SCOPE 2021 – State of Osteoporosis and Its Treatment in European Countries
The SCOPE 2021 project (The Scorecard for Osteoporosis in Europe) by the International Osteoporosis Foundation (IOF) gathered and tabulated data from 29 European countries on the burden of osteoporosis, the quality and availability of services related to the diagnosis and treatment of this disease, and the use of these services in individual states. Within the significantly heterogeneous results, the Czech Republic did not fare very well.
Comparison of 29 European Countries
The aim of the SCOPE project is to help reduce the risks of osteoporosis and ensure that Europeans have access to quality diagnosis and treatment of this disease. The steps or components necessary to achieve this goal include government health policy, the availability of osteoporosis risk assessments, and access to treatment.
In 2021, SCOPE published a tabulated comparison of various aspects of osteoporosis management based on data from 27 EU countries plus Switzerland and the United Kingdom. The data collected fell into four domains: the incidence of osteoporosis and osteoporotic fractures, the political framework, the provision of services, and the utilization of services, including the share of men and women at high risk who do not receive treatment. Some developmental trends were also analyzed. The goal was to highlight the significant differences and inconsistencies between countries in providing primary and secondary care related to osteoporotic fractures. The analyzed points in each domain were converted into a score for each country and marked with green, orange, or red (like a traffic light). The authors summarized the results into a single table, offering a unique insight into the state of osteoporosis management in Europe.
„Scorecard“
Great Heterogeneity of Results and Overall Concerning Situation
The analysis results showed a significant heterogeneity among the analyzed states in all four domains. They highlighted the fact that the equipment for diagnosing osteoporosis and its availability is far from sufficient. The availability of medications for preventing osteoporotic fractures varies greatly between countries. In some countries, effective therapy for osteoporosis patients is unavailable. Less than half of high-risk women are treated, despite the high costs associated with fractures and the existence of cost-effective therapy. In most of the 29 countries, only a small portion of high-risk patients who have already experienced an osteoporotic fracture receive effective treatment. The situation in the Czech Republic is also unfavorable compared to other countries.
Osteoporosis in the Czech Republic
The risk of osteoporotic fractures is high in our country, and their incidence is expected to increase according to estimates. According to WHO diagnostic criteria, there were 572,000 people with osteoporosis in the Czech Republic in 2019, 80% of whom were women. The prevalence of osteoporosis thus reached 5%, which corresponds to the European average (5.6%). It is estimated that the annual incidence of osteoporotic fractures was 22/1000 inhabitants, and the annual mortality rate associated with osteoporotic fractures in the age group ≥ 50 years was 0.159/1000 inhabitants (the European average is 0.116/1000 inhabitants). The lifetime probability of a femoral neck fracture in this age group of Czechs is 6.9% for men and 14.8% for women.
Direct costs associated with the treatment of osteoporotic fractures accounted for 2.7% of total healthcare costs, which is slightly below average compared to other countries (European average 3.5%). Osteoporosis management does not rank among the priorities of the national health policy. The availability of diagnosis is rather poor, with approximately 8 bone densitometers using dual-energy X-ray absorptiometry (DXA) technology available per 1 million inhabitants, placing us at 21st place among the analyzed countries.
Various scoring systems are used to determine fracture risk, most commonly the FRAX tool (Fracture Risk Assessment Tool). This tool is available in the Czech Republic but was used in only 344 cases per 1 million inhabitants; thus, the use of the FRAX score was rated as insufficient. The quality of expert recommendations was evaluated as low, and quality-of-care indicators are not used. The only „good grade“ the Czech Republic received was for professional education.
The proportion of high-risk women for osteoporotic fractures who remain untreated, the so-called treatment gap, is high in our country, reaching 79% (24th place among the analyzed countries). This figure has not significantly changed compared to data from 2010.
Overall, we ranked 6th in the list of countries with the highest burden caused by osteoporosis and 26th in the combined indicator of healthcare quality (within the domains of the political framework and the provision and utilization of services). Thus, the Czech Republic, along with Belgium, Cyprus, Greece, Latvia, Luxembourg, and Malta, ranks among the countries with a high burden and low quality of care.
Call to Action
The table created by IOF allows healthcare professionals and policymakers to assess their country's approach to osteoporosis management within Europe and identify parameters that can be improved. Developmental trends are also evident. It is clear that decisive steps need to be taken. The IOF calls for a pan-European strategy that, in alignment with national strategies, will lead to coordinated care in the field of osteoporosis and reduce the incidence of disabling osteoporotic fractures and their impact on individuals' lives and Europe's healthcare systems.
However, the situation in the Czech Republic has improved somewhat since the publication of the cited analysis. In May 2023, a population program for the early detection of osteoporosis was launched. This includes regular bone densitometry examinations for women aged 60 and older (and younger postmenopausal women if risk factors are present based on the FRAX score). For men, DXA examinations are indicated during preventive check-ups in the presence of risk factors from age 65, and routinely from age 70. Bone densitometry is indicated by a general practitioner or gynecologist as part of a preventive check-up.
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Sources:
1. Kanis J. A., Norton N., Harvey N. C. et al. SCOPE 2021: a new scorecard for osteoporosis in Europe. Arch Osteoporos 2021; 16 (1): 82, doi: 10.1007/s11657-020-00871-9. Available at: www.osteoporosis.foundation/scope-2021
2. Pikner R., Rosa J., Kasalický P. Epidemiology and economic burden of osteoporosis in the Czech Republic. Arch Osteoporos 2022; 17: 23, doi: 10.1007/s11657-021-00969-8.
3. Methodology of implementing the population program for the early detection of osteoporosis in the Czech Republic, version II. Society for Metabolic Bone Diseases CLSp JEP, Association of General Practitioners of the Czech Republic, Association of Private Gynecologists of the Czech Republic, VZP Czech Republic, 17. 5. 2023. Available at: https://media.vzpstatic.cz/media/Default/dokumenty/mso/metodika-screening-osteoporoza-ii-17-5-2023.pdf
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