Barriers and solutions for global access to osteoporosis management: a Position Paper from the International Osteoporosis Foundation

Our ability to optimally manage bone health across the lifecourse, and so minimise the risk of fractures, has advanced substantially in recent decades. Whilst fractures and osteoporosis in older age were historically viewed simply as inherent in normal ageing, they are now recognised as manifestations of age-related disease. Key to advancing the field was the development of conceptual (relating to impaired bone mass and microarchitecture with increased propensity to fracture), and subsequent World Health Organization densitometric definitions of osteoporosis, cementing the role of dual-energy X-ray absorptiometry in bone health management. However, whilst low bone mineral density is a strong risk factor for fracture, many individuals who do fracture have normal or only modestly reduced bone mineral density. Furthermore, the existence of two definitions constituting a condition called "osteoporosis", one based on a measurement, and the other conceptual, has led to uncertainty in clinical practice. The field is therefore moving towards calculation of an individual's absolute fracture risk, based on clinical risk factors, with the option to incorporate bone mineral density (if available) as a risk factor rather than as an indication for treatment. Uptake of this new direction has been variable internationally, with many parts of the world, particularly low- and middle-income countries, still predicating treatment (where osteoporosis services exist) on bone mineral density, despite poor availability of densitometry in many such settings. In this Position Paper, on behalf of the International Osteoporosis Foundation, we review the current barriers which prevent equitable access to optimal bone health management worldwide and recommend potential solutions which might be implemented to overcome them.

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Publication Details

Journal
Osteoporosis International
Published
2025-08-22
DOI
https://doi.org/10.1007/s00198-025-07628-5
Citations
5
Primary Topic
Bone health and osteoporosis research
Type
article
Field-Weighted Citation Impact
8.61

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article

Barriers and solutions for global access to osteoporosis management: a Position Paper from the International Osteoporosis Foundation

Philippe Halbout, Claudia Campusano, Kate Anna Ward, Charlotte Beaudart et al.
5 citations
Osteoporosis International
Bone health and osteoporosis research
8.61
article

Barriers and solutions for global access to osteoporosis management: a Position Paper from the International Osteoporosis Foundation

Philippe Halbout, Claudia Campusano, Kate Anna Ward, Charlotte Beaudart, Yousef Al‐Saleh, John А. Kanis, Eugène McCloskey, Nicholas C. Harvey, T.C. Hough, Ambrish Mithal, Maria Luisa Brandi, Étienne Cavalier, Nasser M. Al‐Daghri, Marise Lazaretti‐Castro, René Rizzoli, Radmila Matijević, Manju Chandran, Nansa Burlet, Bess Dawson‐Hughes, Cyrus Cooper, Ngozi R. Njeze
article en
5 citations

Abstract

Our ability to optimally manage bone health across the lifecourse, and so minimise the risk of fractures, has advanced substantially in recent decades. Whilst fractures and osteoporosis in older age were historically viewed simply as inherent in normal ageing, they are now recognised as manifestations of age-related disease. Key to advancing the field was the development of conceptual (relating to impaired bone mass and microarchitecture with increased propensity to fracture), and subsequent World Health Organization densitometric definitions of osteoporosis, cementing the role of dual-energy X-ray absorptiometry in bone health management. However, whilst low bone mineral density is a strong risk factor for fracture, many individuals who do fracture have normal or only modestly reduced bone mineral density. Furthermore, the existence of two definitions constituting a condition called "osteoporosis", one based on a measurement, and the other conceptual, has led to uncertainty in clinical practice. The field is therefore moving towards calculation of an individual's absolute fracture risk, based on clinical risk factors, with the option to incorporate bone mineral density (if available) as a risk factor rather than as an indication for treatment. Uptake of this new direction has been variable internationally, with many parts of the world, particularly low- and middle-income countries, still predicating treatment (where osteoporosis services exist) on bone mineral density, despite poor availability of densitometry in many such settings. In this Position Paper, on behalf of the International Osteoporosis Foundation, we review the current barriers which prevent equitable access to optimal bone health management worldwide and recommend potential solutions which might be implemented to overcome them.

Osteoporosis InternationalVol. 36(9)
University of Nigeria (NG), Riyadh Armed Forces Hospital (SA), University of Namur (BE), University of Liège (BE), University of Novi Sad (RS), Universidad de Los Andes, Chile (CL), Singapore General Hospital (SG), King Saud University (SA), Max Healthcare (IN), University Hospital of Geneva (CH), Fondazione FADOI (IT), Jean Mayer Human Nutrition Research Center on Aging (US), Institute for Musculoskeletal Health (AU), Arthritis UK (GB), NIHR Southampton Biomedical Research Centre (GB), Duke-NUS Medical School (SG), Centre Hospitalier Universitaire de Liège (BE), Sociedade Brasileira de Educação Matemática (BR), Bone Health and Osteoporosis Foundation (US), MRC Lifecourse Epidemiology Unit (GB), University of Southampton (GB), Monash University (AU), Universidade Federal de São Paulo (BR), University of Sheffield (GB)
International Osteoporosis Foundation, Medical Research Council
Partnerships for the goals
Openalex Percentile: Top 2%
Bone health and osteoporosis research
8.61
DOIOpen Access PDFOpenAlex
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