Epidemiology and Economic Burden of Osteoporosis in Italy

Summary This report describes epidemiology, burden, andtreatment of osteoporosis in Italy.Introduction Osteoporosis is characterized by reducedbone mass and disruption of bone architecture, resultingin increased risks of fragility fractures which representthe main clinical consequence of the disease. Fragilityfractures are associated with substantial pain and suffering,disability and even death for the affected patientsand substantial costs to society. The aim of this study isto describe the epidemiology and economic burden offragility fractures as a consequence of osteoporosis inItaly, as a further detailed addition to the report for theentire European Union (EU27): Osteoporosis in the EuropeanUnion: Medical Management, Epidemiology andEconomic Burden.Methods The literature on fracture incidence and costs offractures in Italy was reviewed and incorporated into amodel estimating the clinical and economic burden ofosteoporotic fractures in 2010. Furthermore, data onsales of osteoporosis treatments and the population athigh risk were used to estimate treatment uptake andtreatment gap.Results It was estimated that approximately 465,000 newfragility fractures were sustained in Italy, comprising 91,000hip fractures, 71,000 clinical vertebral fractures, 72,000forearm fractures and 232,000 other fractures (i.e. fracturesof the pelvis, rib, humerus, tibia, fibula, clavicle, scapula,sternum and other femoral fractures) in 2010. The economicburden of incident and previous fragility fractureswas estimated at € 7,032 million for the same year.Incident fractures represented 61 % of this cost, longtermfracture care 34 % and pharmacological prevention5 %. Previous and incident fractures also accounted for171,300 quality-adjusted life years (QALYs) lost during2010. When accounting for the demographic projectionsfor 2025, the number of incident fractures was estimatedat 598,000 in 2025, representing an increase of 132,000fractures. Hip, clinical vertebral (spine), forearm andother fractures were estimated to increase by 27,900,18,800, 15,400 and 70,300, respectively. The burdenof fractures in Italy in 2025 was estimated to increaseby 23 % to € 8,644 million. Though the uptake ofosteoporosis treatments increased from 2001, the proportionof patients aged 50 or above who receivedtreatment remained at very low levels in the past fewyears. The majority of women at high fracture risk didnot receive active treatment.Conclusions In spite of the high cost of osteoporosis, asubstantial treatment gap and projected increase of the economicburden driven by aging populations, the use of pharmacologicalprevention of osteoporosis is significantly lessthan optimal, suggesting that a change in healthcare policyconcerning the disease is warranted.