for hip fracture [IOF audit]
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