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Q. How many fragility fractures occur each year in Spain?

R.The number of fragility fractures due to osteoporosis in Spain amounts to 285,000 per year, according to 2019 data, that is, 14.8 new fractures per thousand inhabitants. The health, social and economic repercussion derived from this high number of cases should be highlighted.

Q. According to the SCOPE 21 study, the number of fragility fractures in our country is expected to increase by 30% by 2034. What can be done to reverse this situation?

R. It is necessary to be aware that osteoporosis is behind the majority of these fractures and that, furthermore, it is one of the most underdiagnosed and least treated diseases.

We have known for years that the number of fractures will increase in the coming years due to the aging of the population, but very little has been done to curb this problem. If an adequate health policy were adopted, suffering, deaths and the enormous health cost derived from fractures would be saved.

P. 80% of people who have had at least one fragility fracture have not been diagnosed, they are not correctly identified. What could it be due to and how could it be improved?

R. These data are difficult to understand from a social and health point of view. I think it is because osteoporosis and fractures are considered a ‘minor’ health problem in which it is not essential to invest too many resources.

The scientific societies involved in the care of these patients have been aware of this problem for years and have developed clinical practice guidelines with therapeutic decision algorithms and have promoted the training of Multidisciplinary Fracture Coordination Units, known as Fracture, in different hospitals. Liaison Services (FLS).

Although in autonomous communities such as Catalonia, the formation of various FLS has been encouraged at the local level, this is insufficient. A global health policy is needed that allocates more resources and carries out adequate communication campaigns, so that the population and health professionals are aware that a patient who has already suffered a fracture has a risk up to five times greater of developing more in the future and that at least 20% of patients die after a hip fracture, most in the first year.

Núria Guañabens, from the Rheumatology Service of the Hospital Clínic de Barcelona.

Q. How are patients with fractures and severe osteoporosis treated from the clinic?

R. It should be addressed quickly, especially if the fracture is vertebral, hip, distal radius, humerus or pelvis, as this patient has a high risk of developing another fracture, especially if it occurs in the last two years.

Once diagnosed, it is important to start treatment, the choice of which will depend on the level of fracture risk. Recently, the Spanish Society for Bone and Mineral Metabolism Research (SEIOMM) and previously the Spanish Society of Rheumatology (SER) have published clinical practice guidelines (CPG) for dealing with osteoporosis. The SEIOMM CPGs are precisely based on an approach based on the risk of fracture.

Today, although they are efficient, we have few therapeutic alternatives, given that no new drugs have been introduced for osteoporosis in practically the last decade.

Q. Are there unmet treatment needs for patients who have already had a fragility fracture?

R. Unfortunately yes. Recently, a joint position document of the SER and SEIOMM has been published that considers this to be the case.

For women at very high risk of fracture, including imminent risk of fracture or multiple fractures, especially if they have very low bone mineral density, we need fast-acting treatments capable of increasing bone mineral density to a greater extent than the other treatments for osteoporosis and especially, that it is capable of reducing the development of new fractures quickly and significantly.

In fact, the European Medicines Agency has already approved romosozumab, an innovative treatment that meets these characteristics. It is a sclerostin neutralizing monoclonal antibody (inhibitor of the WNT pathway, essential in osteoblastic activity), marketed in different European countries, as well as in the US, and is pending authorization for its marketing in Spain.

Q. Why is it necessary to increase bone formation while decreasing bone resorption in treatments for severe osteoporosis?

R. We currently have antiresorptive drugs, as well as anabolic or bone-forming agents with marked anti-fracture efficacy.

Studies have shown that mechanisms of action such as that of romosozumab, which initially and strongly stimulate bone formation and sustainably reduce resorption, have the ability to produce a marked increase in bone mineral density in just one year.

Q. What prognosis do patients who sustain a fragility fracture have in the immediate future?

R. Patients who suffer a fracture have a very high risk of suffering another in the following years. Very few of these patients are currently treated, so the present is disappointing. We must raise awareness in society, health professionals and managers, because only together can we improve bone health in our country in the near future.

This content has been developed by UE Studio, a creative branded content and content marketing firm from Unidad Editorial, for UCB and Amgen.